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Ibrar M, Rai HK, Main A, McCartney H, Maguire R, Rodriguez MAP. The Experience of Cancer-Related Cognitive Impairment Across Common Cancers: Protocol for a Qualitative Systematic Review. JMIR Res Protoc 2024; 13:e56888. [PMID: 38820581 PMCID: PMC11179027 DOI: 10.2196/56888] [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: 02/01/2024] [Revised: 04/02/2024] [Accepted: 04/10/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Cancer-related cognitive impairment (CRCI) is commonly experienced by patients with cancer during treatment, and 35% of patients experience cognitive impairment after treatment completion. Impairments in memory, attention, executive functioning, and information processing speed are most reported and often negatively impact daily functioning and quality of life (QoL). Despite the large scale of reports, this adverse side effect is underinvestigated across common cancer types, and there is a lack of insight into the CRCI experience. OBJECTIVE This qualitative synthesis aims to explore the evidence in relation to the experience of CRCI across common cancers. It also aims to understand the prevalence of CRCI across various cancer types, cognitive domains, and its impact on QoL and functional ability. METHODS A comprehensive search of databases, including PubMed, American Psychological Association PsycINFO, CINAHL, and Scopus, will be conducted. A total of 2 independent reviewers will screen titles and abstracts for inclusion, followed by full-text screening. A third reviewer will resolve any arising conflicts in the process of data screening and inclusion. Subsequently, data extraction and quality assessment using the Critical Appraisal Skills Programme (CASP) tool will be conducted. The results will be analyzed using thematic analysis. RESULTS This review is part of a PhD program funded in January 2023. The review commenced in June 2023, and data analysis is currently in progress. The qualitative synthesis will explore the experiences of CRCI across common cancers. The included studies are expected to report on numerous cancer types such as breast cancer, prostate cancer, leukemia, and lung cancer. The included study types are most likely to be interviews, focus groups, and surveys with qualitative components. CONCLUSIONS This protocol highlights the need for a qualitative synthesis that will explore the experience of CRCI across common cancer types. It will provide valuable insight into the lived experience of CRCI and the cognitive domains that may be disproportionately affected. There is a growing demand for further management interventions and clinically tested treatments of CRCI and the qualitative exploration of patient experience is crucial for their development. This qualitative synthesis will inform future developments and will contribute to improving QoL after cancer. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56888.
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Affiliation(s)
- Maryam Ibrar
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Harleen Kaur Rai
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Ashleigh Main
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Haruno McCartney
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Roma Maguire
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
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Ma T, Ma T, Wang L, Wang H. Neoadjuvant Chemotherapy Is Effective in Those Infected With SARS-CoV-2: The Real-World Experience of a Large Chinese Breast Cancer Center. J Breast Cancer 2024; 27:27.e17. [PMID: 38769687 DOI: 10.4048/jbc.2023.0299] [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: 12/27/2023] [Revised: 02/27/2024] [Accepted: 04/28/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE During the major shift in China's policies on coronavirus disease 2019 (COVID-19), many residents will be infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) over a short period, including a few patients with breast cancer undergoing neoadjuvant chemotherapy (NAC). Moreover, it is unknown whether this comorbidity affects the efficacy of NAC for breast cancer and the patient's psychological state and quality of life (QOL). This study aims to answer these questions. METHODS The clinical data of 2,793 patients with breast cancer who received NAC at The Affiliated Hospital of Qingdao University were retrospectively collected. The infected and non-infected groups were divided according to whether they were infected with COVID-19 during NAC. Propensity score matching was used to reduce patient selection bias. The effectiveness, psychological well-being, and QOL of the two groups were compared. RESULTS No discernible differences were observed in the pathological complete response rates (p = 0.307) and major histological responses rate (p = 0.398) between the infected and non-infected groups. Following the full course of NAC, the Functional Assessment of Cancer Treatment General (p < 0.001) and Functional Assessment of Cancer Therapy for Breast Cancer (p < 0.001) were lower in the infected group than the non-infected group, the Hospital Anxiety and Depression Scale (HADS) anxiety scale (p < 0.001) and HADS depression scale (p < 0.001) were considerably higher in the infected group than the non-infected group. CONCLUSION With timely treatment and effective medical management, SARS-CoV-2 does not appear to affect the efficacy of NAC; however, it can significantly affect the QOL of patients and increase their psychological distress. Therefore, in addition to a timely assessment of the efficacy of NAC, it is necessary to dynamically understand the patient's psychological state and QOL.
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Affiliation(s)
- Teng Ma
- Breast Disease Center, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tianyi Ma
- Breast Disease Center, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lulu Wang
- Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haibo Wang
- Breast Disease Center, Affiliated Hospital of Qingdao University, Qingdao, China.
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Koevoets EW, Petr J, Monninkhof EM, Geerlings MI, Witlox L, van der Wall E, Stuiver MM, Sonke GS, Velthuis MJ, Jobsen JJ, van der Palen J, Mutsaerts HJMM, de Ruiter MB, May AM, Schagen SB. Effect of Physical Exercise on MRI-Assessed Brain Perfusion in Chemotherapy-Treated Breast Cancer Patients: A Randomized Controlled Trial. J Magn Reson Imaging 2024; 59:1667-1680. [PMID: 37801027 DOI: 10.1002/jmri.28967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Exercise is a promising intervention to alleviate cognitive problems in breast cancer patients, but studies on mechanisms underlying these effects are lacking. PURPOSE Investigating whether an exercise intervention can affect cerebral blood flow (CBF) in cognitively impaired breast cancer patients and to determine if CBF changes relate to memory function. STUDY TYPE Prospective. POPULATION A total of 181 chemotherapy-treated stage I-III breast cancer patients with cognitive problems and relatively low physical activity levels (≤150 minutes moderate to vigorous physical activity per week), divided into an exercise (N = 91) or control group (N = 90). FIELD STRENGTH/SEQUENCE Two-dimensional echo planar pseudo-continuous arterial spin labeling CBF sequence at 3 T. ASSESSMENT The 6-month long intervention consisted of (supervised) aerobic and strength training, 4 × 1 hour/week. Measurements at baseline (2-4 years post-diagnosis) and after 6 months included gray matter CBF in the whole brain, hippocampus, anterior cingulate cortex, and posterior cingulate cortex. Physical fitness and memory function were also assessed. Subgroup analyses were performed in patients with high fatigue levels at baseline. STATISTICAL TESTS Multiple regression analyses with a two-sided alpha of 0.05 for all analyses. RESULTS There was a significant improvement in physical fitness (VO2peak in mL/minute/kg) in the intervention group (N = 53) compared to controls (N = 51, β = 1.47 mL/minute/kg, 95% CI: 0.44-2.50). However, no intervention effects on CBF were found (eg, whole brain: P = 0.565). Highly fatigued patients showed larger but insignificant treatment effects on CBF (eg, whole brain: P = 0.098). Additionally, irrespective of group, a change in physical fitness was positively associated with changes in CBF (eg, whole brain: β = 0.75, 95% CI: 0.07-1.43). There was no significant relation between CBF changes and changes in memory performance. DATA CONCLUSION The exercise intervention did not affect CBF of cognitively affected breast cancer patients. A change in physical fitness was associated with changes in CBF, but changes in CBF were not associated with memory functioning. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 5.
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Affiliation(s)
- Emmie W Koevoets
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan Petr
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mirjam I Geerlings
- Department of General Practice, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life and Personalized Medicine, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration and Mood, Anxiety, Psychosis, Stress, and Sleep, Amsterdam, The Netherlands
| | - Lenja Witlox
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Elsken van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martijn M Stuiver
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gabe S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Jan J Jobsen
- Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Job van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands
- Section Cognition, Data and Education, Universiteit Twente, Enschede, The Netherlands
| | - Henk J M M Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
| | - Michiel B de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Brain and Cognition Group, University of Amsterdam, Amsterdam, The Netherlands
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Naaktgeboren WR, Koevoets EW, Stuiver MM, van Harten WH, Aaronson NK, van der Wall E, Velthuis M, Sonke G, Schagen SB, Groen WG, May AM. Effects of physical exercise during adjuvant chemotherapy for breast cancer on long-term tested and perceived cognition: results of a pragmatic follow-up study. Breast Cancer Res Treat 2024; 205:75-86. [PMID: 38285111 PMCID: PMC11062992 DOI: 10.1007/s10549-023-07220-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/10/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE Cancer-related cognitive impairment (CRCI) following chemotherapy is commonly reported in breast cancer survivors, even years after treatment. Data from preclinical studies suggest that exercise during chemotherapy may prevent or diminish cognitive problems; however, clinical data are scarce. METHODS This is a pragmatic follow-up study of two original randomized trials, which compares breast cancer patients randomized to exercise during chemotherapy to non-exercise controls 8.5 years post-treatment. Cognitive outcomes include an online neuropsychological test battery and self-reported cognitive complaints. Cognitive performance was compared to normative data and expressed as age-adjusted z-scores. RESULTS A total of 143 patients participated in the online cognitive testing. Overall, cognitive performance was mildly impaired on some, but not all, cognitive domains, with no significant differences between groups. Clinically relevant cognitive impairment was present in 25% to 40% of all participants, regardless of study group. We observed no statistically significant effect of exercise, or being physically active during chemotherapy, on long-term cognitive performance or self-reported cognition, except for the task reaction time, which favored the control group (β = -2.04, 95% confidence interval: -38.48; -2.38). We observed no significant association between self-reported higher physical activity levels during chemotherapy or at follow-up and better cognitive outcomes. CONCLUSION In this pragmatic follow-up study, exercising and being overall more physically active during or after adjuvant chemotherapy for breast cancer was not associated with better tested or self-reported cognitive functioning, on average, 8.5 years after treatment. Future prospective studies are needed to document the complex relationship between exercise and CRCI in cancer survivors.
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Affiliation(s)
- Willeke R Naaktgeboren
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Emmie W Koevoets
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martijn M Stuiver
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Center for Quality of Life, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
- Rijnstate Hospital, Arnhem, The Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Miranda Velthuis
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Gabe Sonke
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Brain and Cognition Group, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim G Groen
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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He A, Pu Y, Jia C, Wu M, He H, Xia Y. The Influence of Exercise on Cancer Risk, the Tumor Microenvironment and the Treatment of Cancer. Sports Med 2024:10.1007/s40279-024-02031-2. [PMID: 38687441 DOI: 10.1007/s40279-024-02031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/02/2024]
Abstract
There are several modifiable factors that can be targeted to prevent and manage the occurrence and progression of cancer, and maintaining adequate exercise is a crucial one. Regular physical exercise has been shown to be a beneficial strategy in preventing cancer, potentially amplifying the effectiveness of established cancer therapies, alleviating certain cancer-related symptoms, and possibly mitigating side effects resulting from treatment. Nevertheless, the exact mechanisms by which exercise affects tumors, especially its impact on the tumor microenvironment (TME), remain uncertain. This review aims to present an overview of the beneficial effects of exercise in the context of cancer management, followed by a summary of the exercise parameters, especially exercise intensity, that need to be considered when prescribing exercise for cancer patients. Finally, we discuss the influence of exercise on the TME, including its effects on crucial immune cells (e.g., T cells, macrophages, neutrophils, natural killer cells, myeloid-derived suppressor cells, B cells), intratumor angiogenesis, and cancer metabolism. This comprehensive review provides up-to-date scientific evidence on the effects of exercise training on cancer and offers guidance to clinicians for the development of safe and feasible exercise training programs for cancer patients in clinical practice.
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Affiliation(s)
- Anqi He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yamin Pu
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Chengsen Jia
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Mengling Wu
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hongchen He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Yong Xia
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Wolff J, Seidel S, Wuelfing P, Lux MP, zu Eulenburg C, Smollich M, Baumann F, Seitz S, Kuemmel S, Thill M, Tio J, Braun M, Hollaender H, Seitz A, Horn F, Harbeck N, Wuerstlein R. App-based support for breast cancer patients to reduce psychological distress during therapy and survivorship - a multicentric randomized controlled trial. Front Oncol 2024; 14:1354377. [PMID: 38699636 PMCID: PMC11064693 DOI: 10.3389/fonc.2024.1354377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/04/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction The negative impact of unmanaged psychological distress on quality of life and outcome in breast cancer survivors has been demonstrated. Fortunately, studies indicate that distress can effectively be addressed and even prevented using evidence-based interventions. In Germany prescription-based mobile health apps, known as DiGAs (digital health applications), that are fully reimbursed by health insurances, were introduced in 2020. In this study, the effectiveness of an approved breast cancer DiGA was investigated: The personalized coaching app PINK! Coach supports and accompanies breast cancer patients during therapy and follow-up. Methods PINK! Coach was specifically designed for breast cancer (BC) patients from the day of diagnosis to the time of Follow-up (aftercare). The app offers individualized, evidence-based therapy and side-effect management, mindfulness-based stress reduction, nutritional and psychological education, physical activity tracking, and motivational exercises to implement lifestyle changes sustainably in daily routine. A prospective, intraindividual RCT (DRKS00028699) was performed with n = 434 patients recruited in 7 German breast cancer centers from September 2022 until January 2023. Patients with BC were included independent of their stage of diseases, type of therapy and molecular characteristics of the tumor. Patients were randomized into one of two groups: The intervention group got access to PINK! over 12 weeks; the control group served as a waiting-list comparison to "standard of care." The primary endpoint was psychological distress objectified by means of Patient Health Questionnaire-9 (PHQ-9). Subgroups were defined to investigate the app's effect on several patient groups such as MBC vs. EBC patients, patients on therapy vs. in aftercare, patients who received a chemotherapy vs. patients who did not. Results Efficacy analysis of the primary endpoint revealed a significant reduction in psychological distress (least squares estimate -1.62, 95% confidence interval [1.03; 2.21]; p<0.001) among intervention group patients from baseline to T3 vs, control group. Subgroup analysis also suggested improvements across all clinical situations. Conclusion Patients with breast cancer suffer from psychological problems including anxiety and depression during and after therapy. Personalized, supportive care with the app PINK! Coach turned out as a promising opportunity to significantly improve psychological distress in a convenient, accessible, and low-threshold manner for breast cancer patients independent of their stage of disease (EBC/MBC), therapy phase (aftercare or therapy) or therapy itself (chemotherapy/other therapy options). The app is routinely available in Germany as a DiGA. Clinical Trial Registration: DRKS Trial Registry (DRKS00028699).
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Affiliation(s)
- Josefine Wolff
- Breast Center, Department of Gynecology and Obstetrics, and Comprehensive Cancer Center Ludwig-Maximilian University Munich (LMU) University Hospital, Munich, Germany
- Department Clinical Research, PINK! Gegen Brustkrebs GmbH, Hamburg, Germany
| | - Svenja Seidel
- Department Clinical Research, PINK! Gegen Brustkrebs GmbH, Hamburg, Germany
| | - Pia Wuelfing
- Department Clinical Research, PINK! Gegen Brustkrebs GmbH, Hamburg, Germany
| | - Michael Patrick Lux
- Department of Gynecology and Obstetrics, Frauenklinik St. Louise and St. Josefs-Krankenhaus, St. Vincenz Klinik GmbH, Paderborn, Germany
| | - Christine zu Eulenburg
- Department for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Smollich
- Institute of Nutritional Medicine, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Freerk Baumann
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Stephan Seitz
- Department of Obstetrics and Gynecology, Caritas Hospital St. Josef, University of Regensburg, Regensburg, Germany
| | | | - Marc Thill
- Markus Hospital, Breast Center, Frankfurt, Germany
| | - Joke Tio
- Department of Gynecology and Obstetrics, University Hospital of Münster, Münster, Germany
| | - Michael Braun
- Department of Gynecology, Breast Center, Red Cross Hospital, Munich, Germany
| | - Hannah Hollaender
- Breast Center, Department of Gynecology and Obstetrics, and Comprehensive Cancer Center Ludwig-Maximilian University Munich (LMU) University Hospital, Munich, Germany
| | - Angenla Seitz
- Department Clinical Research, PINK! Gegen Brustkrebs GmbH, Hamburg, Germany
| | - Felicitas Horn
- Department Clinical Research, PINK! Gegen Brustkrebs GmbH, Hamburg, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics, and Comprehensive Cancer Center Ludwig-Maximilian University Munich (LMU) University Hospital, Munich, Germany
| | - Rachel Wuerstlein
- Breast Center, Department of Gynecology and Obstetrics, and Comprehensive Cancer Center Ludwig-Maximilian University Munich (LMU) University Hospital, Munich, Germany
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Park SY, Lee MK. Effects of a self-managed return to work intervention for colorectal cancer survivors: A prospective randomized controlled trial. Eur J Oncol Nurs 2024; 70:102593. [PMID: 38795437 DOI: 10.1016/j.ejon.2024.102593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/31/2024] [Accepted: 04/12/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE The present study aims to assess the efficacy of stage-matched, self-managed Return to Work (RTW) interventions in enhancing RTW outcomes among colorectal cancer (CRC) survivors. METHODS This trial, conducted in South Korea, enrolled 58 unemployed survivors of colorectal cancer. Participants were randomly assigned to either an experimental or a control group. The experimental group received a self-managed return-to-work intervention based on the trans-theoretical model, while the control group received an educational booklet. Assessments were conducted at baseline and at 3, 6, and 12 months to measure changes in various factors including return-to-work status and HRQOL. RESULTS In the experimental group, 28 participants were randomly assigned, while 30 individuals were allocated to the control group. The experimental group exhibited a higher proportion of individuals achieving RTW (64.5% vs 39.3%, p = 0.013) and demonstrated greater improvements in work ability (p = 0.001), RTW self-efficacy (p = 0.035), readiness for RTW in the prepared-for-action (p < 00.0001), uncertain maintenance (p = 0.033), and proactive maintenance (p < 00.0001) stages, quality of working life (p = 0.003), HRQOL (p < 0.05), and illness perception (p < 0.05) compared to the control group at the 12-month follow-up. CONCLUSIONS Stage-matched self-managed RTW interventions incorporating TTM principles may effectively enhance RTW outcomes and work ability among CRC survivors.
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Affiliation(s)
- Soo Yeun Park
- College of Nursing, Research Institute of Nursing Science (Dr. Lee); and Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine (Drs Park), Kyungpook National University, Daegu, South Korea.
| | - Myung Kyung Lee
- College of Nursing, Research Institute of Nursing Science (Dr. Lee); and Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine (Drs Park), Kyungpook National University, Daegu, South Korea.
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Hass HG. [Oncological Rehabilitation for Breast Cancer]. DIE REHABILITATION 2024; 63:119-130. [PMID: 38626791 DOI: 10.1055/a-2129-9279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
As a result of increasingly individualized and multimodal therapy, prognosis of breast cancer has improved significantly over the last years. However, multimodal treatment and the use of new medications can lead to a variety of somatic, sometimes new, side effects such as fatigue, polyneuropathy or autoimmune toxicities. This and the oncological diagnosis lead to a high level of psychological distress in the women affected and often to subsequent psychological disorders (sleep/anxiety disorders, depression, ...). Both the diverse complaints after oncological therapy and the increasingly improved overall prognosis underline the importance of multimodal rehabilitation concepts to improve quality of life and successful professional reintegration.In the following, these secondary disorders after breast cancer, their multimodal therapy and their significance for social-medical performance assessment are presented in more detail.
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Antunes P, Joaquim A, Sampaio F, Nunes C, Ascensão A, Vilela E, Teixeira M, Oliveira J, Capela A, Amarelo A, Leão I, Marques C, Viamonte S, Alves A, Esteves D. Exercise Training Benefits Health-Related Quality of Life and Functional Capacity during Breast Cancer Chemotherapy: A Randomized Controlled Trial. Med Sci Sports Exerc 2024; 56:600-611. [PMID: 38051110 DOI: 10.1249/mss.0000000000003341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
PURPOSE To examine the effectiveness of a supervised exercise training program (SETP) on health-related quality of life (HRQoL) and functional capacity in women with breast cancer (BC) undergoing chemotherapy. METHODS Ninety-three women with early-stage BC were randomly allocated to a SETP plus usual care (exercise, n = 47) or usual care alone (UC, n = 46). The SETP included three sessions per week, combining aerobic and resistance training, conducted concurrently over the chemotherapy. The EORTC Cancer Quality-of-Life-Questionnaire-Core-30 (QLQ-C30) and the BC-specific module (QLQ-BR23) were used to assess HRQoL. Functional capacity was analyzed by maximum voluntary handgrip strength (MVHS) and by the 30-s chair sit-to-stand test (30-s CST). These endpoints were assessed at baseline (t0); middle (t1; after 8 or 12 wk of t0); and at the end of chemotherapy (t2; after 20 wk of t0). Mean changes from baseline were assessed by an intention-to-treat approach. RESULTS Mixed linear model analyses showed that Exercise group experienced less deterioration in several domains of QLQ-C30 at t2, including in global health status/QoL (Δ = 9.39 units; P = 0.034), QLQ-C30 summary score (Δ = 8.08 units; P < 0.001), physical (Δ = 15.14 units; P < 0.001), role ( Δ = 21.81 units; P < 0.001), cognitive (Δ = 9.16 units; P = 0.032) and social functioning (Δ = 11.67 units; P = 0.038), compared with the UC group. Similarly, Exercise group exhibited significant lower levels of fatigue (Δ = -20.19 units; P < 0.001) and appetite loss (Δ = -13.69 units; P = 0.034), compared with the UC group. Significant between-group differences were observed on MVHS of the tumor/surgery upper limb side (Δ = 2.64 kg; P < 0.001) and contralateral limb (Δ = 2.22 kg; P < 0.001), and on the 30-s CST score (Δ = 3.56repetitions; P < 0.001), favoring the Exercise group. No differences were observed on QLQ-BR23 domains. CONCLUSIONS Exercise training was an effective complementary therapy to prevent the deterioration of HRQoL and functional capacity during chemotherapy in women with early-stage BC.
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Affiliation(s)
| | | | | | - Célia Nunes
- Department of Mathematics and Center of Mathematics and Applications, University of Beira Interior, Covilhã, PORTUGAL
| | - António Ascensão
- Laboratory of Metabolism and Exercise (LaMetEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, Porto, PORTUGAL
| | - Eduardo Vilela
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PORTUGAL
| | - Madalena Teixeira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PORTUGAL
| | - Jorge Oliveira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PORTUGAL
| | | | | | | | - Cristiana Marques
- Department of Medical Oncology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PORTUGAL
| | | | | | - Dulce Esteves
- Research Center in Sport Sciences, Health and Human Development (CIDESD), Sport Sciences Department, University of Beira Interior, PORTUGAL
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10
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Peters M, Butson G, Mizrahi D, Denehy L, Lynch BM, Swain CTV. Physical activity and pain in people with cancer: a systematic review and meta-analysis. Support Care Cancer 2024; 32:145. [PMID: 38321248 PMCID: PMC10847204 DOI: 10.1007/s00520-024-08343-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE Physical activity can provide analgesic benefit but its effect on cancer-related pain is unclear. This review synthesised and appraised the evidence for the effect of physical activity on pain in people living with or beyond cancer. METHODS A systematic search of Ovid Medline and Embase was performed to identify randomised controlled trials (RCTs), randomised cross-over studies (RXTs), and prospective observational studies that examined physical activity and pain outcomes in adults living with or beyond cancer. Meta-analyses were performed to generate effect estimates. Risk of bias was assessed, and the GRADE system was used to assess evidence quality. RESULTS One hundred twenty-one studies (n = 13,806), including 102 RCTs, 6 RXTs, and 13 observational studies, met the criteria for inclusion. Meta-analyses of RCTs identified a decrease in pain intensity (n = 3734; standardised mean difference (SMD) - 0.30; 95% confidence interval (CI) - 0.45, - 0.15) and bodily pain (n = 1170; SMD 0.28; 95% CI 0.01, 0.56) but not pain interference (n = 207; SMD - 0.13, 95% CI - 0.42, 0.15) following physical activity interventions. Individual studies also identified a reduction in pain sensitivity but not analgesic use, although meta-analysis was not possible for these outcomes. High heterogeneity between studies, low certainty in some effect estimates, and possible publication bias meant that evidence quality was graded as very low to low. CONCLUSION Physical activity may decrease pain in people living with and beyond cancer; however, high heterogeneity limits the ability to generalise this finding to all people with cancer or to specific types of cancer-related pain.
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Affiliation(s)
- Mitchell Peters
- Cancer Science Unit, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Grace Butson
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - David Mizrahi
- The Daffodil Centre, The University of Sydney, a Joint Venture With Cancer Council NSW, Sydney, NSW, Australia
| | - Linda Denehy
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, University of Melbourne, Level 7, Alan Gilbert Building, 161 Barry St, Melbourne, VIC, 3010, Australia
| | - Brigid M Lynch
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Christopher T V Swain
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, University of Melbourne, Level 7, Alan Gilbert Building, 161 Barry St, Melbourne, VIC, 3010, Australia.
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia.
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11
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Li W, Gan C, Yu S, Xu J, Tang L, Cheng H. Wnt3a/GSK3β/β-catenin Signalling Modulates Doxorubicin-associated Memory Deficits in Breast Cancer. Mol Neurobiol 2024:10.1007/s12035-023-03910-x. [PMID: 38198045 DOI: 10.1007/s12035-023-03910-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/25/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Chemobrain is widespread in breast cancer patients receiving chemotherapy. However, the exact mechanism, especially the associated signalling pathway, is not currently clear. This study was to evaluate the behavioural changes in breast cancer mice after chemotherapy and to further explore the role of Wnt3a/glycogen synthase kinase (GSK3β)/β-catenin signalling in chemobrain. METHODS MMTV-PyMT(+) breast cancer mice were injected intraperitoneally with doxorubicin (4 mg/kg) once a week for three weeks to establish a chemobrain model. The Morris water maze (MWM) and novel object recognition (NOR) tests were performed to assess the learning and memory ability. Electron microscopy was used to observe the structural changes in the hippocampal CA1 region. The brain tissue of breast cancer mice after chemotherapy was taken out for mRNA-seq detection. Then, the expression levels and phosphorylation of key proteins in the Wnt3a/GSK3 β/β-catenin signalling pathway were evaluated through Western blotting (WB) and immunofluorescence. RESULTS Doxorubicin-induced spatial and short-term memory impairment was observed in breast cancer mice, and obvious neuronal damage could be seen in the hippocampal CA1 region. Immunofluorescence staining for GSK3β was increased. Wnt signalling pathway is highly enriched from mRNA-seq analysis, with GSK3β genes at important nodes. The relative protein levels of p-PI3K, p-AKT, p-GSK3 β, Wnt3a and TCF-1 were decreased significantly, while the p-β-catenin level was increased. After injection of the GSK3β inhibitor sb216763 (1 ng/0.5 µl/side), hippocampal neuronal injury was alleviated to some extent, and the changes in the expression of proteins upstream and downstream of this signalling pathway were reversed. CONCLUSION Wnt3a/GSK3 β/β-catenin signalling is likely involved in doxorubicin-induced memory impairment. This result provides basic evidence for the further study of chemobrain in breast cancer.
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Affiliation(s)
- Wen Li
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, Anhui, 230601, China
- Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, 518000, China
| | - Chen Gan
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, Anhui, 230601, China
- Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, 518000, China
| | - Sheng Yu
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, Anhui, 230601, China
- Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, 518000, China
| | - Jian Xu
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, Anhui, 230601, China
- Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, 518000, China
| | - LingXue Tang
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, Anhui, 230601, China
- Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, 518000, China
| | - Huaidong Cheng
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, 510500, China.
- Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, 518000, China.
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12
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Czenczek-Lewandowska E, Szeliga E, Leszczak J. The effect of aquatic and land exercise on the mental well-being of women following breast cancer surgery-comparative study. Breast Cancer Res Treat 2023; 202:585-593. [PMID: 37665473 PMCID: PMC10564663 DOI: 10.1007/s10549-023-07088-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Women after surgical treatment of breast cancer are less likely to engage in physical activity and may exhibit depressive symptoms even for many years post-treatment. The aim of the study was to compare the impact of 6 months aquatic and land exercise on mental well-being of women after breast cancer surgery. METHODS The study was based on a survey which involved a total of 90 women ≥ 50 years of age (including 60 subjects after treatment of breast cancer ≥ 2 years after surgery and 30 healthy control). The study participants were divided into three groups, i.e. women attending general exercise sessions in a gym (A, n = 30), participating in aquatic exercise (B, n = 30), as well as healthy female peers reporting no regular physical exercise for the period of 6 months (C, n = 30). The present data were acquired using standardized questionnaires designed to assess physical activity (IPAQ-SF), mental well-being (WHO-5) and level of anxiety, i.e., Generalized Anxiety Disorder Questionnaire (GAD-7). RESULTS Both the aquatic and land exercise had positive effect on mental well-being of woman after breast cancer surgery and there were no significant differences between them. Analysis of the anxiety level (GAD-7) confirms that women after breast cancer treatment were more exposed to a feeling of generalised anxiety disorder, i.e. 8.67 vs. 6.73, 4.5 (p = 0.001). The results of WHO-5 index were significantly higher in the A and B groups comparing to healthy control, i.e. 13.27 vs. 14.18; 10.10 (p < 0.001), but the obtained results still indicate the low self-esteem of the study group. Women after breast cancer surgery who regularly participated in aquatic exercise were engaged in more vigorous physical activity compared to the other groups, i.e. 1049.33 vs. 521.33; 860.00 MET min/week (p = 0.001). CONCLUSION Regardless of the type of physical activity, 6 months aquatic and land exercise contributed to improved mental well-being and ensured adequate levels of moderate physical activity of woman after BC surgery. Regular physical activity is crucial in the rehabilitation after mastectomy and can be an effective treatment to achieve beneficial mental outcomes.
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Affiliation(s)
| | - Ewa Szeliga
- Institute of Health Sciences, Medical College, University of Rzeszow, Rzeszow, Poland
| | - Justyna Leszczak
- Institute of Health Sciences, Medical College, University of Rzeszow, Rzeszow, Poland
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13
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Wang M, Xu Y, Wu Y, Liu C, Chen Y, Hua D, Liu Q. Evaluating the efficacy of auricular acupuncture for chemotherapy-induced taste alterations: A pilot randomized controlled trial. Eur J Oncol Nurs 2023; 67:102458. [PMID: 37951073 DOI: 10.1016/j.ejon.2023.102458] [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: 08/01/2023] [Revised: 10/06/2023] [Accepted: 10/27/2023] [Indexed: 11/13/2023]
Abstract
PURPOSE Irrespective of the development of acupuncture-based interventions, clinical evidence regarding their efficacy remains controversial owing to issues with the study design and an unclear risk of bias. This study aimed to evaluate the efficacy of auricular acupuncture in managing taste alterations in patients with cancer undergoing platinum-based chemotherapy. METHODS We conducted a pilot randomized controlled trial involving 73 patients randomly assigned to an auricular acupuncture or a control group. The primary outcome was the severity of chemotherapy-induced taste alterations, and the secondary outcomes included quality of life and negative emotions of the patients. RESULTS A total of 49 participants completed the study. Compared to the control group, patients in the auricular acupuncture group showed significant reductions in discomfort, general taste alterations, and total scores on the Chemotherapy-induced Taste Alteration Scale (all p < 0.05). Furthermore, we observed significant improvements in quality of life, including physical function (p = 0.007), role function (p = 0.006), emotional function (p = 0.016), nausea and vomiting (p = 0.021), appetite loss (p = 0.046), and significant improvements in anxiety and depression (p < 0.01). CONCLUSIONS Our findings suggest that auricular acupuncture may be a beneficial intervention for managing chemotherapy-induced taste alterations in patients with cancer receiving platinum-based chemotherapy. It may also contribute to improvements in quality of life and negative emotions. However, these results are preliminary, and further evaluation with larger randomized controlled trials is necessary.
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Affiliation(s)
- Meng Wang
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China.
| | - Yongping Xu
- Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, China.
| | - Yaoyao Wu
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China.
| | - Chao Liu
- Department of Epidemiology and Statistics, Bengbu Medical College, Bengbu, China.
| | - Ying Chen
- Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, China.
| | - Dong Hua
- Department of Oncology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China.
| | - Quan Liu
- Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, China.
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14
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Sturgeon KM, Kok DE, Kleckner IR, Guertin KA, McNeil J, Parry TL, Ehlers DK, Hamilton A, Schmitz K, Campbell KL, Winters‐Stone K. Updated systematic review of the effects of exercise on understudied health outcomes in cancer survivors. Cancer Med 2023; 12:22278-22292. [PMID: 38018376 PMCID: PMC10757127 DOI: 10.1002/cam4.6753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023] Open
Abstract
INTRODUCTION The American College of Sports Medicine provided guidelines for exercise prescriptions in cancer survivors for specific cancer- and treatment-related health outcomes. However, there was insufficient evidence to generate exercise prescriptions for 10 health outcomes of cancer treatment. We sought to update the state of evidence. METHODS We conducted a systematic review of these 10 understudied health outcomes (bone health, sleep, cardiovascular function, chemotherapy-induced peripheral neuropathy (CIPN), cognitive function, falls and balance, nausea, pain, sexual function, and treatment tolerance) and provided an update of evidence. RESULTS While the evidence base for each outcome has increased, there remains insufficient evidence to generate exercise prescriptions. Common limitations observed across outcomes included: variability in type and quality of outcome measurement tools, variability in definitions of the health outcomes, a lack of phase III trials, and a majority of trials investigating breast or prostate cancer survivors only. CONCLUSION We identified progress in the field of exercise oncology for several understudied cancer- and treatment-related health outcomes. However, we were not able to generate exercise prescriptions due to continued insufficient evidence base. More work is needed to prescribe exercise as medicine for these understudied health outcomes, and our review highlights several strategies to aid in research acceleration within these areas of exercise oncology.
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Affiliation(s)
- Kathleen M. Sturgeon
- Department of Public Health SciencesCollege of Medicine, Penn State UniversityHersheyPennsylvaniaUSA
| | - Dieuwertje E. Kok
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Ian R. Kleckner
- Department of Pain & Translational Symptom Science, School of NursingUniversity of Maryland BaltimoreBaltimoreMarylandUSA
| | - Kristin A. Guertin
- Department of Public Health SciencesUniversity of Connecticut HealthStorrsConnecticutUSA
| | - Jessica McNeil
- Department of Kinesiology, School of Health and Human SciencesUniversity of North Carolina at GreensboroGreensboroNorth CarolinaUSA
| | - Traci L. Parry
- Department of Kinesiology, School of Health and Human SciencesUniversity of North Carolina at GreensboroGreensboroNorth CarolinaUSA
| | - Diane K. Ehlers
- Division of Epidemiology, Department of Quantitative Health SciencesMayo Clinic ArizonaPhoenixArizonaUSA
| | - Andrew Hamilton
- Oregon Health & Science University, LibraryPortlandOregonUSA
| | - Kathryn Schmitz
- Division of Hematology/Oncology, University of Pittsburgh School of MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Kristin L. Campbell
- Department of Physical TherapyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Kerri Winters‐Stone
- Division of Oncological Sciences, School of MedicineOregon Health & Science UniversityPortlandOregonUSA
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15
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Duivon M, Lange M, Binarelli G, Lefel J, Hardy-Léger I, Kiasuwa-Mbengi R, Méric JB, Charles C, Joly F. Improve the management of cancer-related cognitive impairment in clinical settings: a European Delphi study. J Cancer Surviv 2023:10.1007/s11764-023-01436-8. [PMID: 37934312 DOI: 10.1007/s11764-023-01436-8] [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: 06/09/2023] [Accepted: 07/21/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Cancer-related cognitive impairment (CRCI) is under-addressed by healthcare professionals owing to a lack of clinical management guidelines. This European Delphi study proposes recommendations to healthcare professionals for the management of CRCI in patients with non-central nervous system (non-CNS) cancers. METHODS Twenty-two recommendations were developed based on a literature review and authors' clinical experience, split into three categories: screening, cognitive assessment, intervention. The survey included European professionals, experts in CRCI. The Delphi method was used: experts rated the clinical relevancy of recommendations on a 9-point Likert scale in three rounds. A recommendation was accepted if all votes were between 7 and 9. Recommendations not accepted in round 1 and round 2 were deleted, or modified and rated in round 3. RESULTS Eighteen professionals (psychologists, physicians, researchers) voted and accepted 15 recommendations. Experts recommended the systematic screening of CRCI, followed by a short objective cognitive assessment, if complaints screened. A comprehensive evaluation is recommended if CRCI persists 6 months post-treatment. Cognitive rehabilitation, physical activity, meditative-movement therapy, and multimodal intervention should be offered. Recommendations about frequency and duration of interventions, the professional to administer cognitive rehabilitation and the use of meditation and cognitive training without psychoeducation were not accepted. CONCLUSIONS This survey provides 15 recommendations to assist healthcare professionals in detecting, assessing and offering interventions for CRCI. IMPLICATIONS FOR CANCER SURVIVORS These recommendations should be included in supportive care to help healthcare professionals to detect CRCI and propose the best available intervention for patients with cognitive complaints. Developing CRCI management in clinical settings would improve patients' quality of life.
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Affiliation(s)
- Mylène Duivon
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, 14000, Caen, France
| | - Marie Lange
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, 14000, Caen, France
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France
- Cancer & Cognition Platform, Ligue Contre le Cancer, 14000, Caen, France
| | - Giulia Binarelli
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, 14000, Caen, France
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France
| | - Johan Lefel
- Care Support Department, Centre Henri Becquerel, 76000, Rouen, France
| | | | - Régine Kiasuwa-Mbengi
- Department of Public Health and Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Jean-Baptiste Méric
- Public Health Division, National Cancer Institute, 52 Avenue André Morizet, 92100, Boulogne-Billancourt, France
| | - Cécile Charles
- Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Florence Joly
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, 14000, Caen, France.
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France.
- Cancer & Cognition Platform, Ligue Contre le Cancer, 14000, Caen, France.
- Medical Oncology Department, CHU de Caen, 14000, Caen, France.
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16
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Li W, Gan C, Yu S, Xu J, Tang L, Li Q, Zhu Z, Cheng H. GSK3β rs3107669 polymorphism implicates chemotherapy-associated retrospective memory deficits in breast cancer survivors. Am J Cancer Res 2023; 13:4961-4975. [PMID: 37970370 PMCID: PMC10636677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/08/2023] [Indexed: 11/17/2023] Open
Abstract
Glycogen synthase kinase-3β (GSK-3β) plays an important role in the development of neurodegenerative diseases. However, the underlying effect of GSK-3β polymorphism on chemobrain in cancer survivors is unclear. This study aimed to evaluate the correlation between GSK-3β polymorphism and chemotherapy-associated retrospective memory deficits in breast cancer survivors. The difference in GSK-3β gene expression between breast cancer patients and healthy controls was confirmed using bioinformatics technology. All participants (197 with breast cancer and 40 healthy controls) underwent prospective and retrospective memory tests, and five single-nucleotide polymorphism loci of GSK-3β (rs3107669, rs1154597, rs334543, rs334558 and rs3755557) were genotyped from peripheral blood. Breast cancer survivors had memory impairment after chemotherapy (P<0.0001). The expression difference of the GSK-3β gene was determined through bioinformation analysis, and a genotype frequency difference of GSK-3β rs3107669 was found between the breast cancer and healthy control groups. GSK-3β rs3107669 was a genetic risk in comparison to the healthy controls (OR=0.382; 95% CI=0.186-0.786; P=0.009). Breast cancer with the GSK-3β rs3107669 (C/A+A/A) genotype was a protective factor for chemobrain (Beta=-0.306; 95% CI=-5.556~-2.145; P<0.0001) from multiple linear regression. The C/A+A/A genotype carrier performed better on the retrospective memory test than the C/C genotype (z=-4.302, P<0.0001). Breast cancer patients with chemotherapy who also carried the GSK-3β rs3107669 (C/C) genotype more easily presented cognitive deficits. The GSK-3β rs3107669 polymorphism was a feasible genetic risk factor for chemotherapy-associated retrospective memory impairments in breast cancer survivors.
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Affiliation(s)
- Wen Li
- Department of Oncology, The Second Hospital of Anhui Medical UniversityHefei 230601, Anhui, P. R. China
- The Third School of Clinical Medicine, Southern Medical UniversityGuangzhou 510500, Guangdong, P. R. China
- Department of Oncology, Shenzhen Hospital of Southern Medical UniversityShenzhen 518000, Guangdong, P. R. China
| | - Chen Gan
- Department of Oncology, The Second Hospital of Anhui Medical UniversityHefei 230601, Anhui, P. R. China
- The Third School of Clinical Medicine, Southern Medical UniversityGuangzhou 510500, Guangdong, P. R. China
- Department of Oncology, Shenzhen Hospital of Southern Medical UniversityShenzhen 518000, Guangdong, P. R. China
| | - Sheng Yu
- Department of Oncology, The Second Hospital of Anhui Medical UniversityHefei 230601, Anhui, P. R. China
- The Third School of Clinical Medicine, Southern Medical UniversityGuangzhou 510500, Guangdong, P. R. China
- Department of Oncology, Shenzhen Hospital of Southern Medical UniversityShenzhen 518000, Guangdong, P. R. China
| | - Jian Xu
- Department of Oncology, The Second Hospital of Anhui Medical UniversityHefei 230601, Anhui, P. R. China
- The Third School of Clinical Medicine, Southern Medical UniversityGuangzhou 510500, Guangdong, P. R. China
- Department of Oncology, Shenzhen Hospital of Southern Medical UniversityShenzhen 518000, Guangdong, P. R. China
| | - Lingxue Tang
- Department of Oncology, The Second Hospital of Anhui Medical UniversityHefei 230601, Anhui, P. R. China
- The Third School of Clinical Medicine, Southern Medical UniversityGuangzhou 510500, Guangdong, P. R. China
- Department of Oncology, Shenzhen Hospital of Southern Medical UniversityShenzhen 518000, Guangdong, P. R. China
| | - Qiang Li
- The Third School of Clinical Medicine, Southern Medical UniversityGuangzhou 510500, Guangdong, P. R. China
- Department of Oncology, Shenzhen Hospital of Southern Medical UniversityShenzhen 518000, Guangdong, P. R. China
| | - Zhenwei Zhu
- The Third School of Clinical Medicine, Southern Medical UniversityGuangzhou 510500, Guangdong, P. R. China
- Department of Oncology, Shenzhen Hospital of Southern Medical UniversityShenzhen 518000, Guangdong, P. R. China
| | - Huaidong Cheng
- Department of Oncology, The Second Hospital of Anhui Medical UniversityHefei 230601, Anhui, P. R. China
- The Third School of Clinical Medicine, Southern Medical UniversityGuangzhou 510500, Guangdong, P. R. China
- Department of Oncology, Shenzhen Hospital of Southern Medical UniversityShenzhen 518000, Guangdong, P. R. China
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17
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Tuğral A, Arıbaş Z, Akyol M, Bakar Y. Assessment of sensorimotor and strength related function of breast cancer patients during systemic drug therapy: a prospective observational study. BMC Cancer 2023; 23:981. [PMID: 37838686 PMCID: PMC10576361 DOI: 10.1186/s12885-023-11494-x] [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: 02/04/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Chemotherapy is a well-known risk factor for sensorial and motor disturbances. Chemotherapy induced peripheral neuropathy (CIPN) which predominantly affects sensory nerves might cause a diminished fine motor function. This prospective observational study aimed to assess the sensorimotor functions of breast cancer patients before, during, and after chemotherapy. METHODS A total of 56 breast cancer patients were evaluated at three different times as follows: T1 (before chemotherapy), T2 (middle chemotherapy), and T3 (completion of chemotherapy). Motor function was assessed with handgrip strength (HGS), peripheral muscle strength (PMS), and the Minnesota Manual Dexterity Test (MMDT). Semmes Weinstein Monofilament Test (SWMT) was performed to assess the sensory function. Fatigue was evaluated with the European Organization for Research and Treatment of Cancer Quality of Life Module Cancer Related Fatigue (EORTC-QLQ-FA12), respectively. RESULTS HGS and MMDT were found significant (χ2: 11.279, p = 0.004 and χ2: 9.893, p = 0.007, respectively) whereas PMS was not found significant (F (2,110) = 1.914, p = 0.152). Pairwise comparisons with Bonferroni adjustments revealed that HGS was found significant between T1 and T3, while significant results were obtained between T1 and T2 as well as T2 and T3 in MMDT (p = 0.01 and p = 0.042). There were significant results in some reference points of SWMT, though they were not found after pairwise comparisons with Bonferroni adjustment (p > 0.05). Fatigue was found significantly increased from T1 through T3 (Median: 19.44 vs 27.77, z: -2.347, p = 0.019, Wilcoxon test). CONCLUSION Our study showed that decreased handgrip strength and fine motor function, as well as increased fatigue, are evident during the chemotherapy. SWMT can be an optional assessment in the context of tracking changes in cutaneous sensation during chemotherapy due to its non-invasive, cheap, and easily repeatable features among cancer patients. To preserve functional capacity as well as independence in daily living, precautions and follow up assessments during the systemic therapy process should be integrated as early as possible to prevent future deteriorations in daily life for patients who undergo chemotherapy. TRIAL REGISTRATION NCT04799080.
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Affiliation(s)
- Alper Tuğral
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakırçay University, Izmir, Turkey.
| | - Zeynep Arıbaş
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakırçay University, Izmir, Turkey
| | - Murat Akyol
- Department of Medical Oncology, Faculty of Medicine, Izmir Bakırçay University, Izmir, Turkey
| | - Yeşim Bakar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakırçay University, Izmir, Turkey
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18
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Barakou I, Sakalidis KE, Abonie US, Finch T, Hackett KL, Hettinga FJ. Effectiveness of physical activity interventions on reducing perceived fatigue among adults with chronic conditions: a systematic review and meta-analysis of randomised controlled trials. Sci Rep 2023; 13:14582. [PMID: 37666869 PMCID: PMC10477297 DOI: 10.1038/s41598-023-41075-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/21/2023] [Indexed: 09/06/2023] Open
Abstract
Fatigue is barrier of physical activity participation in adults with chronic conditions. However, physical activity alleviates fatigue symptoms. This systematic review and meta-analysis aimed to (1) synthesise evidence from randomised controlled trials (RCTs) exploring the effects of physical activity interventions on fatigue reduction and (2) evaluate their effectiveness. Medline/CINAHL/EMBASE/Web of Science and Scopus were searched up to June 24th, 2023. Two reviewers independently conducted study screening and selection (RCTs), extracted data and assessed risk of bias (RoB2). Outcome was the standardised mean difference (SMD) with 95% confidence intervals in fatigue between experimental and control groups. 38 articles met the inclusion criteria. Overall, physical activity interventions moderately reduced fatigue (SMD = 0.54, p < 0.0001). Interventions lasting 2-6 weeks demonstrated a larger effect on fatigue reduction (SMD = 0.86, p < 0.00001). Interventions with 18-24 sessions showed a large effect on fatigue reduction (SMD = 0.97, p < 0.00001). Aerobic cycling and combination training interventions had a large to moderate effect (SMD = 0.66, p = 0.0005; SMD = 0.60, p = 0.0010, respectively). No long-term effects were found during follow-up. Physical activity interventions moderately reduced fatigue among adults with chronic conditions. Duration, total sessions, and mode of physical activity were identified as key factors in intervention effectiveness. Further research is needed to explore the impact of physical activity interventions on fatigue.
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Affiliation(s)
- Ioulia Barakou
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, NE7 7XA, UK
| | - Kandianos Emmanouil Sakalidis
- Department of Sport Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumberland Building, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Ulric Sena Abonie
- Department of Sport Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumberland Building, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Tracy Finch
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, NE7 7XA, UK
| | - Katie L Hackett
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
- CRESTA Fatigue Clinic, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Florentina Johanna Hettinga
- Department of Sport Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumberland Building, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.
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19
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Wang L, Quan M, Nieman DC, Li F, Shi H, Bai X, Xiong T, Wei X, Chen P, Shi Y. Effects of High-Intensity Interval Training and Combined High-Intensity Interval Training Programs on Cancer-Related Fatigue and Cancer Pain: A Systematic Review and Meta-analysis. Med Sci Sports Exerc 2023; 55:1620-1631. [PMID: 37126034 DOI: 10.1249/mss.0000000000003191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE This systematic review and meta-analysis assessed the effectiveness of high-intensity interval training (HIIT) alone and combined HIIT programs compared with usual care on cancer-related fatigue (CRF) and pain related to cancer or cancer-related treatments. METHODS Articles published prior to January 2023 were searched in the following digital databases: PubMed, Cochrane Database of Systematic Reviews and Cochrane Controlled Clinical Trials (CENTRAL), Web of Science, Scopus and ScienceDirect. Randomized controlled trials were included that met the following criteria: (i) adult cancer patients and survivors (>18 yr old); (ii) HIIT or combined HIIT programs versus usual care; (iii) assessment of fatigue and pain. Cochrane tool was used for assessing Risk of Bias (RoB) and Review Manager (RevMan 5.2) was used for data analysis. RESULTS Based on limited number (12) of studies included, we found HIIT and combined HIIT interventions have significant effect sizes on reducing both CRF (standardized mean difference, 0.63; 95% confidence interval, 0.42-0.84; P < 0.001) and cancer-associated pain (standardized mean difference, 0.44; 95% confidence interval, 0.25-0.63; P < 0.001). CONCLUSIONS This systematic review and meta-analysis indicate that HIIT and combined HIIT programs can reduce CRF and pain.
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Affiliation(s)
- Lezheng Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai, CHINA
| | - Minghui Quan
- School of Kinesiology, Shanghai University of Sport, Shanghai, CHINA
| | - David C Nieman
- North Carolina Research Campus, Appalachian State University, Kannapolis, NC
| | - Fei Li
- School of Athletics, Shanghai University of Sport, Shanghai, CHINA
| | - Hui Shi
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, CHINA
| | - Xinyue Bai
- School of Kinesiology, Shanghai University of Sport, Shanghai, CHINA
| | - Ting Xiong
- School of Kinesiology, Shanghai University of Sport, Shanghai, CHINA
| | - Xingyi Wei
- School of Kinesiology, Shanghai University of Sport, Shanghai, CHINA
| | - Peijie Chen
- School of Kinesiology, Shanghai University of Sport, Shanghai, CHINA
| | - Yue Shi
- School of Athletics, Shanghai University of Sport, Shanghai, CHINA
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20
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Plinsinga ML, Singh B, Rose GL, Clifford B, Bailey TG, Spence RR, Turner J, Coppieters MW, McCarthy AL, Hayes SC. The Effect of Exercise on Pain in People with Cancer: A Systematic Review with Meta-analysis. Sports Med 2023; 53:1737-1752. [PMID: 37213049 PMCID: PMC10432370 DOI: 10.1007/s40279-023-01862-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Cancer-related pain is common and undertreated. Exercise is known to have a pain-relieving effect in non-cancer pain. OBJECTIVES This systematic review aimed to evaluate (1) the effect of exercise on cancer-related pain in all cancers, and (2) whether the effect of exercise differed according to exercise mode, degree of supervision, intervention duration and timing (during or after cancer treatment), pain types, measurement tool and cancer type. METHODS Electronic searches were undertaken in six databases to identify exercise studies evaluating pain in people with cancer, published prior to 11 January 2023. All stages of screening and data extraction were conducted independently by two authors. The Cochrane risk of bias tool for randomised trials (RoB 2) was used and overall strength of evidence was assessed using the GRADE approach. Meta-analyses were performed overall and by study design, exercise intervention and pain characteristics. RESULTS In total, 71 studies reported in 74 papers were eligible for inclusion. The overall meta-analysis included 5877 participants and showed reductions in pain favouring exercise (standardised mean difference - 0.45; 95% confidence interval - 0.62, - 0.28). For most (> 82%) of the subgroup analyses, the direction of effect favoured exercise compared with usual care, with effect sizes ranging from small to large (median effect size - 0.35; range - 0.03 to - 1.17). The overall strength of evidence for the effect of exercise on cancer-related pain was very low. CONCLUSION The findings provide support that exercise participation does not worsen cancer-related pain and that it may be beneficial. Better pain categorisation and inclusion of more diverse cancer populations in future research would improve understanding of the extent of benefit and to whom. PROSPERO REGISTRATION NUMBER CRD42021266826.
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Affiliation(s)
- Melanie Louise Plinsinga
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia.
| | - Ben Singh
- Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
| | - Grace Laura Rose
- School of Nursing, Midwifery and Social Work, The University of Queensland, and Mater Research Institute, Brisbane, Australia
| | - Briana Clifford
- School of Nursing, Midwifery and Social Work, The University of Queensland, and Mater Research Institute, Brisbane, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Tom George Bailey
- School of Nursing, Midwifery and Social Work, The University of Queensland, and Mater Research Institute, Brisbane, Australia
| | - Rosalind Renee Spence
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
| | - Jemma Turner
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
| | - Michel Willem Coppieters
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences-Musculoskeletal Health Program, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alexandra Leigh McCarthy
- School of Nursing, Midwifery and Social Work, The University of Queensland, and Mater Research Institute, Brisbane, Australia
| | - Sandra Christine Hayes
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
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21
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Melis M, Schroyen G, Blommaert J, Leenaerts N, Smeets A, Van Der Gucht K, Sunaert S, Deprez S. The Impact of Mindfulness on Functional Brain Connectivity and Peripheral Inflammation in Breast Cancer Survivors with Cognitive Complaints. Cancers (Basel) 2023; 15:3632. [PMID: 37509292 PMCID: PMC10377401 DOI: 10.3390/cancers15143632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Cancer-related cognitive impairment (CRCI) has been linked to functional brain changes and inflammatory processes. Hence, interventions targeting these underlying mechanisms are needed. In this study, we investigated the effects of a mindfulness-based intervention on brain function and inflammatory profiles in breast cancer survivors with CRCI. METHODS Female breast cancer survivors reporting cognitive complaints (n = 117) were randomly assigned to a mindfulness-based intervention (n = 43), physical training (n = 36), or waitlist control condition (n = 38). Region-of-interest (ROI) and graph theory analyses of resting state functional MRI data were performed to study longitudinal group differences in functional connectivity and organization in the default mode, dorsal attention, salience, and frontoparietal network. Additionally, bead-based immunoassays were used to investigate the differences in inflammatory profiles on serum samples. Measures were collected before, immediately after and three months post-intervention. RESULTS No ROI-to-ROI functional connectivity changes were identified. Compared to no intervention, graph analysis showed a larger decrease in clustering coefficient after mindfulness and physical training. Additionally, a larger increase in global efficiency after physical training was identified. Furthermore, the physical training group showed a larger decrease in an inflammatory profile compared to no intervention (IL-12p70, IFN-γ, IL-1β, and IL-8). CONCLUSION Both mindfulness and physical training induced changes in the functional organization of networks related to attention, emotion processing, and executive functioning. While both interventions reduced functional segregation, only physical training increased functional integration of the neural network. In conclusion, physical training had the most pronounced effects on functional network organization and biomarkers of inflammation, two mechanisms that might be involved in CRCI.
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Affiliation(s)
- Michelle Melis
- Department of Imaging and Pathology, Translational MRI, Catholic University Leuven, 1000 Brussels, Belgium
- Research Foundation Flanders (FWO), 1000 Brussels, Belgium
- Leuven Brain Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Leuven Cancer Institute, Catholic University Leuven, 3000 Leuven, Belgium
| | - Gwen Schroyen
- Department of Imaging and Pathology, Translational MRI, Catholic University Leuven, 1000 Brussels, Belgium
- Leuven Brain Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Leuven Cancer Institute, Catholic University Leuven, 3000 Leuven, Belgium
| | - Jeroen Blommaert
- Leuven Brain Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Leuven Cancer Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Department of Oncology, Gynecological Oncology, Catholic University Leuven, 3000 Leuven, Belgium
| | - Nicolas Leenaerts
- Leuven Brain Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Department of Neurosciences, Mind-Body Research, Catholic University Leuven, 3000 Leuven, Belgium
| | - Ann Smeets
- Leuven Cancer Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Department of Oncology, Surgical Oncology, Catholic University Leuven, 3000 Leuven, Belgium
- Department of Surgical Oncology, Multidisciplinary Breast Center, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Katleen Van Der Gucht
- Tilburg School of Social and Behavioral Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands
- Leuven Mindfulness Centre, Faculty of Psychology and Educational Sciences, Catholic University Leuven, 3000 Leuven, Belgium
- Neuromodulation Laboratory, Biomedical Sciences Group, Department of Rehabilitation Sciences, Catholic University Leuven, 3000 Leuven, Belgium
| | - Stefan Sunaert
- Department of Imaging and Pathology, Translational MRI, Catholic University Leuven, 1000 Brussels, Belgium
- Leuven Brain Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Sabine Deprez
- Department of Imaging and Pathology, Translational MRI, Catholic University Leuven, 1000 Brussels, Belgium
- Leuven Brain Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Leuven Cancer Institute, Catholic University Leuven, 3000 Leuven, Belgium
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22
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Wang TC, Chen PL, Liao WC, Tsai IC. Differential Impact of Exercises on Quality-of-Life Improvement in Breast Cancer Survivors: A Network Meta-Analysis of Randomized Controlled Trials. Cancers (Basel) 2023; 15:3380. [PMID: 37444490 DOI: 10.3390/cancers15133380] [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: 04/30/2023] [Revised: 05/22/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
This study aimed to assess the effectiveness of various exercise interventions in enhancing the quality of life for breast cancer survivors. To achieve this, randomized controlled trials were identified from major electronic databases, focusing on the relationship between exercise and quality of life in breast cancer survivors. The primary outcome was the impact of exercise on quality of life 12 weeks after the intervention, with a secondary outcome comparing dropout rates between intervention groups and a regular care control group. The study protocol was registered with INPLASY (INPLASY202340007). A network meta-analysis of nine randomized controlled trials involving 725 participants was conducted, examining aerobic and strength training, aerobic activity, yoga, and strength exercise. Results showed that aerobic and strength training was the most effective intervention, significantly improving the quality of life of breast cancer survivors (1.31; 95% confidence interval: 0.49 to 2.12). Aerobic activity had a borderline effect (0.83; 0.03 to 1.63), while no exercise interventions were associated with an increased dropout risk compared to the control group (regular care). The study concluded that concurrent aerobic and strength training can improve breast cancer survivors' quality of life after 12 weeks of intervention without increasing dropout risk compared to regular care.
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Affiliation(s)
- Tzu-Chieh Wang
- Doctoral Program, Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Nursing, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | | | | | - I-Chen Tsai
- InnovaRad, Taichung 407217, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Congenital Heart Disease Study Group, Asian Society of Cardiovascular Imaging, Seoul 13572, Republic of Korea
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23
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Hiensch AE, Beckhaus J, Witlox L, Monninkhof EM, Schagen SB, van Vulpen JK, Sweegers MG, Newton RU, Aaronson NK, Galvão DA, Steindorf K, Stuiver MM, Mesters I, Knoop H, Goedendorp MM, Bohus M, Thorsen L, Schulz KH, Schmidt ME, Ulrich CM, Sonke GS, van Harten WH, Winters-Stone KM, Velthuis MJ, Taaffe DR, van Mechelen W, Kersten MJ, Nollet F, Wiskemann J, Buffart LM, May AM. Moderators of exercise effects on self-reported cognitive functioning in cancer survivors: an individual participant data meta-analysis. J Cancer Surviv 2023:10.1007/s11764-023-01392-3. [PMID: 37160571 DOI: 10.1007/s11764-023-01392-3] [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: 02/28/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE This individual participant data meta-analysis (IPD-MA) assesses exercise effects on self-reported cognitive functioning (CF) and investigates whether effects differ by patient-, intervention-, and exercise-related characteristics. METHODS IPD from 16 exercise RCTs, including 1987 patients across multiple types of non-metastatic cancer, was pooled. A one-stage IPD-MA using linear mixed-effect models was performed to assess exercise effects on self-reported CF (z-score) and to identify whether the effect was moderated by sociodemographic, clinical, intervention- and exercise-related characteristics, or fatigue, depression, anxiety, and self-reported CF levels at start of the intervention (i.e., baseline). Models were adjusted for baseline CF and included a random intercept at study level to account for clustering of patients within studies. A sensitivity analysis was performed in patients who reported cognitive problems at baseline. RESULTS Minimal significant beneficial exercise effects on self-reported CF (β=-0.09 [-0.16; -0.02]) were observed, with slightly larger effects when the intervention was delivered post-treatment (n=745, β=-0.13 [-0.24; -0.02]), and no significant effect during cancer treatment (n=1,162, β=-0.08 [-0.18; 0.02]). Larger effects were observed in interventions of 12 weeks or shorter (β=-0.14 [-0.25; -0.04]) or 24 weeks or longer (β=-0.18 [-0.32; -0.02]), whereas no effects were observed in interventions of 12-24 weeks (β=0.01 [-0.13; 0.15]). Exercise interventions were most beneficial when provided to patients without anxiety symptoms (β=-0.10 [-0.19; -0.02]) or after completion of treatment in patients with cognitive problems (β=-0.19 [-0.31; -0.06]). No other significant moderators were identified. CONCLUSIONS This cross-cancer IPD meta-analysis observed small beneficial exercise effects on self-reported CF when the intervention was delivered post-treatment, especially in patients who reported cognitive problems at baseline. IMPLICATIONS FOR CANCER SURVIVORS This study provides some evidence to support the prescription of exercise to improve cognitive functioning. Sufficiently powered trials are warranted to make more definitive recommendations and include these in the exercise guidelines for cancer survivors.
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Affiliation(s)
- Anouk E Hiensch
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Julia Beckhaus
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lenja Witlox
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jonna K van Vulpen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maike G Sweegers
- Division of Psychosocial Research and Epidemiology & Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Martijn M Stuiver
- Division of Psychosocial Research and Epidemiology & Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ilse Mesters
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Martine M Goedendorp
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany
- Faculty of Health, University of Antwerp, Antwerp, Belgium
| | - Lene Thorsen
- National Advisory Unit on Late Effects after Cancer, Department of Oncology, Oslo University Hospital, Oslo, Norway
- Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Karl-Heinz Schulz
- Athleticum - Competence Center for Sports- and Exercise Medicine and Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martina E Schmidt
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Cornelia M Ulrich
- Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, USA
| | - Gabe S Sonke
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Kerri M Winters-Stone
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Miranda J Velthuis
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Willem van Mechelen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, location: Vrije Universiteit, Amsterdam, The Netherlands
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Centers, Location University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Joachim Wiskemann
- Working Group Exercise Oncology, Division of Medical Oncology, University Clinic Heidelberg and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Laurien M Buffart
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.
- Department of Physiology, Radboudumc, Nijmegen, The Netherlands.
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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24
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Cheung YT, Ma CT, Li MCH, Zhou KR, Loong HHF, Chan ASY, Wong KC, Li CK. Associations between Lifestyle Factors and Neurocognitive Impairment among Chinese Adolescent and Young Adult (AYA) Survivors of Sarcoma. Cancers (Basel) 2023; 15:cancers15030799. [PMID: 36765757 PMCID: PMC9913447 DOI: 10.3390/cancers15030799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The effect of lifestyle on neurocognitive impairment among cancer survivors remain an understudied area. This study explored the association between lifestyle factors and neurocognitive outcomes (specifically, attention, memory, processing speed and cognitive flexibility) in AYA survivors (aged 15-39 years) of sarcoma. METHODS This study recruited 116 AYA survivors (age 28.2 (SD = 8.2) years), who were diagnosed with osteosarcoma (49%) or soft-tissue sarcoma (51%) at age 13.3 (SD = 7.2) years. The neurocognitive battery included measures of attention, memory, motor-processing speed, and cognitive flexibility. Survivors reported health-damaging practices, which included: physical inactivity, smoking, alcohol intake, inadequate sleep (<7 h of actual sleep/day), sleep-related fatigue (Multidimensional Fatigue Scale) and long working hours (>9 h/day). General linear modeling was conducted to examine the association between lifestyle factors and neurocognitive outcomes, adjusting for age at diagnosis, sex, education attainment and clinical/treatment variables. RESULTS At 14.9 (SD = 7.6) years post-diagnosis, survivors demonstrated impairment in attentiveness (4.3-13.0%), processing speed (34.5%) and cognitive flexibility (18.1%). Nearly half (45.7%) had developed a chronic health condition (CHC). Low physical activity (estimate = -0.97, p = 0.003) and sleep-related fatigue (estimate = -0.08, p = 0.005) were associated with inattention. Survivors who worked >9 h/day (n = 15) demonstrated worse attention (estimate = 5.42, p = 0.023) and cognitive flexibility (estimate = 5.22, p = 0.005) than survivors who worked ≤9 h/day (n = 66). Interaction analysis (CHCs*physical activity) showed that survivors who developed CHCs and reported low physical activity had worse attention (p = 0.032) and cognitive-flexibility (p = 0.019) scores than other subgroups. CONCLUSION Treatment-related CHCs, coupled with continued physical inactivity, may exacerbate inattention and executive dysfunction among survivors. Long working hours and sleep-related fatigue are associated with worse functioning; this finding should be validated with prospective assessment of work-related stressors and objective sleep measures.
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Affiliation(s)
- Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Correspondence: ; Tel.: +852-3943-6833; Fax: +852-2603-5295
| | - Chung Tin Ma
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Michael Can Heng Li
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Keary Rui Zhou
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Herbert Ho Fung Loong
- Department of Clinical Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Agnes Sui Yin Chan
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Kwok Chuen Wong
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, China
| | - Chi Kong Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong, China
- Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
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25
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Zhang H, Zhang Y, Sheng S, Xing Y, Mou Z, Zhang Y, Shi Z, Yu Z, Gao Q, Cai W, Jing Q. Relationship Between Physical Exercise and Cognitive Impairment Among Older Adults with Type 2 Diabetes: Chain Mediating Roles of Sleep Quality and Depression. Psychol Res Behav Manag 2023; 16:817-828. [PMID: 36960417 PMCID: PMC10030003 DOI: 10.2147/prbm.s403788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023] Open
Abstract
Objective Although physical exercise has been shown to boost physical, psychological, and psychiatric conditions in older adults, there is a relative lack of research on the mechanisms involved in this process for older adults with type 2 diabetes mellitus (T2DM). We thus evaluated whether sleep quality and depression mediated the relationship between physical exercise and cognitive impairment in older adults with T2DM by focusing on the exercise-physiology-psychology and psychiatry connection. Methods Self-reported data were collected from 2646 older adults with T2DM in Weifang, Shandong, China. Regression and bootstrap analyses were conducted to explore the chain mediator model including physical exercise, cognitive impairment, sleep quality, and depression. Results Engaging in physical exercise (coefficient = -0.6858, p < 0.001), high levels of sleep quality (coefficient = -0.3397, p = 0.015), and low levels of depression (coefficient = 0.3866, p < 0.001) were significantly associated with a low level of cognitive impairment. Sleep quality and depression mediated the chain effect between physical exercise and cognitive impairment (total effect = -1.0732, 95% CI [-1.3652, -0.7862]; direct effect = -0.6858, 95% CI [-0.9702, -0.3974]; indirect effect = -0.3875, 95% CI [-0.5369, -0.2521]). Conclusion Physical exercise may improve sleep quality in older adults with T2DM, alleviating depression and delaying the development of cognitive impairment. Physical exercise can enhance patients' ability to resist depression and cognitive impairment, and creating comfortable sleep environments can also reinforce the effects of this process. These findings have important implications for promoting healthy aging in older adults with T2DM.
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Affiliation(s)
- Han Zhang
- School of Management, Weifang Medical University, Weifang, Shandong, People’s Republic of China
- “Health Shandong” Collaborative Innovation Center for Severe Social Risk Prediction and Governance, Weifang, People’s Republic of China
- China Academy of Rehabilitation and Health, Weifang Medical University, Weifang, People’s Republic of China
| | - Yefan Zhang
- School of Management, Weifang Medical University, Weifang, Shandong, People’s Republic of China
- “Health Shandong” Collaborative Innovation Center for Severe Social Risk Prediction and Governance, Weifang, People’s Republic of China
- China Academy of Rehabilitation and Health, Weifang Medical University, Weifang, People’s Republic of China
| | - Sen Sheng
- School of Management, Weifang Medical University, Weifang, Shandong, People’s Republic of China
- “Health Shandong” Collaborative Innovation Center for Severe Social Risk Prediction and Governance, Weifang, People’s Republic of China
| | - Yang Xing
- Weifang People’s Hospital, Weifang, People’s Republic of China
| | - Zhongchen Mou
- School of Psychology, Weifang Medical University, Weifang, People’s Republic of China
| | - Yanqiu Zhang
- School of Management, Weifang Medical University, Weifang, Shandong, People’s Republic of China
- “Health Shandong” Collaborative Innovation Center for Severe Social Risk Prediction and Governance, Weifang, People’s Republic of China
- China Academy of Rehabilitation and Health, Weifang Medical University, Weifang, People’s Republic of China
| | - Zhixue Shi
- School of Management, Weifang Medical University, Weifang, Shandong, People’s Republic of China
- “Health Shandong” Collaborative Innovation Center for Severe Social Risk Prediction and Governance, Weifang, People’s Republic of China
- China Academy of Rehabilitation and Health, Weifang Medical University, Weifang, People’s Republic of China
| | - Zhenjie Yu
- School of Management, Weifang Medical University, Weifang, Shandong, People’s Republic of China
- “Health Shandong” Collaborative Innovation Center for Severe Social Risk Prediction and Governance, Weifang, People’s Republic of China
| | - Qianqian Gao
- School of Management, Weifang Medical University, Weifang, Shandong, People’s Republic of China
- “Health Shandong” Collaborative Innovation Center for Severe Social Risk Prediction and Governance, Weifang, People’s Republic of China
- China Academy of Rehabilitation and Health, Weifang Medical University, Weifang, People’s Republic of China
| | - Weiqin Cai
- School of Management, Weifang Medical University, Weifang, Shandong, People’s Republic of China
- “Health Shandong” Collaborative Innovation Center for Severe Social Risk Prediction and Governance, Weifang, People’s Republic of China
- China Academy of Rehabilitation and Health, Weifang Medical University, Weifang, People’s Republic of China
- Correspondence: Weiqin Cai; Qi Jing, School of Management, Weifang Medical University, No. 7166 Baotongxi Street, Weifang, 261053, People’s Republic of China, Tel +8618106369128, Email ;
| | - Qi Jing
- School of Management, Weifang Medical University, Weifang, Shandong, People’s Republic of China
- “Health Shandong” Collaborative Innovation Center for Severe Social Risk Prediction and Governance, Weifang, People’s Republic of China
- China Academy of Rehabilitation and Health, Weifang Medical University, Weifang, People’s Republic of China
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26
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Koevoets EW, Geerlings MI, Monninkhof EM, Mandl R, Witlox L, van der Wall E, Stuiver MM, Sonke GS, Velthuis MJ, Jobsen JJ, van der Palen J, Bos MEMM, Göker E, Menke-Pluijmers MBE, Sommeijer DW, May AM, de Ruiter MB, Schagen SB. Effect of physical exercise on the hippocampus and global grey matter volume in breast cancer patients: A randomized controlled trial (PAM study). Neuroimage Clin 2023; 37:103292. [PMID: 36565574 PMCID: PMC9800528 DOI: 10.1016/j.nicl.2022.103292] [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: 08/23/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Physical exercise in cancer patients is a promising intervention to improve cognition and increase brain volume, including hippocampal volume. We investigated whether a 6-month exercise intervention primarily impacts total hippocampal volume and additionally hippocampal subfield volumes, cortical thickness and grey matter volume in previously physically inactive breast cancer patients. Furthermore, we evaluated associations with verbal memory. METHODS Chemotherapy-exposed breast cancer patients (stage I-III, 2-4 years post diagnosis) with cognitive problems were included and randomized in an exercise intervention (n = 70, age = 52.5 ± 9.0 years) or control group (n = 72, age = 53.2 ± 8.6 years). The intervention consisted of 2x1 hours/week of supervised aerobic and strength training and 2x1 hours/week Nordic or power walking. At baseline and at 6-month follow-up, volumetric brain measures were derived from 3D T1-weighted 3T magnetic resonance imaging scans, including hippocampal (subfield) volume (FreeSurfer), cortical thickness (CAT12), and grey matter volume (voxel-based morphometry CAT12). Physical fitness was measured with a cardiopulmonary exercise test. Memory functioning was measured with the Hopkins Verbal Learning Test-Revised (HVLT-R total recall) and Wordlist Learning of an online cognitive test battery, the Amsterdam Cognition Scan (ACS Wordlist Learning). An explorative analysis was conducted in highly fatigued patients (score of ≥ 39 on the symptom scale 'fatigue' of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire), as previous research in this dataset has shown that the intervention improved cognition only in these patients. RESULTS Multiple regression analyses and voxel-based morphometry revealed no significant intervention effects on brain volume, although at baseline increased physical fitness was significantly related to larger brain volume (e.g., total hippocampal volume: R = 0.32, B = 21.7 mm3, 95 % CI = 3.0 - 40.4). Subgroup analyses showed an intervention effect in highly fatigued patients. Unexpectedly, these patients had significant reductions in hippocampal volume, compared to the control group (e.g., total hippocampal volume: B = -52.3 mm3, 95 % CI = -100.3 - -4.4)), which was related to improved memory functioning (HVLT-R total recall: B = -0.022, 95 % CI = -0.039 - -0.005; ACS Wordlist Learning: B = -0.039, 95 % CI = -0.062 - -0.015). CONCLUSIONS No exercise intervention effects were found on hippocampal volume, hippocampal subfield volumes, cortical thickness or grey matter volume for the entire intervention group. Contrary to what we expected, in highly fatigued patients a reduction in hippocampal volume was found after the intervention, which was related to improved memory functioning. These results suggest that physical fitness may benefit cognition in specific groups and stress the importance of further research into the biological basis of this finding.
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Affiliation(s)
- E W Koevoets
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands; Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands; Department of General Practice, Amsterdam UMC, Amsterdam, the Netherlands
| | - E M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - R Mandl
- Department of Psychiatry, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - L Witlox
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - E van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - M M Stuiver
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands; Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, the Netherlands; Center of Expertise Urban Vitality, Faculty of Health, University of Applied Sciences, Amsterdam, the Netherlands
| | - G S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M J Velthuis
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - J J Jobsen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - J van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Research Methodology, Measurement, Universiteit Twente, Enschede, the Netherlands
| | - M E M M Bos
- Department of Medical Oncology, ErasmusMC Cancer Institute, Rotterdam, the Netherlands
| | - E Göker
- Department of Medical Oncology, Alexander Monro Hospital, Bilthoven, the Netherlands
| | | | - D W Sommeijer
- Department of Internal Medicine, Flevohospital, Almere, the Netherlands; Department of Medical Oncology, Amsterdam UMC, Amsterdam, the Netherlands
| | - A M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - M B de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - S B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Brain and Cognition Group, University of Amsterdam, Amsterdam, the Netherlands.
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