Rationale for Promoting Physical Activity Among Cancer Survivors: Literature Review and Epidemiologic Examination

Development of an intervention aimed at the prevention and treatment of chronic pain in breast cancer survivors: An intervention mapping approach

OBJECTIVE

Pain is prevalent among breast cancer survivors and can persist for years, impeding quality of life. Both prevention and pain treatment are important. However, this requires an interdisciplinary approach and complex models of care. We report on the design and implementation of an intervention that follows a step-wise care model, aimed at timely and adequate pain follow-up among breast cancer survivors.

METHODS

We used intervention mapping to guide our planning process. The intervention was developed in co-design with relevant stakeholders, such as breast cancer survivors and healthcare providers.

RESULTS

An e-learning training was developed aimed at changing healthcare providers' knowledge, beliefs, and interprofessional behaviour regarding pain follow-up. Second, guides were produced to empower patients in talking about pain and stimulate referral to other disciplines.

CONCLUSION

To achieve change in pain follow-up, multiple levels should be addressed. Additionally, the implementation and adoption of an intervention opposes challenges. Intervention mapping can serve as a theory-based and data-driven approach for decision-making during planning.

PRACTICE IMPLICATIONS

This study can inform others about how to prepare for the development and implementation of an intervention. The developed intervention can also be adapted according to the target population and context, and used for other cancer populations.

Efficacy of a 4-Week Nurse-Led Exercise Rehabilitation Program in Improving the Quality of Life in Women Receiving a Post-Mastectomy Reconstruction Using the Motiva ErgonomixTM Round SilkSurface

We assessed the efficacy of a 4-week nurse-led exercise rehabilitation (ER) program in improving the quality of life (QOL) of breast cancer survivors (BCS) receiving an implant-based breast reconstruction. The eligible patients were equally randomized to either of both groups: the intervention group (n = 30; a 4-week nurse-led ER program) and the control group (n = 30; a 4-week physical therapist-supervised one). Both after a 4-week ER program and at baseline, the patients were evaluated for the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Fatigue Severity Scale (FSS) scores. There was a significantly higher degree of increase in global health status/QOL scores, physical functioning scores, role functioning scores, and emotional functioning scores at 4 weeks from baseline in the intervention group as compared with the control group (p = 0.001). However, there was a significantly higher degree of decrease in fatigue scores, nausea/vomiting scores, pain scores, dyspnea scores, and FSS scores in the intervention group as compared with the control group (p = 0.001). In conclusion, our results indicate that a 4-week nurse-led ER program might be effective in the QOL in BCS receiving a post-mastectomy implant-based reconstruction using the Motiva Ergonomix^TM Round SilkSurface.

Exploring healthcare providers’ perceptions regarding the prevention and treatment of chronic pain in breast cancer survivors: A qualitative analysis among different disciplines

Background

The prevention and treatment of chronic pain problems in breast cancer follow-up care require an adequate response from healthcare providers. Generally, this involves the uptake of evidence-based principles regarding pain management in everyday practice. However, despite the extensive literature on effective pain interventions, systematic and coordinated follow-up care is lacking for breast cancer survivors with pain problems in Flanders, Belgium.

Objective

This study aimed to gather insight into healthcare providers’ perceptions of pain prevention and treatment in breast cancer follow-up care, particularly with attention to the multilevel influences on pain follow-up.

Methods

We conducted four online focus groups with twenty-two healthcare providers from different disciplines such as oncologists, pharmacists, nurses, physiotherapists, and psychologists. Data analysis was guided by the Qualitative Analysis Guide of Leuven. This guide is inspired by the constant comparison method, based on Grounded Theory.

Results

The identified influencing factors were thematically grouped into four levels: at the level of the individual healthcare provider, in interaction with the patient, in interaction with colleagues, and at the context level. At each level, we distinguished factors related to healthcare providers’ perceptions such as awareness, knowledge, attitudes, beliefs, experiences, and intentions. For example, because of a lack of knowledge and certain beliefs among healthcare providers, referral to other disciplines often does not happen in the context of pain.

Conclusion

This study points out the need to explore the prevention and treatment of chronic pain after breast cancer from a multidimensional point of view. This involves not only the characteristics of individual healthcare providers but is also inherently interactional and system-like in nature. This analysis provides opportunities for the development of interventions that target the influencing factors of prevention and treatment of chronic pain in breast cancer survivors.

Feasibility and acceptability of a group-mediated exercise intervention for gynecological cancer survivors

PURPOSE

Examine feasibility and acceptability of a group-mediated cognitive-behavioral (GMCB) intervention targeting planned, self-managed physical activity (PA).

DESIGN

Sequential mixed methods, single arm pre-/post-test design with a 4-week follow-up.

PARTICIPANTS

Post-treatment gynecologic cancer survivors.

METHODS

Participants attended 8 weekly facilitator-led group sessions and completed assessments at baseline, post-intervention and follow-up. Feasibility was assessed by recruitment rate, retention rate, capture of outcomes, intervention usability and intervention fidelity. Acceptability was examined via qualitative interviews. Preliminary estimates of intervention effectiveness (PA, PA social cognitions and sleep) were collected.

FINDINGS

355 participants were approached and 38 consented. Twenty took part in the study and 17 (85%) completed the intervention. Thematic content analysis revealed positive group experiences. Cognitive-behavioral strategies were beneficial. Goal-setting and shared cancer recovery experience facilitated connection among group members.

IMPLICATIONS

Program acceptability was high among a diverse sample of gynecologic cancer survivors and delivery of the program is feasible to this group of gynecologic cancer survivors. Recruitment challenges were present but study retention was high.

Nursing intervention focusing on health promotion behaviors in adult cancer patients: a scoping review

OBJECTIVE

This review aims to map and provide an overview of literature concerning nursing strategies and intervention programs that promote healthy behaviors in cancer patients.

METHOD

A scoping review was conducted using the methodological framework developed by Joanna Briggs Institute and preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews. Twelve databases were searched (2012-2019). Retrieved data included descriptive analyses exploring studies' methodological characteristics and results.

RESULTS

From 1589 studies, 12 were included. Most studies included patients on survivorship period (n=10) and selected intervention strategies focusing patient's knowledge and awareness (n=8). Educational sessions were supported by behavioral change reinforcements and motivational incentives. Only two of the considered studies analysed intervention cost effectiveness, but none disclosed intervention-related costs.

CONCLUSION

Nursing interventions are effective in promoting health behaviors when include health education and encouragement towards change. Survivorship is the perfect time for health promotion. Nurses can be considered health promoters, by encouraging health education and enhance survivor's motivation.

A Retrospective, Cross-Sectional Study of Self-Reported Physical Activity and Depression Among Breast, Gynecologic, and Thoracic Cancer Survivors

OBJECTIVES

To describe cancer survivors' self-reported frequency and intensity of physical activity and depression.

SAMPLE & SETTING

1,412 breast (n = 375), gynecologic (n = 369), and thoracic (n = 668) cancer survivors at an urban comprehensive cancer center between July 2017 and December 2018.

METHODS & VARIABLES

Attainment of recommended physical activity was assessed using the Godin-Shepard Leisure-Time Physical Activity Questionnaire, and depression was assessed using the Patient Health Questionnaire (PHQ)-2 or PHQ-9. Abstracted characteristics, including age, sex, race, years since diagnosis, pain, body mass index, smoking, and marital and employment status, were also assessed.

RESULTS

872 patients were insufficiently active, and 105 patients reported some level of depression. Breast cancer survivors were significantly more likely to attain recommended activity levels than gynecologic or thoracic survivors. There was no intergroup difference in the incidence or severity of depression.

IMPLICATIONS FOR NURSING

Nurses working with survivors should assess physical activity and support patients to meet weekly exercise duration and intensity recommendations.

Physical Activity and Cancer Care in the Atlantic Canadian Provinces: an Examination of Provider Beliefs, Practices, Resources, Barriers, and Enablers

Despite the well-established benefits of physical activity for cancer survivors, the vast majority of survivors are not sufficiently active to reap these benefits. While cancer-specific physical activity guidelines exist, it remains unclear whether there are sufficient resources to support these recommendations. The purpose of this qualitative study was to describe the available cancer-specific physical activity programs for cancer survivors in Atlantic Canada and explore barriers and enablers to program implementation. Interviews were conducted with a purposefully selected sample of oncology healthcare professionals, administrators, and cancer-specific physical activity program leaders to examine the attitudes and practices of key stakeholders with respect to physical activity and cancer-specific programming. Thirty participants, including 7 oncologists, 7 nurses, 6 allied healthcare professionals, 5 administrators, and 5 program leaders, completed an interview. Three over-arching themes emerged, including (1) knowledge, attitudes and need for physical activity; (2) implementation barriers; and (3) implementation enablers. The results of this study suggest that cancer survivors in Atlantic Canada may require additional resources and support with respect to physical activity throughout their cancer care journey.

A systematic review summarizing the effect of health care provider-delivered physical activity interventions on physical activity behaviour in cancer survivors

OBJECTIVE

To synthesize knowledge regarding the effect of health care provider-delivered physical activity interventions on cancer survivors' physical activity behaviour.

METHODS

Ten electronic databases were searched for articles reporting on the effect of health care provider-delivered physical activity interventions on cancer survivors' physical activity behaviour. Articles were included if they met the following criteria: English-language, participants were adult cancer survivors, the effect of health care provider-delivered physical activity interventions on physical activity behaviour was assessed, and physical activity behaviour was measured at least twice. Data were extracted and summarized descriptively.

RESULTS

Seventeen articles representing 11 studies met inclusion criteria. Two studies reported within-person increases in physical activity behaviour and one reported decreases. Nine studies reported between-group differences in physical activity behaviour favouring the intervention group.

CONCLUSIONS

Health care provider-delivered physical activity interventions may increase cancer survivors' physical activity behaviour. However, increases may depend on administering additional behaviour change techniques and resources. Given the limited number of studies, degree of heterogeneity, and high level of bias observed, more research is needed to ascertain the effect of health care provider-delivered interventions on cancer survivors' physical activity behaviour and to compare different interventions.

The requirements of a specialist breast centre

This article is an update of the requirements of a specialist breast centre, produced by EUSOMA and endorsed by ECCO as part of Essential Requirements for Quality Cancer Care (ERQCC) programme, and ESMO. To meet aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this article, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.

Overview of Physical Activity Counseling in Primary Care

Physical inactivity is a global health burden. Promoting physical activity in primary care through physical activity counseling is an effective intervention. This article provides an overview of and perspectives on physical activity counseling in primary care. The identification of physical inactivity as a health problem may increase the awareness of physical inactivity among patients and primary care providers, which will lead to an action plan. The contents of physical activity counseling should be based on evidence-based recommendations. Safety issues should be evaluated appropriately to optimize the utilization of primary care services. Physical activity counseling methods should be "tailored" for an individual using appropriate counseling methods and setting-specific resources. Multilevel barriers to physical activity counseling in primary care (i.e., healthcare providers, patients, and systems) must be addressed. Setting-specific strategies to overcome these barriers should be implemented to maximize the effectiveness of physical activity counseling in primary care.

Predicting physical activity among cancer survivors: Meta-analytic path modeling of longitudinal studies

OBJECTIVE

We conducted meta-analyses and meta-analytic structural equation modeling of longitudinal studies among cancer survivors to (a) quantify associations between psychosocial predictors and physical activity, (b) test how psychosocial predictors combine to influence physical activity, and (c) identify study, demographic, and clinical characteristics that moderate associations.

METHOD

Eligible studies used a longitudinal, observational design, included a sample of cancer survivors, and measured both a psychosocial predictor at baseline and physical activity at a later time-point. Of 2,431 records located through computerized searches, 25 independent tests (N = 5,897) met the inclusion criteria for the review. Random effects meta-analyses and meta-analytic structural equation modeling were conducted.

RESULTS

Eight psychosocial predictors of physical activity were identified. Self-efficacy (r+ = 0.26) and intentions (r+ = 0.33) were the strongest predictors in bivariate analyses. The structural equation models included attitudes, injunctive norms, self-efficacy, intentions, and physical activity (k = 22, N = 4,385). The model with the best fit, χ2(2) = 0.11, p = .95, root mean square error of approximation = .00, comparative fit index = 1.00, Tucker-Lewis index = 1.00, indicated that all specified paths were significant. Intentions were the strongest predictor of physical activity (β = 0.27, p < .001), and attitudes and self-efficacy were strong predictors of intentions (both βs = 0.29, ps < .001). Few significant moderators were observed.

CONCLUSION

This review indicates that self-efficacy and intentions are direct predictors of physical activity in cancer survivors. Further, attitudes and norms predict physical activity through intentions. Findings inform intervention development to increase physical activity engagement among cancer survivors. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Objectively Measured Physical Activity and All-Cause Mortality Among Cancer Survivors: National Prospective Cohort Study

OBJECTIVE

The understanding of the effects of physical activity on all-cause mortality among cancer survivors is limited. We attempted to draw a relation between physical activity and survival among those with a diagnosis of cancer.

METHODS

Data from the 2003-2006 National Health and Nutrition Examination Survey was used, with follow-up through 2011. A total of 515 adult cancer survivors wore an accelerometer for ≥4 days.

RESULTS

After adjusting for age, sex, race/ethnicity, poverty level, cotinine, C-reactive protein, body mass index, and comorbid illness, participants had a 15% reduced hazard rate (hazard rate 0.85, 95% confidence interval 0.73-0.99, P < 0.001) for every 60-minute/day increase in physical activity.

CONCLUSIONS

Physical activity may have a protective effect on survival among cancer survivors.

Health Benefits of Light-Intensity Physical Activity: A Systematic Review of Accelerometer Data of the National Health and Nutrition Examination Survey (NHANES)

BACKGROUND

The health effects of light-intensity physical activity (PA) are not well known today.

OBJECTIVE

We conducted a systematic review to assess the association of accelerometer-measured light-intensity PA with modifiable health outcomes in adults and older adults.

METHODS

A systematic literature search up to March 2016 was performed in the PubMed, EMBASE, Web of Science and Google Scholar electronic databases, without language limitations, for studies of modifiable health outcomes in adults and older adults in the National Health and Nutrition Examination Survey accelerometer dataset.

RESULTS

Overall, 37 cross-sectional studies and three longitudinal studies were included in the analysis, with considerable variation observed between the studies with regard to their operationalization of light-intensity PA. Light-intensity PA was found to be beneficially associated with obesity, markers of lipid and glucose metabolism, and mortality. Few data were available on musculoskeletal outcomes and results were mixed.

CONCLUSIONS

Observational evidence that light-intensity PA can confer health benefits is accumulating. Currently inactive or insufficiently active people should be encouraged to engage in PA of any intensity. If longitudinal and intervention studies corroborate our findings, the revision of PA recommendations to include light-intensity activities, at least for currently inactive populations, might be warranted.

Physical Activity Among Postoperative Esophageal Cancer Patients

BACKGROUND

Previous literature has reported that regular physical activity enhances health-related quality of life for cancer patients. However, there is a lack of studies that focus on physical activity among postoperative esophageal cancer patients.

OBJECTIVE

The aims of this study were to (1) describe the prevalence of physical activity among postoperative esophageal cancer patients, (2) explore variables related to physical activity (demographics, nutrition, dysphagia, and health-related qualify of life), and (3) examine potential reasons for inactivity among participants who scored low using case studies.

METHODS

In this cross-sectional design, physical activity was evaluated by the Japanese version of the International Physical Activity Questionnaire. Variables were analyzed using Spearman rank correlation coefficients, Mann-Whitney U tests, or Fisher exact tests.

RESULTS

Fifty-eight patients participated in this study; 79% met the recommended physical activity guidelines. Present occupational status and past leisure-time physical activity behavior before the cancer diagnosis were related to current leisure-time physical activity and meeting the guidelines postoperatively. Participants who scored 0 (little or no activity) in the questionnaire also scored low in health-related quality of life.

CONCLUSIONS

Participants performed especially well in physical activity related to leisure time and transportation. Positive reinforcement is needed for patients who perform adequate levels of physical activity, and reviewing the benefits of regular physical activity is encouraged for all.

IMPLICATIONS FOR PRACTICE

Occupational status and past leisure-time physical activity before diagnosis can be indicators for promoting physical activity among postoperative esophageal cancer patients. Inactive participants should be supported to promote both physical activity and health-related qualify of life.

Promoting Team-Based Exercise Among African American Breast Cancer Survivors

Physical activity benefits the health and well-being of breast cancer survivors (BCS). Yet, many African American survivors do not routinely exercise and have increased risk of poor outcomes. The purpose of this mixed-method study was to identify motivational factors compelling African American BCS to participate in a 14-week team walking program and to intend to continue exercise after the intervention concluded. Focus groups were held with participants ( n = 12) before and after training. Content analysis discovered themes before the intervention: Not wanting to go at it alone, exercise not a life or treatment priority, cancer treatment affected activity, advocates to exercise, and can exercise really help? Four themes postintervention themes included: In the same boat, changed mind-set, improved weight and activity, and overcoming barriers. Physical data verified improvements. Results suggest that a team-based exercise training program may assist in overcoming a sedentary behavior tendency and subsequently improve health among survivors.

What Do Breast Cancer Survivors Expect From Exercise?

BACKGROUND

Exercise outcome expectations (OEs) (ie, what one expects to obtain or avoid by exercising) are influential to increase exercise among cancer survivors.

OBJECTIVE

The aim of this study was to measure the accessibility (ie, frequency one thinks about exercise resulting in an outcome) and importance (ie, one's value of the outcome) of OEs among breast cancer survivors.

METHODS

Stage IA to IIB breast cancer survivors who were 1 to 5 years posttreatment completed OE questionnaires. Descriptive statistics were used to examine OE accessibility and importance.

RESULTS

The sample (n = 73) was 91.8% white, 5.4% African American, 1.4% Asian or Pacific Islander, and 1.4% other. The mean age was 58 (SD, 9.6) years. Outcome expectation importance mean was 6.1 (SD, 0.4), indicating OEs are overall "important." Accessibility mean was 4.8 (SD, 0.6), demonstrating breast cancer survivors think about exercise OEs "sometimes/50% of the time." There was a moderate (rs = 0.48) relationship between OE importance and accessibility, indicating they are related, yet distinct.

CONCLUSIONS

Outcome expectations are generally important to breast cancer survivors. Thus, OEs may motivate increased exercise among this population.

IMPLICATIONS FOR PRACTICE

Oncology providers should encourage patients to think about OEs more often to increase exercise. Compared with traditional approaches of informing patients about exercise benefits, this may be a more comprehensive and powerful approach to motivate exercise among breast cancer survivors.

A randomized phase II trial of MOVING ON: An intervention to increase exercise outcome expectations among breast cancer survivors

OBJECTIVE

The objective of the study is to test theoretical intervention fidelity and feasibility of MOVING ON, a self-directed, home-based, randomized controlled trial to increase exercise outcome expectations (OEs) (what one expects to obtain or avoid as a result of a behavior or lack thereof), among breast cancer survivors.

METHOD

Stage Ia to IIb survivors (n = 60) were given the MOVING ON intervention or control booklet. Data were collected through online surveys and an accelerometer at baseline, 4, 8, and 12 weeks postintervention. Fidelity was measured by questions assessing participant perceptions of MOVING ON (score ≥2) and direction of intervention effects. Feasibility was measured by recruitment rate (target of 60 participants in 6 months), retention (total attrition <17%), and acquisition of accelerometer data (% ≥subjective exercise data obtained). Analyses consisted of descriptive statistics, mixed models, and content analysis.

RESULTS

Fidelity met a priori criteria (mean = 3.31, SD = 0.87). Outcome expectations increased 0.01 points, and weekly steps increased by 970 every 4 weeks in the intervention arm compared to the control arm. All effect sizes were small, ranging from 0.01 to 0.09. Target enrollment, achieved in 17 weeks, met a priori feasibility criteria. Retention (66%) and accelerometer data acquisition (60%) (compared to 73% of subjective exercise data) did not.

CONCLUSION

MOVING ON influenced OEs as intended and was well received by participants. A fully powered study, of this low-cost, easy-to-implement intervention, is warranted. Intervention and measurement strategies used in MOVING ON can be incorporated in any study targeting OEs as a mediator of exercise or collecting exercise data with an accelerometer.

Wearable Activity Technology And Action-Planning (WATAAP) to promote physical activity in cancer survivors: Randomised controlled trial protocol

Background/Objective: Colorectal and gynecologic cancer survivors are at cardiovascular risk due to comorbidities and sedentary behaviour, warranting a feasible intervention to increase physical activity. The Health Action Process Approach (HAPA) is a promising theoretical framework for health behaviour change, and wearable physical activity trackers offer a novel means of self-monitoring physical activity for cancer survivors. Method: Sixty-eight survivors of colorectal and gynecologic cancer will be randomised into 12-week intervention and control groups. Intervention group participants will receive: a Fitbit Alta™ to monitor physical activity, HAPA-based group sessions, booklet, and support phone-call. Participants in the control group will only receive the HAPA-based booklet. Physical activity (using accelerometers), blood pressure, BMI, and HAPA constructs will be assessed at baseline, 12-weeks (post-intervention) and 24-weeks (follow-up). Data analysis will use the Group x Time interaction from a General Linear Mixed Model analysis. Conclusions: Physical activity interventions that are acceptable and have robust theoretical underpinnings show promise for improving the health of cancer survivors.

Exploration of Exercise Outcome Expectations Among Breast Cancer Survivors

BACKGROUND

Exercise is associated with decreased recurrence risk and improved survival and quality of life for breast cancer survivors. However, only an estimated 17% to 37% of survivors adhere to the American Cancer Society exercise guidelines. A critical first step to increase exercise among survivors is to understand how they believe exercise will affect them.

OBJECTIVE

The aim of this study is to explore common exercise outcome expectations among 20 female survivors of stage IA to IIB breast cancer who completed adjuvant treatment and an exercise intervention.

METHODS

A mixed-method descriptive study consisting of semistructured telephone interviews assessed exercise outcome expectations and how the experience of cancer and its treatment influenced the expected outcomes of exercise. The qualitative data were analyzed using a summative content analysis procedure; means were calculated for each item of the exercise outcome questionnaire. The qualitative and quantitative data were compared and contrasted.

RESULTS

The sample was 70% white and 30% African American, with a mean (SD) age of 62 (8.5) years, and mean (SD) time since treatment completion of 4.2 (1.3) years. Three themes emerged from the interviews: (1) prevalence of common expectations, (2) pervasive impact of fatigue, and (3) a brighter future. Overall, findings revealed that breast cancer survivors have low levels of agreement that exercise may mitigate late and long-term cancer and treatment effects.

CONCLUSIONS

In general, breast cancer survivors (even those who are motivated to exercise) do not hold strong beliefs that exercise will decrease late and long-term treatment effects.

IMPLICATIONS FOR PRACTICE

Clinicians can educate survivors about exercise benefits.

Physical activity levels and counseling by health care providers in cancer survivors

Physical activity guidelines for cancer survivors issued by the American Cancer Society and the American College of Sports Medicine emphasize the essential role of a health care provider (HCP) in counseling cancer survivors to achieve healthier lifestyles. However, research has not established whether HCP's recommendations to engage in physical activity are associated with increased physical activity levels of cancer survivors. The study examines this potential association using the 2005 and 2010 National Health Interview Survey data. The final analytic sample consisted of 3320 cancer survivors and 38,955 adults without cancer who reported seeing or talking to a HCP and if or not they had received a physical activity recommendation in the prior year. Consistent with the aforementioned guidelines, physical activity levels were categorized as inactive, insufficiently active, and sufficiently active (i.e., meeting guidelines). Average adjusted predictions and marginal effects were estimated from generalized ordered logit models. Multivariable regressions controlled for socio-demographic and health-related characteristics and survey year. On average, receipt of a HCP's physical activity recommendation was associated with a lower adjusted prevalence of inactivity by 8.3 percentage points and a higher adjusted prevalence of insufficient and sufficient activity by 4.6 and 3.7 percentage points, respectively, regardless of cancer diagnosis (P's<0.05). A HCP's recommendation is associated with higher levels of leisure-time aerobic physical activity among cancer survivors and adults without cancer. The communication between cancer survivors and their HCPs may act as a 'window' of opportunity to increase physical activity levels among the U.S. cancer survivors.

Physical Activity Correlates, Barriers, and Preferences for Women With Gynecological Cancer

Objective

Physical activity is associated with improved health outcomes for people with cancer. We aimed to identify physical activity correlates, barriers, and preferences among women with gynecological cancer.

Methods and Materials

A self-administered questionnaire was completed by 101 women diagnosed with gynecological cancer (mostly ovarian cancer [59%] and endometrial cancer [23%]) within the previous 2 years, at 2 major hospitals in Sydney, Australia. Physical activity was measured for the past 7 days. Thirteen potential barriers were scored on a 5-point scale. Associations with physical activity were assessed using Spearman correlations (rs) and multivariate logistic regression.

Results

Factors associated with being sufficiently active (≥150 min/wk physical activity) were being in the follow-up phase of the cancer trajectory (odds ratio [OR], 7.0; 95% confidence interval [CI], 1.5 to 33.4 compared with other phases) and prediagnosis physical activity (OR, 4.6; 95% CI, 1.1 to 18.5 for the highest vs lowest tertile). The most common barriers were “too tired” and “not well enough,” and both were associated with lower physical activity (rs, −0.20 and −0.22, respectively). The odds of having disease-specific barriers was higher for women with ovarian cancer (OR, 4.6; P = 0.04) and women receiving chemotherapy or radiation therapy (OR, 8.3; P = 0.008). “Lack of interest” (rs, −0.26) and “never been active” (rs, −0.23) were also inversely correlated with physical activity, although less common. Forty-three percent of women indicated that they were extremely or very interested to have a one-to-one session with an exercise physiologist. Participants’ preferred time of starting a physical activity program was 3 to 6 months after treatment (26%) or during treatment (23%). Walking was the preferred type of physical activity.

Conclusions

Strategies to increase physical activity among women with gynecological cancer should include a focus on reducing disease-specific barriers and target women who have done little physical activity in the past or who are in the treatment phases of care.

Moderate-intensity exercise reduces fatigue and improves mobility in cancer survivors: a systematic review and meta-regression

QUESTION

Is there a dose-response effect of exercise on inflammation, fatigue and activity in cancer survivors?

DESIGN

Systematic review with meta-regression analysis of randomised trials.

PARTICIPANTS

Adults diagnosed with cancer, regardless of specific diagnosis or treatment.

INTERVENTION

Exercise interventions including aerobic and/or resistance as a key component.

OUTCOME MEASURES

The primary outcome measures were markers of inflammation (including C-reactive protein and interleukins) and various measures of fatigue. The secondary outcomes were: measures of activity, as defined by the World Health Organization's International Classification of Functioning, Disability and Health, including activities of daily living and measures of functional mobility (eg, 6-minute walk test, timed sit-to-stand and stair-climb tests). Risk of bias was evaluated using the PEDro scale, and overall quality of evidence was assessed using the Grades of Research, Assessment, Development and Evaluation (GRADE) approach.

RESULTS

Forty-two trials involving 3816 participants were included. There was very low-quality to moderate-quality evidence that exercise results in significant reductions in fatigue (SMD 0.32, 95% CI 0.13 to 0.52) and increased walking endurance (SMD 0.77, 95% CI 0.26 to 1.28). A significant negative association was found between aerobic exercise intensity and fatigue reduction. A peak effect was found for moderate-intensity aerobic exercise for improving walking endurance. No dose-response relationship was found between exercise and markers of inflammation or exercise duration and outcomes. Rates of adherence were typically high and few adverse events were reported.

CONCLUSIONS

Exercise is safe, reduces fatigue and increases endurance in cancer survivors. The results support the recommendation of prescribing moderate-intensity aerobic exercise to reduce fatigue and improve activity in people with cancer.

REVIEW REGISTRATION

PROSPERO CRD42015019164.

Risk Factors, Preventive Practices, and Health Care Among Breast Cancer Survivors, United States, 2010

INTRODUCTION

We compared behavioral risk factors and preventive measures among female breast cancer survivors, female survivors of other types of cancers, and women without a history of cancer. Survivorship health care indicators for the 2 groups of cancer survivors were compared.

METHODS

Using data from the 2010 Behavioral Risk Factor Surveillance System, we calculated the proportion of women with risk factors and their engagement in preventive practices, stratified by cancer status (cancer survivors or women with no history of cancer), and compared the proportions after adjusting for sociodemographic characteristics.

RESULTS

A significantly higher proportion of breast cancer survivors had mammography in the previous year (79.5%; 95% confidence interval [CI], 76.0%-83.0%) than did other cancer survivors (68.1%; 95% CI, 65.6%-70.7%) or women with no history of cancer (66.4%; 95% CI, 65.5%-67.3%). Breast cancer survivors were also more likely to have had a Papanicolaou (Pap) test within the previous 3 years than women with no history of cancer (89.4%; 95% CI, 85.9%-93.0 vs 85.1%; 95% CI, 84.4%-85.8%) and a colonoscopy within the previous 10 years (75.4%; 95% CI, 71.7%-79.0%) than women with no history of cancer (60.0%; 95% CI, 59.0%-61.0%). Current smoking was significantly lower among survivors of breast cancer (10.3%; 95% CI, 7.4%-13.2%) than other cancer survivors (20.8%; 95% CI, 18.4%-23.3%) and women with no history of cancer (18.3%; 95% CI, 17.5%-19.1%). After adjusting for sociodemographic characteristics, we found that breast cancer survivors were significantly more likely to have had mammography, a Pap test, and colonoscopy, and less likely to be current smokers.

CONCLUSION

Breast cancer survivors are more likely to engage in cancer screening and less likely to be current smokers than female survivors of other types of cancer or women with no history of cancer.

Physical activity-related beliefs and discrepancies between beliefs and physical activity behavior for various chronic diseases

BACKGROUND

We have a limited understanding of factors that may explain the discrepancy between believing physical activity (PA) may help prevent various chronic diseases and actually engaging sufficient PA to prevent such diseases. Similarly, few studies have examined potential discrepancies between engaging in PA to help prevent chronic disease and actual compliance with PA recommendations. Lastly, our understanding of whether young adults believe that evidence-based PA strategies are indeed effective is limited. We address these gaps in the literature.

METHODS

231 undergraduate college students completed a survey assessing all study parameters.

RESULTS

Main findings include: (a) Most students believed that PA could help to prevent various cardiovascular chronic diseases, with less of an understanding of the beneficial effects of PA on cancer and neurological conditions; (b) most students believed that PA evidenced-based strategies would help to facilitate PA; and (c) participants with a higher BMI were more likely to have a discrepancy between their belief and PA.

CONCLUSIONS

Educational messages to college students with a higher BMI may wish to focus less on the benefits of PA (with the exception of Alzheimer's and Parkinson's diseases), but more on the provision and utilization of PA-related evidenced-based strategies.

Breast Cancer Survivorship Care: Targeting a Colorectal Cancer Education Intervention

Breast cancer survivors are at risk of developing a second primary cancer. Colorectal cancer (CRC) is one of the leading second primary cancers, and it is often preventable. We developed a multi-component educational tool to inform and encourage women breast cancer survivors to engage in CRC screening. To assess the strengths and weakness of the tool and to improve the relevancy to the target audience, we convened four focus groups of women breast cancer survivors in Missouri. We also assessed the potential impact of the tool on the knowledge, attitudes, and beliefs regarding CRC and collected information on the barriers to CRC screening through pre- and post-focus groups' questionnaires. A total of 43 women breast cancer survivors participated and provided very valuable suggestions on design and content to update the tool. Through the process and comparing pre- and post-focus group assessments, a significantly higher proportion of breast cancer survivors strongly agreed or agreed that CRC is preventable (78.6% vs. 96.9%, p = 0.02) and became aware that they were at a slightly increased risk for CRC (18.6% vs. 51.7%, p = 0.003). The most cited barrier was the complexity of preparation for colonoscopy.

Physical activity is the best buy in medicine, but perhaps for less obvious reasons

This commentary's premise addresses why physical activity may be considered the 'best buy' in medicine, with a focus on the identification of a novel mechanism.

Exercise preferences, levels and quality of life in lung cancer survivors

PURPOSE

Lung cancer poses multiple challenges to adopting an exercise (EX) program, and the ideal timing of an EX program to improve quality of life (QoL) is unknown. This study explored the EX counselling and programming preferences of lung cancer survivors and examined the association of EX before diagnosis, during treatment and after treatment on QoL.

METHODS

Cross-sectional, retrospective survey design in a sample of lung cancer survivors. EX preferences were compared between patients who had received radical chest radiation or lung surgery versus those who had not. EX was measured by self-report using the Godin Leisure Time Exercise Questionnaire (GLTEQ). Separate linear regression models, controlling for significant covariates, examined the association of EX at each time point with scores on QoL measures and subscales.

RESULTS

Participants (N = 66, M age 66.4 ± 9.1) were between 4 months and 11.5 years after lung cancer diagnosis (M = 31.7 ± 22.9 months). Patients who had lung surgery were more likely to prefer to start an EX program during adjuvant treatment than those who did not have surgery (t(33) = 2.43, p = .025). Compared to prediagnosis EX (M = 36.7 ± 56.0 MET h/week), EX levels declined significantly during (M = 12.4 ± 25.0 MET h/week) and after (M = 12.3 ± 17.4 MET h/week) treatment (p < .05). After controlling for disease stage and income, regression models were not significant, but EX after treatment was a significant individual predictor of fatigue (β = .049, p = .006) and QoL measured by the Chronic Respiratory Disease Questionnaire (β = .163, p = .025).

CONCLUSIONS

Lung cancer patient preferences indicate that EX program timing should take into account whether the patient has undergone surgery. Lung cancer survivors' EX levels declined after diagnosis and engaging in EX after treatment may improve fatigue and QoL.

Accelerometer-assessed physical activity and sedentary time among colon cancer survivors: associations with psychological health outcomes

PURPOSE

The purpose of this study was to determine associations of objectively assessed moderate-to-vigorous intensity physical activity (MVPA) and sedentary time with psychological health outcomes including depression symptoms, anxiety symptoms, and overall satisfaction with life in colon cancer survivors.

METHODS

Colon cancer survivors (N = 180) from Alberta, Canada (n = 91), and Western Australia (n = 89) completed a mailed survey that assessed depression symptom severity, state anxiety, and satisfaction with life (SWL). Sedentary time and MVPA were assessed using the Actigraph(®) GT3X+ accelerometer (60-s epochs) via a 7-day monitoring protocol. MVPA and sedentary time were corrected for wear time and then examined as quartiles (Q). Multivariate analysis of variance was used to examine associations of MVPA and sedentary time with psychological health.

RESULTS

There was a significant association between psychological health outcomes and objectively assessed MVPA [Wilks' λ = 0.886, F(3382.2) = 2.156, p = 0.024] that suggested a small and significant association between MVPA and SWL (p = 0.032). A significant multivariate analysis of variance (MANOVA) [Wilks' λ = 0.945, F(3159) = 3.1, p = 0.028] suggested participants meeting guidelines reported significantly fewer anxiety symptoms (M(diff) = -1.23, p = 0.027) and higher perceptions of SWL (M(diff) = 3.0, p = 0.008). No significant associations emerged for sedentary time [Wilks' λ = 0.956, F(9382.3) = 0.788, p = 0.628].

CONCLUSIONS

Contrary to previously published research using self-reports, objectively assessed MVPA and sedentary time were not associated with depression symptoms. Objectively assessed MVPA was associated with SWL and anxiety outcomes in colon cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Colon cancer survivors should continue to engage in regular and sustained MVPA for the accrual of psychological health benefits.

Physical activity and cancer survivorship

There has been an increase in the cancer survivor population in the United States over the past several decades primarily due to improvements in early detection of first malignancies and effective treatment modalities. A wealth of evidence has demonstrated that regular physical activity is associated with a lower risk of death, all-cause mortality, cancer recurrence, and several chronic diseases, including type 2 diabetes and cardiovascular disease, common comorbid conditions in people who have survived cancer. Physical activity also is a central component of weight management.

METHODS

This review summarizes the current physical activity recommendations and the evidence linking physical activity to improvements in weight management, physiological effects, and psychological health outcomes for cancer survivors.

RESULTS

The available literature suggests physical activity is safe and is positively associated with weight management, cardiorespiratory fitness, muscular strength and endurance, quality of life, fatigue, and other psychosocial factors in cancer survivors. Yet relationships related to specific cancer diagnoses, treatments, and underlying cardiometabolic mechanisms associated with survival have not been thoroughly examined in randomized controlled trials. Furthermore, factors that influence adherence to physical activity behaviors must be identified to develop effective exercise programs. The use of objective measures of physical activity and the standardization of reporting outcome measures within intervention trials are needed to complement this effort.

CONCLUSIONS

Healthcare providers should consider individual differences among cancer survivors and tailor physical activity programs to meet the individual needs of the patient to assist in the adoption and maintenance of a physically active lifestyle.