1
|
Wang CP, Knowlton H, Kee D, Vang S, Mazumdar M, Agarwal P. A Nationwide Comparison of the Provision of Ambulatory Care Services to Those Living With and Without Cancer, 2016-2018. J Gen Intern Med 2024; 39:1777-1780. [PMID: 38498290 DOI: 10.1007/s11606-024-08691-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/20/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Christina P Wang
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Dustin Kee
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Suzanne Vang
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Madhu Mazumdar
- Tisch Cancer Institute, Institute for Healthcare Delivery Science and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1425 @ East 98th Street L2-37, 2nd Floor, New York, NY, USA
| | - Parul Agarwal
- Tisch Cancer Institute, Institute for Healthcare Delivery Science and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1425 @ East 98th Street L2-37, 2nd Floor, New York, NY, USA.
| |
Collapse
|
2
|
Bronsema I, van Lonkhuijzen L, Scholten P, Laan J, Westerveld H, Stalpers L. Improving referral rates for smoking cessation: A multifaceted intervention aimed at radiation oncologists. Tech Innov Patient Support Radiat Oncol 2024; 29:100225. [PMID: 38173986 PMCID: PMC10761906 DOI: 10.1016/j.tipsro.2023.100225] [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: 08/11/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024] Open
Abstract
Objective Continuation of smoking after a cancer diagnosis increases the burdensome side effects from cancer treatment, and decreases the chances of cure. Smoking cessation may improve oncological outcomes in cancer patients. This study aims to evaluate if radiation oncologists can be motivated by a smoking cessation awareness intervention to discuss smoking status more frequently and increase the referral rate for smoking cessation-support.Study design and Setting:A multifaceted approach was used to improve awareness: First, current practice was evaluated by a retrospective chart review of 282 patients referred for radiotherapy to ascertain smoking status, discussion of smoking cessation support and referral rates. Secondly, radiation oncologists were interviewed about their motives and barriers to discuss smoking status and smoking cessation support. The results were fed back in a teaching lecture to the doctors involved. Finally, the effect of this smoking cessation awareness intervention was prospectively evaluated in 100 patients. Results After the smoking cessation awareness intervention, smoking cessation was more frequently discussed compared to baseline (77% (10/13)) and 39.5% (17/43) respectively. The referral rate for smoking cessation increased from 2.3% (1/43) to 69.2% (9/13). Conclusion Without an active smoking prevention awareness policy, referral for smoking cessation support for cancer patients by radiation oncologists is low. A relatively short and simple smoking awareness intervention for radiation oncologist may result in a more frequent discussion with patients about smoking cessation and an even larger increase in referrals for smoking cessation support.
Collapse
Affiliation(s)
- Iris Bronsema
- Department of Radiotherapy, Amsterdam UMC, University of Amsterdam, Location AMCMeibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Luc van Lonkhuijzen
- Department of Gynaecology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Peter Scholten
- Department of Radiotherapy, Amsterdam UMC, University of Amsterdam, Location AMCMeibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Department of Gynaecology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Janna Laan
- Department of Radiotherapy, Amsterdam UMC, University of Amsterdam, Location AMCMeibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Henrike Westerveld
- Department of Radiotherapy, Amsterdam UMC, University of Amsterdam, Location AMCMeibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Lukas Stalpers
- Department of Radiotherapy, Amsterdam UMC, University of Amsterdam, Location AMCMeibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| |
Collapse
|
3
|
Kesireddy M, Tenner L. Colon Cancer Survivorship in Patients Who Have Received Adjuvant Chemotherapy. Clin Colorectal Cancer 2023; 22:361-374. [PMID: 37574392 DOI: 10.1016/j.clcc.2023.07.001] [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: 06/11/2023] [Accepted: 07/07/2023] [Indexed: 08/15/2023]
Abstract
The number of colon cancer survivors in the United States is increasing due to improved early detection, better treatments that extend survival, and the growing aging population who are at high risk for cancer. Following initial active treatment, colon cancer survivors experience a wide range of long-term physical, psychological, and socio-economic effects that impact their overall well-being. Healthcare providers caring for survivors need to prioritize not only monitoring for cancer recurrence but also optimizing their overall health through addressing these long-term effects; managing their comorbidities; promoting healthy behaviors (like exercise, nutrition, and weight loss); and screening for a second primary cancer depending on their risk. Personalized survivorship care plans should be formulated clearly outlining the roles of various healthcare providers involved in their care. Our review article focuses on these various aspects of colon cancer survivorship, including surveillance for cancer recurrence specific to those who received adjuvant chemotherapy with curative intent.
Collapse
Affiliation(s)
- Meghana Kesireddy
- Division of Hematology-Oncology, University of Nebraska Medical Center- Fred & Pamela Buffett Cancer Center, Omaha, NE
| | - Laura Tenner
- Division of Hematology-Oncology, University of Nebraska Medical Center- Fred & Pamela Buffett Cancer Center, Omaha, NE.
| |
Collapse
|
4
|
Ueland K, Sanchez SC, Rillamas-Sun E, Shen H, Schattenkerk L, Garcia G, VanDoren M, Myers SA, Santiago-Torres M, Di C, Dey N, Guthrie KA, Yung R, Davidson NE, Greenlee H. A digital health intervention to improve nutrition and physical activity in breast cancer survivors: Rationale and design of the Cook and Move for Your Life pilot and feasibility randomized controlled trial. Contemp Clin Trials 2022; 123:106993. [PMID: 36336249 DOI: 10.1016/j.cct.2022.106993] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/24/2022] [Accepted: 10/31/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The design of a randomized pilot trial evaluating the feasibility of two doses of a digital health intervention promoting changes in nutrition and physical activity in breast cancer (BC) survivors is described. METHODS Eligible women were adults with history of early-stage breast cancer and > 60 days post-treatment, consumed <5 servings/day of fruits/vegetables and/or engaged in <150 min/week of aerobic moderate-to-vigorous physical activity, and had internet access. Participants were randomized to 6 months of either a "low" (1 session) or "high" (12 sessions) dose digital health intervention. Zoom-delivered sessions focused on improving diet and physical activity through didactic and experiential classes delivered by a registered dietitian, chef, exercise physiologist, and culinary educator. All study participants received weekly motivational texts, a Fitbit, and study website access. Diet, accelerometry, anthropometric, psychosocial, and biospecimen data were collected remotely at baseline and six months. Primary outcome was feasibility measured via accrual rate, adherence, retention, and acceptability. RESULTS Recruitment began in December 2019, was suspended in March 2020 due to the COVID-19 pandemic, resumed September 2020, and concluded in January 2021. Women were identified from the local BC registry and flyers posted in the oncology clinic. Of 929 women recruited, 321 completed the screening assessment, and of these, 138 were eligible. A total of 74 women were enrolled and randomized to the study. CONCLUSION BC survivors were successfully enrolled in a digital health nutrition and physical activity intervention. If feasible, this intervention will be tested in larger and more diverse populations of cancer survivors. TRIAL REGISTRATION ClinicalTrials.govNCT04200482.
Collapse
Affiliation(s)
- Katherine Ueland
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N., Seattle, WA 98109, USA.
| | - Sofia Cobos Sanchez
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N., Seattle, WA 98109, USA.
| | - Eileen Rillamas-Sun
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N., Seattle, WA 98109, USA.
| | - Hanjie Shen
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N., Seattle, WA 98109, USA.
| | - Liza Schattenkerk
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N., Seattle, WA 98109, USA
| | - Gino Garcia
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N., Seattle, WA 98109, USA
| | - Matthew VanDoren
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N., Seattle, WA 98109, USA.
| | - Samantha A Myers
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N., Seattle, WA 98109, USA; Rehabilitation Sciences, The University of British Columbia, 212-2177 Westbrook Mall, Vancouver V6T 1Z3, Canada.
| | - Margarita Santiago-Torres
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N., Seattle, WA 98109, USA.
| | - Chongzhi Di
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N., Seattle, WA 98109, USA.
| | - Neelendu Dey
- Clinical Research Division, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N., Seattle, WA 98109, USA; Division of Gastroenterology, Department of Medicine, University of Washington, 1959 NE Pacific St, Box 356424, Seattle, WA 98195-6424, USA.
| | - Katherine A Guthrie
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N., Seattle, WA 98109, USA.
| | - Rachel Yung
- Division of Medical Oncology, Department of Medicine, Seattle Cancer Care Alliance, 825 Eastlake Ave. E, Seattle, WA 98109-1023, USA.
| | - Nancy E Davidson
- Clinical Research Division, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N., Seattle, WA 98109, USA; Division of Medical Oncology, Department of Medicine, Seattle Cancer Care Alliance, 825 Eastlake Ave. E, Seattle, WA 98109-1023, USA.
| | - Heather Greenlee
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N., Seattle, WA 98109, USA; Clinical Research Division, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N., Seattle, WA 98109, USA; Division of Medical Oncology, Department of Medicine, Seattle Cancer Care Alliance, 825 Eastlake Ave. E, Seattle, WA 98109-1023, USA.
| |
Collapse
|
5
|
Koo CY, Zheng H, Tan LL, Foo LL, Hausenloy DJ, Chng WJ, Lee SC, Richards AM, Ling LH, Lim SL, Lee CH, Chan MY. Prior Cancer Is Associated with Lower Atherosclerotic Cardiovascular Disease Risk at First Acute Myocardial Infarction. Biomedicines 2022; 10:biomedicines10112681. [PMID: 36359201 PMCID: PMC9687197 DOI: 10.3390/biomedicines10112681] [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: 08/27/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Patients with cancer are at increased risk of acute myocardial infarction (AMI). It is unclear if the Atherosclerotic Cardiovascular Disease (ASCVD) risk score at incident AMI is reflective of this higher risk in patients with prior cancer than those without. Methods: We linked nationwide AMI and cancer registries from 2008 to 2019. A total of 18,200 eligible patients with ASCVD risk score calculated at incident AMI were identified (1086 prior cancer; 17,114 no cancer). Results: At incident AMI, age-standardized mean ASCVD risk was lower in the prior cancer group (18.6%) than no cancer group (20.9%) (p < 0.001). Prior to incident AMI, smoking, hypertension, hyperlipidemia and diabetes mellitus were better controlled in the prior cancer group. However post-AMI, prior cancer was associated with lower guideline-directed medical therapy usage and higher all-cause mortality (adjusted hazard ratio 1.85, 95% confidence interval 1.66−2.07). Conclusions: AMI occurred despite better control of cardiovascular risk factors and lower age-standardized estimated mean 10-year ASCVD risk among patients with prior cancer than no cancer. Prior cancer was associated with lower guideline-directed medical therapy post-AMI and higher mortality.
Collapse
Affiliation(s)
- Chieh Yang Koo
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
- Correspondence: ; Tel.: +65-6908-2222
| | - Huili Zheng
- National Registry of Diseases Office, Health Promotion Board, Singapore 168937, Singapore
| | - Li Ling Tan
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
| | - Ling-Li Foo
- National Registry of Diseases Office, Health Promotion Board, Singapore 168937, Singapore
| | - Derek J. Hausenloy
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore 169609, Singapore
- The Hatter Cardiovascular Institute, University College London, London WC1E6BT, UK
- Cardiovascular Research Centre, College of Medical and Health Sciences, Asia University, Taichung 41354, Taiwan
| | - Wee-Joo Chng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, Singapore 119074, Singapore
| | - Soo Chin Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, Singapore 119074, Singapore
| | - Arthur Mark Richards
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Christchurch Heart Institute, University of Otago, Dunedin 9016, New Zealand
| | - Lieng-Hsi Ling
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Shir Lynn Lim
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Mark Y. Chan
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| |
Collapse
|
6
|
Jung MH, Yi SW, An SJ, Yi JJ, Ihm SH, Han S, Ryu KH, Jung HO, Youn HJ. Associations between the triglyceride-glucose index and cardiovascular disease in over 150,000 cancer survivors: a population-based cohort study. Cardiovasc Diabetol 2022; 21:52. [PMID: 35429972 PMCID: PMC9013459 DOI: 10.1186/s12933-022-01490-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/04/2022] [Indexed: 01/04/2023] Open
Abstract
Background The prevention of subsequent cardiovascular disease (CVD) is an essential part of cancer survivorship care. We conducted the present study to investigate the association between the TyG index (a surrogate marker of insulin resistance) and the risk of cardiovascular disease (CVD) events in cancer survivors. Methods Adult cancer patients, who underwent routine health examinations during 2009–2010 and were survived for more than 5 years as of January 1, 2011, were followed for hospitalization of CVD (either ischemic heart disease, stroke, or heart failure) until December 2020. Cox model was used to calculate hazard ratios associated with baseline TyG index (loge [fasting triglyceride (mg) × fasting glucose (mg)/2]) for the CVD hospitalization. Results A total of 155,167 cancer survivors (mean age 59.9 ± 12.0 years, female 59.1%) were included in this study. A graded positive association was observed between TyG and CVD hospitalization. An 8% elevated risk for CVD hospitalization was observed for a TyG index of 8-8.4 (aHR 1.08 [95% CI 1.01–1.14]); 10% elevated risk for a TyG index of 8.5–8.9 (aHR 1.10 [95% CI 1.03–1.17]); 23% elevated risk for a TyG index of 9.0-9.4 (aHR 1.23 [95% CI 1.15–1.31]); 34% elevated risk for a TyG index of 9.5–9.9 (aHR 1.34 [95% CI 1.23–1.47]); and 55% elevated risk for a TyG index ≥ 10 compared to the reference group (TyG index < 8). Per 1-unit increase in the TyG index, a 16% increase in CVD hospitalization and a 45% increase in acute myocardial infarction hospitalization were demonstrated. Graded positive associations were evident for atherosclerotic CVD subtypes, such as ischemic heart disease, acute myocardial infarction, and ischemic stroke, but not for hemorrhagic stroke or heart failure. Conclusions The TyG index may serve as a simple surrogate marker for the risk stratification of future CVD events, particularly atherosclerotic subtypes, in cancer survivors. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01490-z.
Collapse
|
7
|
Duangchan C, Steffen A, Matthews AK. Thai oncology nurses' perspectives toward survivorship care plan components and implementation for colorectal cancer survivors. Support Care Cancer 2022; 30:4089-4098. [PMID: 35066665 DOI: 10.1007/s00520-021-06766-w] [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: 06/11/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe oncology nurses' perspectives regarding survivorship care plan (SCP) components and implementation for colorectal cancer (CRC) survivors in Thailand. METHODS A cross-sectional, descriptive online study was conducted between October and November 2020. Thai oncology nurses were recruited using Facebook and the Line application. Study participants (n = 160) rated the usefulness of four standard SCP components (treatment summaries, surveillance, late/long-term effects, and health promotion and psychosocial needs; n = 23 items) and gave input on the implementation of SCPs in clinical practice (n = 11 items). Data were analyzed using descriptive statistics. RESULTS Most oncology nurses supported providing CRC survivors with SCPs (93.2%) and felt that SCPs were an important part of their practice (93.7%). Nurses rated all four SCP components as "very useful," including treatment summaries (76.4%), surveillance (81.9%), late/long-term effects (85.7%), and health behavior and psychosocial concerns (80.2%). In terms of implementation, most nurses indicated that oncologists should prepare (84.4%) and provide SCPs (95%), but 61.9% and 69.4% of nurses, respectively, also believed that they should perform these tasks. In addition, most nurses indicated that they should play a significant role in the ongoing management of CRC survivors (95.7%) and that evidence-based surveillance guidelines are needed (96.2%). CONCLUSION Oncology nurses believed that the four SCP components were helpful to the long-term management of CRC survivors, supported SCP provision, and expressed their perceived responsibilities for preparing and delivering SCPs. The findings suggested opportunities for oncology nurses to play a significant role in developing and implementing SCPs. However, additional efforts are needed to expand nurses' roles in survivorship care and establish practice guidelines that will facilitate integration of SCPs into nursing practice.
Collapse
Affiliation(s)
- Cherdsak Duangchan
- University of Illinois at Chicago College of Nursing, Chicago, IL, USA. .,Faculty of Nursing, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand.
| | - Alana Steffen
- University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Alicia K Matthews
- University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| |
Collapse
|
8
|
Fu JB. The Past, Present, and Future of American Cancer Rehabilitation. Phys Ther Res 2022; 24:187-194. [PMID: 35036251 DOI: 10.1298/ptr.r0016] [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: 07/29/2021] [Accepted: 08/10/2021] [Indexed: 11/23/2022]
Abstract
Cancer rehabilitation in the United States has gone from a small obscure rehabilitation subspecialty to an area of intense interest. American cancer rehab's recent growth can be attributed to the ever increasing number of cancer survivors. The future of cancer rehabilitation may be accelerated by the concept of exercise as cancer medicine.
Collapse
Affiliation(s)
- Jack B Fu
- University of Texas MD Anderson Cancer Center, USA
| |
Collapse
|
9
|
Watson G, Coyne Z, Houlihan E, Leonard G. Exercise oncology: an emerging discipline in the cancer care continuum. Postgrad Med 2021; 134:26-36. [PMID: 34854802 DOI: 10.1080/00325481.2021.2009683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Exercise is an essential component of healthy living and well-being. While there is a global acceptance of the benefits of exercise for the general population, there exists hesitancy and confusion among health-care professionals, particularly oncologists, as to whether these benefits translate to cancer patients. Patient referrals to accessible, structured exercise programs in this setting are often overlooked by physicians when formulating a cancer management plan. There is however increasing awareness and acceptance of cancer survivorship as a part of the cancer care continuum, identifying multiple factors that contribute to well-being beyond just cancer outcomes. Efforts to optimize cancer survivorship have stimulated further academic interest in the benefits of healthy living and particularly exercise oncology. There is now compelling evidence that exercise, which includes daily activities such as walking, as well as structured programs, improves multiple-cancer outcomes such as fatigue, quality of life and likely survival, and warrants consideration in the multidisciplinary care of cancer patients. International guidelines have been established that recommend counseling cancer patients with regard to healthy lifestyle changes including exercise. However, there still remains a reluctance from oncology physicians to prescribe exercise for these patients, largely due to uncertainty with regard to their patients' ability to tolerate such an intervention, coupled with insufficient understanding of the potential benefits of these programs. There also exist patient barriers and attitudes that must be overcome. Exercise strategies and bespoke programs that are tailored to the unique abilities and goals of the patients will enhance participation. To move the field forward and integrate exercise oncology into standard practice, it is imperative to raise awareness of the benefits of exercise to cancer patients and their health-care providers. This will facilitate the prescription of exercise as part of the multimodal treatment plan with the ultimate aim of promoting an active lifestyle to optimize patient care and well-being.
Collapse
Affiliation(s)
- Ga Watson
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
| | - Zl Coyne
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
| | - E Houlihan
- Department of Physiotherapy, Cancer Care West, Galway, Ireland
| | - Gd Leonard
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
| |
Collapse
|
10
|
Santiago-Torres M, Contento I, Koch P, Tsai WY, Brickman AM, Gaffney AO, Thomson CA, Crane TE, Dominguez N, Sepulveda J, Marín-Chollom AM, Paul R, Shi Z, Ulanday KT, Hale C, Hershman D, Greenlee H. ¡Mi Vida Saludable! A randomized, controlled, 2 × 2 factorial trial of a diet and physical activity intervention among Latina breast cancer survivors: Study design and methods. Contemp Clin Trials 2021; 110:106524. [PMID: 34365016 PMCID: PMC8595705 DOI: 10.1016/j.cct.2021.106524] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 07/21/2021] [Accepted: 08/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Most Latina breast cancer survivors do not meet diet and physical activity (PA) guidelines for cancer survivors and effective lifestyle interventions to adopt and maintain these recommendations are limited, especially among underserved populations. Here we describe the design, methods and enrollment of a 2 × 2 factorial-designed trial testing the separate effects of the ¡Mi Vida Saludable! (My Healthy Life!) intervention program on changes in diet and PA behaviors among Latina breast cancer survivors. METHODS Latinas with a history of stage 0-III breast cancer, no evidence of recurrent/metastatic disease, and > 90 days post-treatment were primarily identified via cancer registries and physician referral. Participants were randomized to four arms: 1) 4 weeks of in-person group sessions plus 11 months of eHealth communication, 2) in-person group sessions alone, 3) eHealth alone, or 4) control. All participants received a Fitbit to self-monitor PA. Assessments at baseline, 6 and 12 months include diet, PA, anthropometrics, predictors and mediators of behavior change, psychosocial and quality of life outcomes, and blood draw. RESULTS Of 884 women screened between January 2016 and September 2018, 27% were eligible. Primary reasons for ineligibility included not being willing/able to participate due to work/life responsibilities, health reasons, or transportation. Of 241 eligible women, 167 completed baseline assessment and enrolled. CONCLUSIONS We successfully enrolled a diverse group of breast cancer survivors representing more than 15 Latin American nationalities to a diet and physical activity trial. If effective, the ¡Mi Vida Saludable! program can be implemented by community groups and medical centers. TRIAL REGISTRATION ClinicalTrials.gov, NCT02780271, registered May 2016.
Collapse
Affiliation(s)
- Margarita Santiago-Torres
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Isobel Contento
- Program in Nutrition, Teachers College, Columbia University, New York, NY, USA
| | - Pamela Koch
- Program in Nutrition, Teachers College, Columbia University, New York, NY, USA
| | - Wei-Yann Tsai
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | - Cynthia A Thomson
- Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Tracy E Crane
- College of Nursing, University of Arizona, Tucson, AZ, USA
| | | | | | - Amanda M Marín-Chollom
- Department of Psychological Science, Central Connecticut State University, Connecticut, CT, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rachel Paul
- Program in Nutrition, Teachers College, Columbia University, New York, NY, USA; Rachel Paul Nutrition LLC, New York, NY, USA
| | - Zaixing Shi
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Kathleene T Ulanday
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Christiane Hale
- Columbia University Irving Medical Center, New York, NY, USA
| | - Dawn Hershman
- College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Heather Greenlee
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| |
Collapse
|
11
|
Koo CY, Zheng H, Tan LL, Foo LL, Seet R, Chong JH, Hausenloy DJ, Chng WJ, Richards AM, Lee CH, Chan MY. Lipid profiles and outcomes of patients with prior cancer and subsequent myocardial infarction or stroke. Sci Rep 2021; 11:21167. [PMID: 34707180 PMCID: PMC8551171 DOI: 10.1038/s41598-021-00666-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/11/2021] [Indexed: 01/22/2023] Open
Abstract
Patients with cancer are at increased risk of myocardial infarction (MI) and stroke. Guidelines do not address lipid profile targets for these patients. Within the lipid profiles, we hypothesized that patients with cancer develop MI or stroke at lower low density lipoprotein cholesterol (LDL-C) concentrations than patients without cancer and suffer worse outcomes. We linked nationwide longitudinal MI, stroke and cancer registries from years 2007–2017. We identified 42,148 eligible patients with MI (2421 prior cancer; 39,727 no cancer) and 43,888 eligible patients with stroke (3152 prior cancer; 40,738 no cancer). Median LDL-C concentration was lower in the prior cancer group than the no cancer group at incident MI [2.43 versus 3.10 mmol/L, adjusted ratio 0.87 (95% CI 0.85–0.89)] and stroke [2.81 versus 3.22 mmol/L, adjusted ratio 0.93, 95% CI 0.91–0.95)]. Similarly, median triglyceride and total cholesterol concentrations were lower in the prior cancer group, with no difference in high density lipoprotein cholesterol. Prior cancer was associated with higher post-MI mortality [adjusted hazard ratio (HR) 1.48, 95% CI 1.37–1.59] and post-stroke mortality (adjusted HR 1.95, 95% CI 1.52–2.52). Despite lower LDL-C concentrations, patients with prior cancer had worse post-MI and stroke mortality than patients without cancer.
Collapse
Affiliation(s)
- Chieh Yang Koo
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore.,Cardiac Department, Yong Loo Lin School of Medicine, National University of Singapore, 1E, Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Huili Zheng
- Health Promotion Board, National Registry of Diseases Office, Singapore, Singapore
| | - Li Ling Tan
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Ling-Li Foo
- Health Promotion Board, National Registry of Diseases Office, Singapore, Singapore
| | - Raymond Seet
- Cardiac Department, Yong Loo Lin School of Medicine, National University of Singapore, 1E, Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Jun-Hua Chong
- National Heart Centre Singapore, Singapore, Singapore
| | - Derek J Hausenloy
- Cardiac Department, Yong Loo Lin School of Medicine, National University of Singapore, 1E, Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore.,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore.,National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore.,The Hatter Cardiovascular Institute, University College London, London, UK
| | - Wee-Joo Chng
- Cardiac Department, Yong Loo Lin School of Medicine, National University of Singapore, 1E, Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore.,Department of Haematology-Oncology, National University Cancer Institute of Singapore, Singapore, Singapore
| | - A Mark Richards
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore.,Cardiac Department, Yong Loo Lin School of Medicine, National University of Singapore, 1E, Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore.,Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore.,Cardiac Department, Yong Loo Lin School of Medicine, National University of Singapore, 1E, Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore. .,Cardiac Department, Yong Loo Lin School of Medicine, National University of Singapore, 1E, Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore.
| |
Collapse
|
12
|
Saltaouras G, Lightowler H, Coe S, Horne A, Matthews S, Caulfield L, Watson EK. Diet and nutrition in patients who have received pelvic radiotherapy: A mixed-methods study to explore dietary habits, nutritional awareness, and experiences of nutritional care. Nutrition 2021; 89:111309. [PMID: 34166893 DOI: 10.1016/j.nut.2021.111309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Individuals who have survived cancer may benefit from dietary modifications to improve quality of life and future health outcomes. The aim of this study was to explore dietary habits and experiences of nutritional support in patients with a cancer diagnosis who have received radiotherapy to the pelvic area. METHODS A mixed-methods approach was used. Individuals diagnosed with a pelvic cancer (anal, bladder, rectal, and cancers of the reproductive organs), either undergoing or having completed pelvic radiotherapy 6 to 24 mo previously, were invited to participate in a postal survey. A purposive subsample was also invited to take part in telephone interviews. Thematic analysis of interview data was undertaken and integrated with data from quantitative analysis. RESULTS The survey was completed by 254 (38%) respondents. Two-thirds of respondents (170) reported dietary changes since diagnosis; most notable changes were reduction of sugary foods (48%) and alcohol (41%). Receipt of support from the health care team was significantly associated with dietary change (odds ratio, 3.26; 95% confidence interval, 1.58-6.75); however, only 43% (108) had received dietary support from the health care team. Of the respondents, 68% (171) said they would like to receive additional dietary support. The effect of the condition on diet was highlighted in the theme "Impact of diagnosis and treatments on dietary choices." Self-management of disease was influenced by personal resources, social resources, comorbidities and disabilities, influence of work, regaining normality, and barriers to dietary changes. CONCLUSION Lack of routine provision of nutritional care to patients after a cancer diagnosis and patient interest in this area highlighted unmet needs in managing diet-related problems and leading a healthy future lifestyle.
Collapse
Affiliation(s)
- Georgios Saltaouras
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK; Oxford School of Nursing and Midwifery, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford, UK.
| | - Helen Lightowler
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
| | - Shelly Coe
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
| | - Amanda Horne
- Department of Radiotherapy, Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sara Matthews
- Oxford School of Nursing and Midwifery, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford, UK; Department of Radiotherapy, Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Loryn Caulfield
- Department of Radiotherapy, Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Eila K Watson
- Oxford School of Nursing and Midwifery, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford, UK
| |
Collapse
|
13
|
Arreskov AB, Graungaard AH, Kristensen MT, Søndergaard J, Davidsen AS. Life goes on… Patient perspectives on having a cancer diagnosis and other comorbid diseases: A qualitative study. Chronic Illn 2021; 17:17-28. [PMID: 30537851 DOI: 10.1177/1742395318815954] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Due to a growing population with both cancer and chronic diseases, we explored patients' experiences of living with a cancer diagnosis and comorbidities, the possible effects on everyday living and management of comorbidities. METHODS Semi-structured interviews were conducted during 2016 with 15 patients in Denmark, with finished cancer treatment and preexisting comorbidities. Analysis was performed by Systematic Text Condensation. RESULTS Symptoms which disrupted everyday function were given attention, regardless of the disease from which the symptoms originated. The awareness of cancer and comorbidities constituted an inverse process over time. Most patients perceived cancer as being transient, whereas experiences of comorbidities varied from ignorance to worry. Most patients reported maintaining their chronic illness consultations with their general practitioner as before cancer. CONCLUSION Patients prioritized an everyday life with normal chores highly in contrast to paying attention to diseases. Disruptive symptoms, rather than specific diseases, took up patients' attention. Cancer did not change the patients' attendance at chronic care consultations. General practitioners should focus on maintaining the patient's functional level in everyday life. Further, they should continue to prioritize the chronic care management, as this might increase the patients' own view of the importance of self-management.
Collapse
Affiliation(s)
- Anne B Arreskov
- Department of Public Health, University of Copenhagen, Denmark
| | | | | | - Jens Søndergaard
- Institute of Public Health, University of Southern Denmark, Denmark
| | | |
Collapse
|
14
|
Koo CY, Tai BC, Chan DKH, Tan LL, Tan KK, Lee CH. Chemotherapy and adverse cardiovascular events in colorectal cancer patients undergoing surgical resection. World J Surg Oncol 2021; 19:21. [PMID: 33478503 PMCID: PMC7819286 DOI: 10.1186/s12957-021-02125-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/11/2021] [Indexed: 02/07/2023] Open
Abstract
Abstract Background Colorectal cancer patients undergoing surgical resection are at increased short-term risk of post-operative adverse events. However, specific predictors for long-term major adverse cardiac and cerebrovascular events (MACCE) are unclear. We hypothesised that patients who receive chemotherapy are at higher risk of MACCE than those who did not. Methods In this retrospective study, 412 patients who underwent surgical resection for newly diagnosed colorectal cancer from January 2013 to April 2015 were grouped according to chemotherapy status. MACCE was defined as a composite of cardiovascular death, myocardial infarction, stroke, unplanned revascularisation, hospitalisation for heart failure or angina. Predictors of MACCE were identified using competing risks regression, with non-cardiovascular death a competing risk. Results There were 200 patients in the chemotherapy group and 212 patients in the non-chemotherapy group. The overall prevalence of prior cardiovascular disease was 20.9%. Over a median follow-up duration of 5.1 years from diagnosis, the incidence of MACCE was 13.3%. Diabetes mellitus and prior cardiovascular disease were associated with an increased risk of MACCE (subdistribution hazard ratio, 2.56; 95% CI, 1.48-4.42) and 2.38 (95% CI, 1.36-4.18) respectively. The chemotherapy group was associated with a lower risk of MACCE (subdistribution hazard ratio, 0.37; 95% CI, 0.19-0.75) compared to the non-chemotherapy group. Conclusions Amongst colorectal cancer patients undergoing surgical resection, there was a high incidence of MACCE. Diabetes mellitus and prior cardiovascular disease were associated with an increased risk of MACCE. Chemotherapy was associated with a lower risk of MACCE, but further research is required to clarify this association.
Collapse
Affiliation(s)
- Chieh Yang Koo
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore, 119228, Singapore.
| | - Bee-Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Dedrick Kok Hong Chan
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System Singapore, Singapore, Singapore
| | - Li Ling Tan
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore, 119228, Singapore
| | - Ker Kan Tan
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System Singapore, Singapore, Singapore
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore, 119228, Singapore
| |
Collapse
|
15
|
Arem H, Duan X, Ehlers DK, Lyon ME, Rowland JH, Mama SK. Provider Discussion about Lifestyle by Cancer History: A Nationally Representative Survey. Cancer Epidemiol Biomarkers Prev 2020; 30:278-285. [PMID: 33268489 DOI: 10.1158/1055-9965.epi-20-1268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/12/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Providers are uniquely positioned to encourage health-promoting behaviors, particularly among cancer survivors where patients develop trust in providers. METHODS We utilized the National Health Interview Survey to identify adults who reported a visit to a provider in the prior year (44,385 individuals with no cancer history and 4,792 cancer survivors), and reported prevalence of provider discussions on weight loss, physical activity, diet, and smoking. We used generalized linear mixed models to examine predicted prevalence of provider lifestyle discussions by cancer history overall, and among those who do not meet body mass index (BMI), activity, or smoking guidelines. RESULTS Among those with a BMI of 25-<60 kg/m2, 9.2% of those with a cancer history and 11.6% of those without a cancer history reported being told to participate in a weight loss program (P < 0.001). Overall, 31.7% of cancer survivors and 35.3% of those with no cancer history were told to increase their physical activity (P < 0.001). Only 27.6% of cancer survivors and 32.2% of those with no cancer history reported having a general discussion of diet (P < 0.001). Among smokers, 67.3% of cancer survivors and 69.9% of those with no cancer history reported counseling on smoking (P = 0.309). CONCLUSIONS Fewer cancer survivors, who are at increased risk for health complications, are reporting provider discussions about critical lifestyle issues than those with no cancer history. IMPACT Our nationally representative results suggest that providers are missing an opportunity for influencing patient lifestyle factors, which could lead to mitigation of late and long-term effects of treatment.
Collapse
Affiliation(s)
- Hannah Arem
- Department of Epidemiology, George Washington Milken Institute School of Public Health, Washington, DC.
- George Washington Cancer Center, Washington, DC
| | - Xuejing Duan
- Department of Biostatistics, George Washington Milken Institute School of Public Health, Washington, DC
| | | | | | | | - Scherezade K Mama
- Division of Cancer Prevention and Population Sciences, Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
16
|
Denlinger CS, Sanft T, Moslehi JJ, Overholser L, Armenian S, Baker KS, Broderick G, Demark-Wahnefried W, Friedman DL, Goldman M, Henry NL, Hill-Kayser C, Hudson M, Khakpour N, Koura D, McDonough AL, Melisko M, Mooney K, Moore HCF, Moryl N, O'Connor T, Paskett ED, Patel C, Peterson L, Pirl W, Rodriguez MA, Ruddy KJ, Shockney L, Smith S, Syrjala KL, Tevaarwerk A, Zee P, McMillian NR, Freedman-Cass DA. NCCN Guidelines Insights: Survivorship, Version 2.2020. J Natl Compr Canc Netw 2020; 18:1016-1023. [PMID: 32755975 DOI: 10.6004/jnccn.2020.0037] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for consequences of adult-onset cancer and its treatment, with the goal of helping healthcare professionals who work with survivors, including those in primary care. The guidelines also provide recommendations to help clinicians promote physical activity, weight management, and proper immunizations in survivors and facilitate care coordination to ensure that all of the survivors' needs are addressed. These NCCN Guidelines Insights summarize additions and changes made to the guidelines in 2020 regarding cardiovascular disease risk assessment and screening for subsequent primary malignancies.
Collapse
Affiliation(s)
| | - Tara Sanft
- Yale Cancer Center/Smilow Cancer Hospital
| | | | | | | | - K Scott Baker
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | - Mindy Goldman
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | - Melissa Hudson
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | - Kathi Mooney
- Huntsman Cancer Institute at the University of Utah
| | - Halle C F Moore
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | - Electra D Paskett
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Lindsay Peterson
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | - Lillie Shockney
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Karen L Syrjala
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Phyllis Zee
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University; and
| | | | | |
Collapse
|
17
|
Bigelow EO, Blackford AL, Eytan DF, Eisele DW, Fakhry C. Reply to Survivors of cancer despite poor quality of care are heroes. Cancer 2020; 126:3373-3374. [PMID: 32343837 DOI: 10.1002/cncr.32924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Elaine O Bigelow
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Amanda L Blackford
- Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Danielle F Eytan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
18
|
Lizewski L, Flaherty G, Wilde P, Brownson R, Wang C, Maitin-Shepard M, Li Y, Mozaffarian D, Zhang FF. Federal, State, and Local Nutrition Policies for Cancer Prevention: Perceived Impact and Feasibility, United States, 2018. Am J Public Health 2020; 110:1006-1008. [PMID: 32437284 DOI: 10.2105/ajph.2020.305644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives. To assess stakeholder perceptions of the impact and feasibility of 21 national, state, and local nutrition policies for cancer prevention across 5 domains in the United States.Methods. We conducted an online survey from October through December 2018. Participants were invited to take the survey via direct e-mail contact or an organizational e-newsletter.Results. Federal or state Medicare/Medicaid coverage of nutrition counseling and federal or state subsidies on fruits, vegetables, and whole grains for participants in the Supplemental Nutrition Assistance Program were the policies rated as having the highest perceived impact and feasibility. Overall, the 170 respondents rated policy impact higher than policy feasibility. Polices at the federal or state level had a higher perceived impact, whereas local policies had higher perceived feasibility.Conclusions. Our findings might guide future research and advocacy that can ultimately motivate and target policy actions to reduce cancer burdens and disparities in the United States.
Collapse
Affiliation(s)
- Lauren Lizewski
- Lauren Lizewski, Grace Flaherty, Parke Wilde, Dariush Mozaffarian, and Fang Fang Zhang are with the Tufts University Friedman School of Nutrition Science and Policy, Boston, MA. Ross Brownson is with the Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, MO. Claire Wang is with the New York Academy of Medicine, New York, NY. Melissa Maitin-Shepard is an independent consultant, Alexandria, VA. Yan Li is with the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Grace Flaherty
- Lauren Lizewski, Grace Flaherty, Parke Wilde, Dariush Mozaffarian, and Fang Fang Zhang are with the Tufts University Friedman School of Nutrition Science and Policy, Boston, MA. Ross Brownson is with the Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, MO. Claire Wang is with the New York Academy of Medicine, New York, NY. Melissa Maitin-Shepard is an independent consultant, Alexandria, VA. Yan Li is with the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Parke Wilde
- Lauren Lizewski, Grace Flaherty, Parke Wilde, Dariush Mozaffarian, and Fang Fang Zhang are with the Tufts University Friedman School of Nutrition Science and Policy, Boston, MA. Ross Brownson is with the Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, MO. Claire Wang is with the New York Academy of Medicine, New York, NY. Melissa Maitin-Shepard is an independent consultant, Alexandria, VA. Yan Li is with the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ross Brownson
- Lauren Lizewski, Grace Flaherty, Parke Wilde, Dariush Mozaffarian, and Fang Fang Zhang are with the Tufts University Friedman School of Nutrition Science and Policy, Boston, MA. Ross Brownson is with the Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, MO. Claire Wang is with the New York Academy of Medicine, New York, NY. Melissa Maitin-Shepard is an independent consultant, Alexandria, VA. Yan Li is with the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Claire Wang
- Lauren Lizewski, Grace Flaherty, Parke Wilde, Dariush Mozaffarian, and Fang Fang Zhang are with the Tufts University Friedman School of Nutrition Science and Policy, Boston, MA. Ross Brownson is with the Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, MO. Claire Wang is with the New York Academy of Medicine, New York, NY. Melissa Maitin-Shepard is an independent consultant, Alexandria, VA. Yan Li is with the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Melissa Maitin-Shepard
- Lauren Lizewski, Grace Flaherty, Parke Wilde, Dariush Mozaffarian, and Fang Fang Zhang are with the Tufts University Friedman School of Nutrition Science and Policy, Boston, MA. Ross Brownson is with the Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, MO. Claire Wang is with the New York Academy of Medicine, New York, NY. Melissa Maitin-Shepard is an independent consultant, Alexandria, VA. Yan Li is with the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yan Li
- Lauren Lizewski, Grace Flaherty, Parke Wilde, Dariush Mozaffarian, and Fang Fang Zhang are with the Tufts University Friedman School of Nutrition Science and Policy, Boston, MA. Ross Brownson is with the Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, MO. Claire Wang is with the New York Academy of Medicine, New York, NY. Melissa Maitin-Shepard is an independent consultant, Alexandria, VA. Yan Li is with the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Dariush Mozaffarian
- Lauren Lizewski, Grace Flaherty, Parke Wilde, Dariush Mozaffarian, and Fang Fang Zhang are with the Tufts University Friedman School of Nutrition Science and Policy, Boston, MA. Ross Brownson is with the Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, MO. Claire Wang is with the New York Academy of Medicine, New York, NY. Melissa Maitin-Shepard is an independent consultant, Alexandria, VA. Yan Li is with the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Fang Fang Zhang
- Lauren Lizewski, Grace Flaherty, Parke Wilde, Dariush Mozaffarian, and Fang Fang Zhang are with the Tufts University Friedman School of Nutrition Science and Policy, Boston, MA. Ross Brownson is with the Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, MO. Claire Wang is with the New York Academy of Medicine, New York, NY. Melissa Maitin-Shepard is an independent consultant, Alexandria, VA. Yan Li is with the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
19
|
DeGuzman PB, Chu C, Keim-Malpass J. Built and Natural Environment Barriers and Facilitators to Physical Activity in Rural, Suburban, and Small Urban Neighborhoods. Oncol Nurs Forum 2020; 46:545-555. [PMID: 31424449 DOI: 10.1188/19.onf.545-555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore built and natural environment barriers and facilitators to walking for exercise in cancer survivors. PARTICIPANTS & SETTING Cancer survivors (N = 7) living in rural, suburban, and small urban neighborhoods in central Virginia. METHODOLOGIC APPROACH The authors used a qualitative descriptive design with photovoice to explore the cancer survivors' experience with residential walkability. FINDINGS The following three themes were identified from the data. IMPLICATIONS FOR NURSING Clinicians should consider an evaluation of the built and natural environment to support walking in cancer survivors. These findings may be used in conjunction with known individual-level barriers to physical activity to develop guidance for oncology nurses to help survivors safely achieve physical activity goals.
Collapse
|
20
|
Jarvandi S, Pérez M, Margenthaler J, Colditz GA, Kreuter MW, Jeffe DB. Improving Lifestyle Behaviors After Breast Cancer Treatment Among African American Women With and Without Diabetes: Role of Health Care Professionals. Ann Behav Med 2020; 55:1-13. [PMID: 32298407 PMCID: PMC7880224 DOI: 10.1093/abm/kaaa020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Little is known about the effect of health professionals' advice on promoting healthy lifestyle behaviors (diet and exercise) among breast cancer patients. PURPOSE To identify predictors of receiving lifestyle advice from health professionals and its impact on healthy lifestyle behaviors. METHODS We used data from a randomized controlled trial of an interactive, cancer-communication video program using African American breast cancer survivor stories for newly diagnosed African American breast cancer patients (Stages 0-III). Participants completed five interviews over 2 years. This intervention did not significantly affect changes in quality-of-life outcomes. In secondary analysis, we examined differences in baseline variables between women with and without diabetes. Logistic regression models identified independent predictors of receiving advice from "a doctor or other health professional" to improve diet and exercise and of self-reported change in diet and exercise habits at 2 year follow-up. RESULTS Of 193 patients included (85% of 228 enrolled), 53 (28%) had diabetes. At 2 year follow-up, a greater proportion of women with (vs. without) diabetes reported receiving advice by a doctor/health professional to improve their diet (73% vs. 57%, p = .04,). Predictors of receiving dietary advice were obesity, diabetes, and breast-conserving surgery (each p < .05). Women receiving dietary advice were 2.75 times more likely to report improving their diet (95% confidence interval: 1.17, 6.46) at follow-up, but receiving physical activity advice was not significantly associated with patients reporting an increase in exercise. CONCLUSIONS Although receiving dietary advice predicted dietary improvements, receiving exercise advice did not lead to an increase in physical activity. CLINICAL TRIAL REGISTRATION Trial Number NCT00929084.
Collapse
Affiliation(s)
- Soghra Jarvandi
- Department of Family and Consumer Sciences, University of Tennessee, Knoxville, TN, USA,Soghra Jarvandi
| | - Maria Pérez
- Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Julie Margenthaler
- Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Graham A Colditz
- Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew W Kreuter
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Donna B Jeffe
- Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| |
Collapse
|
21
|
Nicklett EJ, Chen J, Xiang X, Abrams LR, Sonnega AJ, Johnson KE, Cheng J, Assari S. Associations Between Diagnosis with Type 2 Diabetes and Changes in Physical Activity among Middle-Aged and Older Adults in the United States. Innov Aging 2020; 4:igz048. [PMID: 32099903 PMCID: PMC7032072 DOI: 10.1093/geroni/igz048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Physical activity (PA) is an effective strategy for diabetes self-management and is central to the diabetes regimen. Diagnostic events present an opportunity for health behavior change; however, many older adults with type 2 diabetes (T2D) do not engage in regular PA. The relationships between diagnosis events and subsequent changes in PA are not well understood. Drawing upon life-course theory, this is the first study to examine whether the diagnosis of T2D is followed by a change in PA, whether these changes are sustained, and the sociodemographic characteristics associated with these changes. RESEARCH DESIGN AND METHODS We examined associations between T2D diagnosis and PA changes among 2,394 adults ages 51+ from the Health and Retirement Study (2004-2014). PA changes were measured using metabolic equivalents of task (METs) estimated values accounting for the vigor and frequency of self-reported PA. Using piecewise mixed models, we examined initial and sustained changes in METs over time and tested whether these changes were modified by race/ethnicity, educational level, gender, and age at diagnosis. RESULTS Across participants, a significant postdiagnosis increase was observed in self-reported PA following the diagnostic event (β: 0.54, 95% CI: 0.10, 0.97). The steepness of decline in PA participation over time did not change significantly following T2D diagnosis. Age at diagnosis and race/ethnicity significantly moderated these relationships: participants diagnosed at older ages were less likely to improve PA following diagnosis and non-Hispanic whites experienced relatively steeper rates of decline following diagnosis with T2D. DISCUSSION AND IMPLICATIONS Modest diagnosis-related increases in PA were observed among participants overall. The usual rate of decline in PA appears unaffected by diagnosis overall. Age at diagnosis and race/ethnicity moderated these relationships. Key implications for future research and clinical practice are discussed.
Collapse
Affiliation(s)
- Emily J Nicklett
- School of Social Work, University of Michigan, Ann Arbor,Address correspondence to: Emily J. Nicklett, PhD, MA, MSSW, School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109-2029. E-mail:
| | - Jieling Chen
- Department of Social Work and Social Administration, The University of Hong Kong
| | - Xiaoling Xiang
- School of Social Work, University of Michigan, Ann Arbor
| | - Leah R Abrams
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| | - Amanda J Sonnega
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
| | - Kimson E Johnson
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| | - Jianjia Cheng
- School of Social Work, University of Michigan, Ann Arbor
| | - Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, University of California, Los Angeles
| |
Collapse
|
22
|
Perry CK, Ali W, Solanki E, Winters-Stone K. Attitudes and Beliefs of Older Female Breast Cancer Survivors and Providers About Exercise in Cancer Care. Oncol Nurs Forum 2020; 47:56-69. [PMID: 31845920 DOI: 10.1188/20.onf.56-69] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To understand breast cancer survivors' and providers' attitudes and beliefs regarding exercise counseling and structured exercise programs within cancer care. SAMPLE & SETTING 61 female breast cancer survivors and 11 breast cancer providers from a university cancer center in the Pacific Northwest. METHODS & VARIABLES Survivors completed anonymous self-report surveys, and providers participated in semistructured interviews. Survey data were analyzed using descriptive statistics, and interview transcripts were analyzed using qualitative content analysis. RESULTS Breast cancer survivors and providers believed that including exercise counseling within cancer care was important. More than half of the survivors reported that they would attend structured exercise classes; a majority of providers thought cancer centers should offer exercise programs. IMPLICATIONS FOR NURSING Nurses could facilitate exercise counseling within cancer care and advocate for clinic-based exercise programs.
Collapse
Affiliation(s)
| | - Wafaa Ali
- King Saud bin Abdulaziz University for Health Sciences
| | | | | |
Collapse
|
23
|
Cespedes Feliciano EM, Chen WY, Bradshaw PT, Prado CM, Alexeeff S, Albers KB, Castillo AL, Caan BJ. Adipose Tissue Distribution and Cardiovascular Disease Risk Among Breast Cancer Survivors. J Clin Oncol 2019; 37:2528-2536. [PMID: 31369302 PMCID: PMC7001794 DOI: 10.1200/jco.19.00286] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Cardiovascular disease (CVD) is a major source of morbidity and mortality among breast cancer survivors. Although body mass index (BMI) is associated with CVD risk, adipose tissue distribution may better identify patients with a high risk of CVD after breast cancer. METHODS Among 2,943 patients with nonmetastatic breast cancer without prior CVD, we used International Classification of Diseases (9th and 10th revisions) codes to identify incidence of nonfatal stroke, myocardial infarction, heart failure, or CVD death. From clinically acquired computed tomography scans obtained near diagnosis, we measured visceral adiposity (centimeters squared), subcutaneous adiposity (centimeters squared), and intramuscular adiposity (fatty infiltration into muscle [Hounsfield Units, scored inversely]). We estimated hazard ratios (HRs) and 95% CIs per SD increase in adiposity accounting for competing risks and adjusting for demographics, smoking, cancer treatment, and pre-existing CVD risk factors. RESULTS Mean (SD) age was 56 (12) years. Over a median follow-up of 6 years, 328 CVD events occurred. Each SD increase in visceral or intramuscular adiposity was associated with an increase in CVD risk (HR, 1.15 [95% CI, 1.03 to 1.29] and HR, 1.21 [95% CI, 1.06 to 1.37]), respectively). Excess visceral and intramuscular adiposity occurred across all BMI categories. Among normal-weight patients, each SD greater visceral adiposity increased CVD risk by 70% (HR, 1.70 [95% CI, 1.10 to 2.62]). CONCLUSION Visceral and intramuscular adiposity were associated with increased CVD incidence after breast cancer diagnosis, independent of pre-existing CVD risk factors and cancer treatments. The increased CVD incidence among normal-weight patients with greater visceral adiposity would go undetected with BMI alone. Measures of adipose tissue distribution may help identify high-risk patients and tailor CVD prevention strategies.
Collapse
Affiliation(s)
| | - Wendy Y. Chen
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Dana Farber Cancer Institute, Boston, MA
| | | | | | | | | | | | | |
Collapse
|
24
|
Halilova KI, Pisu M, Azuero A, Williams CP, Kenzik KM, Williams GR, Rocque GB, Martin MY, Kvale EA, Demark-Wahnefried W. Healthy lifestyle discussions between healthcare providers and older cancer survivors: Data from 12 cancer centers in the Southeastern United States. Cancer Med 2019; 8:7123-7132. [PMID: 31568695 PMCID: PMC6853832 DOI: 10.1002/cam4.2568] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/28/2019] [Accepted: 09/03/2019] [Indexed: 11/17/2022] Open
Abstract
Background Little is known about the prevalence of healthy lifestyle (HLS) discussions between providers and older cancer survivors. Methods We utilized cross‐sectional data from older cancer survivors (≥65 years) seen at 12 southeastern cancer centers during 2013‐2015. Data on demographics, time since diagnosis, weight, height, and healthy behaviors were collected. Respondents were asked if providers (oncologists, other physicians, and/or nurses) discussed exercise, healthy diet, weight management, and/or smoking cessation during clinical encounters. Descriptive statistics and bivariate associations between HLS topics and survivor characteristics were calculated. Results Among 1460 cancer survivors, mean age was 74 years (SD 6), most were white (81%), and >1 year postdiagnosis (84%). The majority (71%) reported discussing at least one of three HLS topics (exercise 49%, healthy diet 53%, vegetable consumption 28%); 17% received counseling on all three. Weight loss was recommended to 33% of overweight/obese survivors and smoking cessation to 85% of current smokers. Oncologists and nurses discussed HLS less frequently compared to other physicians. Younger survivors (65‐74 years) received recommendations for exercise, weight loss, and tobacco cessation more often than older survivors (≥75 years). Compared to white respondents, minorities reported discussions on all topics more often except for tobacco cessation. Excluding tobacco cessation, survivors with recent cancer diagnoses (<1 year) reported HLS discussions more often than survivors >1 year postdiagnosis. Conclusion Despite the American Cancer Society's recommendations, older survivors reported a low prevalence of HLS discussions with their providers, with some variation by demographic groups. Strategies are needed to promote these important discussions in this population.
Collapse
Affiliation(s)
- Karina I Halilova
- UAB Division of Preventive Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,UAB Comprehensive Cancer Center, Birmingham, AL, USA.,UAB Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Maria Pisu
- UAB Division of Preventive Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,UAB Comprehensive Cancer Center, Birmingham, AL, USA
| | - Andres Azuero
- UAB School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Courtney P Williams
- UAB Division of Hematology & Oncology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Kelly M Kenzik
- UAB Division of Hematology & Oncology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Grant R Williams
- UAB Comprehensive Cancer Center, Birmingham, AL, USA.,UAB Division of Hematology & Oncology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Gabrielle B Rocque
- UAB Comprehensive Cancer Center, Birmingham, AL, USA.,UAB Division of Hematology & Oncology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | | | | | - Wendy Demark-Wahnefried
- UAB Comprehensive Cancer Center, Birmingham, AL, USA.,UAB Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| |
Collapse
|
25
|
Spring B, Stump T, Penedo F, Pfammatter AF, Robinson JK. Toward a health-promoting system for cancer survivors: Patient and provider multiple behavior change. Health Psychol 2019; 38:840-850. [PMID: 31436465 PMCID: PMC6709684 DOI: 10.1037/hea0000760] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This paper examines how and why to improve care systems for disease management and health promotion for the growing population of cancer survivors with cardiovascular multi-morbidities. METHOD We reviewed research characterizing cancer survivors' and their multiple providers' common sense cognitive models of survivors' main health threats, preventable causes of adverse health events, and optimal coping strategies. RESULTS Findings indicate that no entity in the health care system self-identifies as claiming primary responsibility to address longstanding unhealthy lifestyle behaviors that heighten survivors' susceptibility to both cancer and cardiovascular disease (CVD) and whose improvement could enhance quality of life. CONCLUSIONS To address this gap, we propose systems-level changes that integrate health promotion into existing survivorship services by including behavioral risk factor vital signs in the electronic medical record, with default proactive referral to a health promotionist (a paraprofessional coach adept with mobile technologies and supervised by a professional expert in health behavior change). By using the patient's digital tracking data to coach remotely and periodically report progress to providers, the health promotionist closes a gap, creating a connected care system that supports, reinforces, and maintains accountability for healthy lifestyle improvement. No comparable resource solely dedicated to treatment of chronic disease risk behaviors (smoking, obesity, physical inactivity, treatment nonadherence) exists in current models of integrated care. Integrating health promotionists into care delivery channels would remove burden from overtaxed PCPs and instantiate a comprehensive, actionable systems-level schema of health risks and coping strategies needed to have preventive impact with minimal interference to clinical work flow. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
- Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Tammy Stump
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Frank Penedo
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | | | - June K. Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine
| |
Collapse
|
26
|
Arreskov AB, Graungaard AH, Kristensen MT, Søndergaard J, Davidsen AS. General practitioners' perspectives on chronic care consultations for patients with a history of cancer: a qualitative interview study. BMC FAMILY PRACTICE 2019; 20:119. [PMID: 31455259 PMCID: PMC6710867 DOI: 10.1186/s12875-019-1009-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/19/2019] [Indexed: 01/07/2023]
Abstract
Background General practitioners (GPs) are responsible for managing chronic care in the growing population of patients with comorbid chronic conditions and cancer. Studies have shown, however, that cancer patients are less likely to receive appropriate chronic care compared to patients without cancer. Patients say that how GPs engage in the care of comorbidities influences their own priority of these conditions. No studies have explored GPs’ attitudes to and prioritization of chronic care in patients who have completed primary cancer treatment. This study aims to explore GPs’ experiences, prioritization of, and perspectives on treatment and follow-up of patients with cancer and comorbidity. Methods Semi-structured interviews were conducted during 2016 with 13 GPs in Region Zealand in Denmark. We used Systematic Text Condensation in the analysis. Results All participating GPs said that chronic care in patients with a history of cancer was a high priority, and due to a clear structure in their practice, they experienced that few patients were lost to follow-up. Two different approaches to chronic care consultations were identified: one group of GPs described them as imitating outpatient clinics, where the GP sets the agenda and focuses on the chronic condition. The other group described an approach that was more attuned to the patient’s agenda, which could mean that chronic care consultations served as an “alibi” for the patients to disclose other matters of concern. Both groups of GPs said that chronic care consultations for these patients supported normalcy, but in different ways. Some GPs said that offering future appointments in the chronic care process gave patients hope and a sense of normalcy. Other GPs strove for normalcy by focusing exclusively on the chronic condition and dealing with cancer as cured. Conclusions The participating GPs gave a high priority to chronic care in patients with a history of cancer. Some GPs, however, followed a rigorous agenda. GPs should be aware that a very focused and biomedical approach to chronic care might increase fragmentation of care and collide with a holistic and patient-centered approach. It could also affect GPs’ self-perception of their role and the core values of general practice.
Collapse
Affiliation(s)
- Anne Beiter Arreskov
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark. .,The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014, Copenhagen, Denmark.
| | | | | | - Jens Søndergaard
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | |
Collapse
|
27
|
Hyland KA, Jacobs JM, Lennes IT, Pirl WF, Park ER. Are cancer survivors following the national comprehensive cancer network health behavior guidelines? An assessment of patients attending a cancer survivorship clinic. J Psychosoc Oncol 2019; 36:64-81. [PMID: 29303476 DOI: 10.1080/07347332.2017.1399193] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Engaging in positive health behaviors post-treatment is important for cancer survivors' health. However, little is known about whether survivors are practicing health promoting behaviors. We aimed to explore whether survivors are meeting the recent health behavior guidelines set forth by the National Comprehensive Cancer Network (NCCN) and to examine associations between health behaviors and distress. METHODS Sixty-six survivors completed a cross-sectional questionnaire assessing health behaviors prior to an initial appointment at a survivorship care clinic. Information about sociodemographic, clinical, and psychosocial variables and six health behavior recommendations, including physical activity, sunscreen use, tobacco use, alcohol consumption, weight management, and annual primary care provider visits, was collected. FINDINGS Only 7.6% of survivors met all six NCCN health behavior guidelines. One in ten (10.6%) survivors had smoked a cigarette in the previous 30 days, and half did not use sunscreen regularly (50%), had an unhealthy body mass index (53%), and did not engage in >10 MET-h/week of physical activity (50%). Approximately 1 in 6 (15.1%) survivors reported drinking beyond the recommended limit, and a similar proportion had not seen a PCP in the previous year (27.3%). Clinically significant levels of distress (>5; range 0-10) on the NCCN distress scale were reported by 64.6% of survivors. Participants with clinical levels of distress were less likely to adhere to health behavior guidelines than those who were not distressed (p = .002). CONCLUSIONS Overall, survivors engaged at a survivorship clinic did not meet the NCCN recommended health behavior guidelines. Implications for Psychosocial Providers or Policy: Survivors' health behaviors and distress should be assessed and intervened upon during survivorship care. Survivorship clinics may provide a unique forum in which to provide ongoing behavioral health counseling and psychosocial support for these patients.
Collapse
Affiliation(s)
- Kelly A Hyland
- a Department of Health Outcomes and Behavior , Moffitt Cancer Center , Tampa , Florida , USA.,b Department of Psychology , University of South Florida , Tampa , Florida , USA.,e Department of Psychiatry , Sylvester Comprehensive Cancer Center , Miami , Florida , USA
| | - Jamie M Jacobs
- c Massachusetts General Hospital Cancer Center , Boston , Massachusetts , USA.,d Mongan Institute for Health Policy, Massachusetts General Hospital , Boston , Massachusetts , USA
| | - Inga T Lennes
- c Massachusetts General Hospital Cancer Center , Boston , Massachusetts , USA
| | - William F Pirl
- c Massachusetts General Hospital Cancer Center , Boston , Massachusetts , USA.,d Mongan Institute for Health Policy, Massachusetts General Hospital , Boston , Massachusetts , USA.,f Sylvester Cancer Center , Miami , Florida , USA
| | - Elyse R Park
- c Massachusetts General Hospital Cancer Center , Boston , Massachusetts , USA.,d Mongan Institute for Health Policy, Massachusetts General Hospital , Boston , Massachusetts , USA.,e Department of Psychiatry , Sylvester Comprehensive Cancer Center , Miami , Florida , USA
| |
Collapse
|
28
|
Howell JC, Rose SR. Pituitary disease in pediatric brain tumor survivors. Expert Rev Endocrinol Metab 2019; 14:283-291. [PMID: 31131647 DOI: 10.1080/17446651.2019.1620599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/15/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Treatment of childhood brain tumors, including surgical resection and especially external beam radiation, often results in endocrine complications manifested by hypopituitarism, which can involve growth hormone deficiency, hypothyroidism, adrenal insufficiency, disorders of puberty, diabetes insipidus, and hypothalamic obesity. AREAS COVERED A comprehensive literature search was conducted on Medline (publications from the 1990s to 01/2019) including systematic reviews, meta-analyses, longitudinal controlled studies, retrospective cohort studies, and case reports. Herein, we present an up-to-date review of the current literature regarding endocrine sequellae of childhood brain tumor survivors. EXPERT OPINION Late endocrine sequellae can arise many years after the initial treatment of tumor, so at least annual surveillance of growth, puberty, weight, development, and endocrine status is recommended for at least 10 years after tumor therapy. This follow up should encompass childhood and adulthood among survivors. If found early, outcomes of endocrinopathies are favorable when treated appropriately. Newer tumor therapy modalities, such as proton beam radiation, offer the potential for fewer endocrine complications, but such benefit has yet to be demonstrated, and more research into short- and long-term outcomes is needed.
Collapse
Affiliation(s)
- Jonathan C Howell
- a Division of Pediatric Endocrinology , Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Susan R Rose
- a Division of Pediatric Endocrinology , Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati , OH , USA
| |
Collapse
|
29
|
Arreskov AB, Olsen MÅ, Pouplier SS, Siersma V, Andersen CL, Friis S, de Fine Olivarius N. The impact of cancer on diabetes outcomes. BMC Endocr Disord 2019; 19:60. [PMID: 31185995 PMCID: PMC6560822 DOI: 10.1186/s12902-019-0377-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 04/30/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Survival from many cancer types is steadily increasing, and as a result, a growing number of cancer patients will live with other chronic diseases, of which diabetes is one of the most prevalent. This study aims to describe the impact of cancer on health outcomes in patients with type 2 diabetes and to compare the effectiveness of a multifactorial intervention in diabetes patients with and without cancer. METHODS The randomized controlled trial Diabetes Care in General Practice (DCGP) included 1381 patients newly diagnosed with type 2 diabetes. Patients were randomized to either six years of structured personal diabetes care or routine care. In a post hoc analysis, we followed patients for 19 years in Danish national registries for the occurrence of diabetes-related outcomes. We used Cox regression models to estimate hazard ratios for outcomes. RESULTS At diagnosis 48 patients had cancer, and 243 patients were diagnosed with cancer during follow up. Patients with diabetes and cancer had excess all-cause mortality (HR 3.33; 95%CI 2.72-4.06), as well as an increased incidence of myocardial infarction (HR 1.76; 95%CI 1.29-2.39) and any diabetes-related outcome (HR 1.36; 95%CI 1.07-1.71). The intervention reduced the risk of both these endpoints in patients without cancer. Furthermore, there was no statistically significant difference in the effectiveness of the intervention among patients with and without cancer. CONCLUSIONS Diabetes patients with cancer had an increased risk of myocardial infarction and any diabetes-related outcome. The observed positive effect of structured personal diabetes care on clinical outcomes did not differ between patients with and without cancer. Attention to and prevention of diabetes complications in patients with both type 2 diabetes and cancer is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT01074762 (February 24, 2010).
Collapse
Affiliation(s)
- Anne Beiter Arreskov
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014 Copenhagen K, Denmark
| | - Maria Å. Olsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014 Copenhagen K, Denmark
| | - Sandra Sinius Pouplier
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014 Copenhagen K, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014 Copenhagen K, Denmark
| | - Christen L. Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014 Copenhagen K, Denmark
| | - Søren Friis
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014 Copenhagen K, Denmark
| |
Collapse
|
30
|
Gallaway MS, Huang B, Chen Q, Tucker TC, McDowell JK, Durbin E, Stewart SL, Tai E. Smoking and Smoking Cessation Among Persons with Tobacco- and Non-tobacco-Associated Cancers. J Community Health 2019; 44:552-560. [PMID: 30767102 PMCID: PMC6504566 DOI: 10.1007/s10900-019-00622-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To examine smoking and use of smoking cessation aids among tobacco-associated cancer (TAC) or non-tobacco-associated cancer (nTAC) survivors. Understanding when and if specific types of cessation resources are used can help with planning interventions to more effectively decrease smoking among all cancer survivors, but there is a lack of research on smoking cessation modalities used among cancer survivors. METHODS Kentucky Cancer Registry data on incident lung, colorectal, pancreatic, breast, ovarian, and prostate cancer cases diagnosed 2007-2011, were linked with health administrative claims data (Medicaid, Medicare, private insurers) to examine the prevalence of smoking and use of smoking cessation aids 1 year prior and 1 year following the cancer diagnosis. TACs included colorectal, pancreatic, and lung cancers; nTAC included breast, ovarian, and prostate cancers. RESULTS There were 10,033 TAC and 13,670 nTAC survivors. Smoking before diagnosis was significantly higher among TAC survivors (p < 0.0001). Among TAC survivors, smoking before diagnosis was significantly higher among persons who: were males (83%), aged 45-64 (83%), of unknown marital status (84%), had very low education (78%), had public insurance (89%), Medicaid (85%) or were uninsured (84%). Smoking cessation counseling and pharmacotherapy were more common among TAC than nTAC survivors (p < 0.01 and p = 0.05, respectively). DISCUSSION While smoking cessation counseling and pharmacotherapy were higher among TAC survivors, reducing smoking among all cancer survivors remains a priority, given cancer survivors are at increased risk for subsequent chronic diseases, including cancer. Tobacco cessation among all cancer survivors (not just those with TAC) can help improve prognosis, quality of life and reduce the risk of further disease. Health care providers can recommend for individual, group and telephone counseling and/or pharmacotherapy recommendations. These could also be included in survivorship care plans.
Collapse
Affiliation(s)
- M Shayne Gallaway
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health, 4770 Buford Highway, MS F76, Atlanta, GA, 30341, Georgia.
| | - Bin Huang
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
- Kentucky Cancer Registry, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Quan Chen
- Kentucky Cancer Registry, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Thomas C Tucker
- Kentucky Cancer Registry, College of Medicine, University of Kentucky, Lexington, KY, USA
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Jaclyn K McDowell
- Kentucky Cancer Registry, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Eric Durbin
- Kentucky Cancer Registry, College of Medicine, University of Kentucky, Lexington, KY, USA
- Division of Biomedical Informatics, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Sherri L Stewart
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health, 4770 Buford Highway, MS F76, Atlanta, GA, 30341, Georgia
| | - Eric Tai
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health, 4770 Buford Highway, MS F76, Atlanta, GA, 30341, Georgia
| |
Collapse
|
31
|
Gallaway MS, Glover-Kudon R, Momin B, Puckett M, Lunsford NB, Ragan KR, Rohan EA, Babb S. Smoking cessation attitudes and practices among cancer survivors - United States, 2015. J Cancer Surviv 2019; 13:66-74. [PMID: 30612253 PMCID: PMC6387634 DOI: 10.1007/s11764-018-0728-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 12/19/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The prevalence of smoking among cancer survivors is similar to the general population. However, there is little evidence on the prevalence of specific smoking cessation behaviors among adult cancer survivors. METHODS The 2015 National Health Interview Survey (NHIS) data were analyzed to examine the prevalence of smoking cessation behaviors and use of treatments among cancer survivors. Weighted self-reported prevalence estimates and 95% confidence intervals were calculated using a sample of 2527 cancer survivors. RESULTS Among this sample of US cancer survivors, 12% were current smokers, 37% were former smokers, and 51% were never smokers. Compared with former and never smokers, current smokers were younger (< 65 years), less educated, and less likely to report being insured or Medicaid health insurance (p < 0.01). More males were former smokers than current or never smokers. Current smokers reported wanting to quit (57%), a past year quit attempt (49%), or a health professional advised them to quit (66%). Current smokers reported the use of smoking cessation counseling (8%) or medication (38%). CONCLUSIONS Even after a cancer diagnosis, about one in eight cancer survivors continued to smoke. All could have received advice to quit smoking by a health professional, but a third did not. IMPLICATIONS FOR CANCER SURVIVORS Health professionals could consistently advise cancer survivors about the increased risks associated with continued smoking, provide them with cessation counseling and medications, refer them to other free cessation resources, and inform them of cessation treatments covered by their health insurance.
Collapse
Affiliation(s)
- M Shayne Gallaway
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway, MS-F76, Atlanta, GA, 30341, USA.
| | - Rebecca Glover-Kudon
- Centers for Disease Control and Prevention, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Behnoosh Momin
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway, MS-F76, Atlanta, GA, 30341, USA
| | - Mary Puckett
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway, MS-F76, Atlanta, GA, 30341, USA
| | - Natasha Buchanan Lunsford
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway, MS-F76, Atlanta, GA, 30341, USA
| | - Kathleen R Ragan
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway, MS-F76, Atlanta, GA, 30341, USA
| | - Elizabeth A Rohan
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway, MS-F76, Atlanta, GA, 30341, USA
| | - Stephen Babb
- Centers for Disease Control and Prevention, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| |
Collapse
|
32
|
|
33
|
Underwood JM, Hyde-Rolland SJ, Thorsness J, Stewart SL. A Novel Public Health Approach to Measuring Tobacco Cessation Needs Among Cancer Survivors in Alaska. J Community Health 2018; 42:956-961. [PMID: 28528524 DOI: 10.1007/s10900-017-0341-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cancer survivors who continue to smoke have poorer response to treatment, higher risk for future cancers and lower survival rates than those who quit tobacco after diagnosis. Despite the increased risk for negative health outcomes, tobacco use among Alaskan cancer survivors is 19%, among the highest in the nation. To characterize and address tobacco cessation needs among cancer survivors who called a quit line for help in quitting tobacco, Alaska's Comprehensive Cancer Control program initiated a novel partnership with the state's Tobacco Quit Line. Alaska's Tobacco Quit Line, a state-funded resource that provides confidential coaching, support, and nicotine replacement therapies for Alaskan adults who wish to quit using tobacco, was used to collect demographic characteristics, health behaviors, cessation referral methods and other information on users. From September 2013- December 2014, the Alaska Quit Line included questions about previous cancer status and other chronic conditions to assess this information from cancer survivors who continue to use tobacco. Alaska's Tobacco Quit Line interviewed 3,141 smokers, 129 (4%) of whom were previously diagnosed with cancer. Most cancer survivors who called in to the quit line were female (72%), older than 50 years of age (65%), white (67%), and smoked cigarettes (95%). Cancer survivors reported a higher prevalence of asthma, COPD and heart disease than the non-cancer cohort. Approximately 34% of cancer survivors were referred to the quit line by a health care provider. This report illustrates the need for health care provider awareness of persistent tobacco use among cancer survivors in Alaska. It also provides a sound methodologic design for assessing ongoing tobacco cessation needs among cancer survivors who call a quit line. This survey methodology can be adapted by other public health programs to address needs and increase healthy behaviors among individuals with chronic disease.
Collapse
Affiliation(s)
- J Michael Underwood
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., MS-F76, Atlanta, GA, 30341, USA
| | - Samantha J Hyde-Rolland
- Chronic Disease Prevention and Health Promotion, Alaska Division of Public Health, Department of Health and Social Services, Anchorage, AK, 99503, USA
| | - Julia Thorsness
- Chronic Disease Prevention and Health Promotion, Alaska Division of Public Health, Department of Health and Social Services, Anchorage, AK, 99503, USA
- Alaska Comprehensive Cancer Control Program, Division of Public Health, Department of Health and Social Services, Anchorage, AK, 99503, USA
| | - Sherri L Stewart
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., MS-F76, Atlanta, GA, 30341, USA.
| |
Collapse
|
34
|
Changes in health behaviours and body mass index after a breast cancer diagnosis: results from a prospective cohort study. Eur J Cancer Prev 2018; 28:330-337. [PMID: 30272598 DOI: 10.1097/cej.0000000000000469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of the study was to describe changes in health behaviours and BMI after breast cancer diagnosis, depicting the potential influence of sociodemographic, clinical and psychological characteristics. A total of 428 breast cancer patients were prospectively followed for 3 years, since diagnosis. At the end of follow-up, women were classified regarding their adherence to recommendations for cancer prevention, prediagnosis and after 3 years, including not smoking, alcohol consumption up to one drink per day, intake of at least five portions per day of fruits and/or vegetables, physical activity and body mass index (BMI) less than 25.0 kg/m. To quantify associations between patients' characteristics and changes in adherence to each recommendation, age, education and cancer stage-adjusted odds ratio (OR) with 95% confidence intervals (CIs) were calculated. Among women adhering to each recommendation before diagnosis, 54.1% reduced their physical activity, 32.4% became overweight or obese and 6.1% reduced fruits and/or vegetables intake, but there were virtually no changes in alcohol consumption or smoking. Older and more educated participants were more likely to reduce their physical activity (OR=4.71, 95% CI: 1.17-18.99; OR=11.53, 95% CI: 2.20-60.53, respectively). Among participants not following each recommendation before diagnosis, 29.1% stopped smoking, 24.6% reduced alcohol consumption, 9.9% became physically active, 7.8% increased fruits and/or vegetables intake and 3.3% reduced their BMI to less than 25.0 kg/m. Older women were less likely to become physically active (OR=0.32, 95% CI: 0.14-0.75). Breast cancer patients showed some positive changes in their health behaviours after diagnosis. However, there is a large margin for improvement, which highlights the importance of health promotion interventions in this context.
Collapse
|
35
|
Pearlstein KA, Basak R, Chen RC. Cardiovascular Care Among Cancer Survivors in the United States. JNCI Cancer Spectr 2018; 2:pky049. [PMID: 31360872 PMCID: PMC6649739 DOI: 10.1093/jncics/pky049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 08/05/2018] [Accepted: 08/10/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a leading cause of mortality among cancer survivors, but whether survivors receive routine cardiovascular monitoring and preventive care has not been well studied. This study uses a population-based dataset to examine this question. METHODS Data from the National Health Interview Survey were used to identify 13 266 cancer survivors who completed surveys from 2011 to 2015. Prevalence of CVD and associated risk factors, patterns of doctor visitation, and receipt of CVD preventive care were examined. We used multivariable logistic regression analysis to examine factors associated with the receipt of preventive care for survivors with and without CVD risk factors. RESULTS CVD risk factors were prevalent in older cancer survivors 65 years and older (56.9% with hyperlipidemia, 66.8% with hypertension) and younger survivors younger than 50 years (35.4% obese, 30.3% current smokers). Rates of blood pressure, cholesterol, and glucose monitoring were high, but rates of lifestyle modification were lower (54.8% moderate exercise, 47.1% smoking cessation attempts among smokers). Although 71.5% of survivors at 2 years or less from diagnosis saw both general and specialist doctors, only 51.6% of survivors at 5 or more years saw both, and 43.5% saw only a general doctor. On multivariable analysis, receipt of CVD preventive care was strongly associated with general doctor visitation for those with and without CVD risk factors. CONCLUSIONS CVD and associated risk factors are prevalent among both older and younger cancer survivors across the United States. This study identifies areas for improvement related to lifestyle modification in survivors, and also highlights the importance of care transition to the primary care provider for long-term survivors.
Collapse
Affiliation(s)
| | | | - Ronald C Chen
- Department of Radiation Oncology
- Lineberger Comprehensive Cancer Center
- Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|
36
|
Schneeberger D, Golubíc M, Moore HCF, Weiss K, Abraham J, Montero A, Doyle J, Sumego M, Roizen M. Lifestyle Medicine-Focused Shared Medical Appointments to Improve Risk Factors for Chronic Diseases and Quality of Life in Breast Cancer Survivors. J Altern Complement Med 2018; 25:40-47. [PMID: 30256657 DOI: 10.1089/acm.2018.0154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Poor lifestyle choices play a significant role in the development and progression of preventable chronic diseases, including cancer. In this study, we evaluate the effectiveness of a comprehensive lifestyle medicine intervention on chronic disease risk factors and quality of life in breast cancer survivors. DESIGN This is a retrospective review of a clinical program from January 2016 to July 2017. SETTINGS/LOCATION It includes seven 2-h group medical visits held every other week at an outpatient wellness facility. SUBJECTS Eligible participants are breast cancer survivors who have completed treatment, including those who remain on hormonal therapy. INTERVENTION Patients receive education and experience in nutrition, culinary medicine, physical activity, and stress relief practices. OUTCOME MEASURES Participants' weight, body mass index (BMI), body fat mass, lean body mass, and percent body fat were measured at visit 1 and visit 7. Standard validated questionnaires were used to measure perceived stress, depression, patient activation, physical and mental quality of life, dietary fat consumption, and dietary fruit, vegetable, and fiber consumption. RESULTS A total of 31 patients participated in the group visits. Pre-post comparison data were not available for 10 patients. More than three-quarters of the 21 breast cancer survivors who attended 5 or more of the 7 group visits and provided data at the first and the last group visit decreased their body weight. On average, patients lost 4.9 pounds (-2.6%, p < 0.01), and their BMI decreased by 0.8 kg/m2 (-2.5%, p < 0.01). Changes in psychosocial variables of perceived stress, depression, patient activation, and quality of life trended in a positive direction, but did not reach statistical significance. Patients reported a significant decrease in average weekly fat consumption (-31.5%, p < 0.01). Most patients found the program educational and enjoyable, and nearly half of them described it as life changing. CONCLUSIONS Breast cancer survivors could employ the prescribed lifestyle modifications to produce clinically relevant health benefits. Interdisciplinary teams of health care professionals may help breast cancer survivors with chronic diseases implement evidence-based, individualized, and effective lifestyle prescription through group medical visits.
Collapse
Affiliation(s)
- Dana Schneeberger
- 1 Center for Integrative and Lifestyle Medicine, Wellness Institute, Cleveland Clinic, Lyndhurst, OH
| | - Mladen Golubíc
- 1 Center for Integrative and Lifestyle Medicine, Wellness Institute, Cleveland Clinic, Lyndhurst, OH
| | | | - Kenneth Weiss
- 3 Regional Oncology, Cleveland Clinic, Twinsburg, OH
| | - Jame Abraham
- 2 Hematology & Oncology, Cleveland Clinic, Cleveland, OH
| | | | - Jonathan Doyle
- 1 Center for Integrative and Lifestyle Medicine, Wellness Institute, Cleveland Clinic, Lyndhurst, OH
| | | | - Michael Roizen
- 1 Center for Integrative and Lifestyle Medicine, Wellness Institute, Cleveland Clinic, Lyndhurst, OH
| |
Collapse
|
37
|
Eng L, Pringle D, Su J, Shen X, Mahler M, Niu C, Charow R, Tiessen K, Lam C, Halytskyy O, Naik H, Hon H, Irwin M, Pat V, Gonos C, Chan C, Villeneuve J, Harland L, Shani RM, Brown MC, Selby P, Howell D, Xu W, Liu G, Alibhai SMH, Jones JM. Patterns, perceptions, and perceived barriers to physical activity in adult cancer survivors. Support Care Cancer 2018; 26:3755-3763. [DOI: 10.1007/s00520-018-4239-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/26/2018] [Indexed: 11/28/2022]
|
38
|
Smoking Cessation Treatment Programs Offered at Hospitals Providing Oncology Services. J Smok Cessat 2018; 14:65-71. [PMID: 30057648 DOI: 10.1017/jsc.2018.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Many people with cancer continue smoking despite evidence that it negatively effects cancer treatment, worsens chemotherapy toxicity, and increases risk for a second cancer. Aims We examined tobacco treatment services offered to cancer patients at hospitals providing oncology services, including National Cancer Institute (NCI)-Designated Cancer Centers (NDCCs). Methods We examined survey data of 6,400 U.S. hospitals from 2008 to 2015 to determine the manner in which tobacco treatment/cessation program services were provided among NDCCs and non-NDCC hospitals providing oncology services (HPOs). Results From 2008 to 2015, 784 responses from NDCCs and 18,281 responses from HPOs were received. NDCCs (86%) reported significantly higher tobacco treatment/cessation programs owned by the hospital compared to HPOs (68%) (p < 0.001). Among NDCCs, there was a significant increasing trend of tobacco treatment/cessation programs reported owned by the hospital, the health system, or other contractual mechanism from 2008 to 2015 (p = 0.03). Conclusions More than 80% of oncology providing hospitals report providing tobacco cessation programs, with higher percentages reported in NDCCs. As hospitals implement smoking cessation programs, partnerships between hospitals and cancer coalitions could help bring tobacco cessation activities to communities they both serve, and link discharged patients to these cessation resources so they can continue quit attempts that they initialised while hospitalised.
Collapse
|
39
|
Cheville AL, Smith SR, Basford JR. Rehabilitation Medicine Approaches to Pain Management. Hematol Oncol Clin North Am 2018; 32:469-482. [PMID: 29729782 DOI: 10.1016/j.hoc.2018.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Rehabilitation medicine offers strategies that reduce musculoskeletal pain, targeted approaches to alleviate movement-related pain, and interventions to optimize patients' function despite the persistence of pain. These approaches fall into four categories: modulating nociception, stabilizing and unloading painful structures, influencing pain perception, and alleviating soft tissue musculotendinous pain. Incorporating these interventions into individualized, comprehensive pain management programs offers the potential to empower patients and limit pain associated with mobility and required daily activities. Rehabilitative approach may be particularly helpful for patients with refractory movement-associated pain and functional vulnerability, and for those who do not wish for, or cannot, tolerate pharmacoanalgesia.
Collapse
Affiliation(s)
- Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Sean R Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, University of Michigan Health System, Burlington Building, 325 East Eisenhower Parkway, Ann Arbor, MI 48108, USA
| | - Jeffrey R Basford
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| |
Collapse
|
40
|
Pisu M, Azuero A, Halilova KI, Williams CP, Kenzik KM, Kvale EA, Williams GR, Meneses K, Sullivan M, Yagnik SK, Goertz HP, Rocque GB. Most impactful factors on the health-related quality of life of a geriatric population with cancer. Cancer 2018; 124:596-605. [PMID: 29250775 DOI: 10.1002/cncr.31048] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND As the population of older adults with cancer continues to grow, the most important factors contributing to their health-related quality of life (HRQOL) remain unclear. METHODS A total of 1457 older adults (aged ≥65 years) with cancer participated in a telephone survey. Outcomes were measured using the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the 12-Item Short Form Survey (SF-12) from the Medical Outcomes Study (version 2). Statistical techniques used to identify factors in 4 domains (physical, psychological, social, and spiritual) most strongly associated with HRQOL included linear models, recursive partitioning, and random forests. Models were developed in a training data set (920 respondents) and performance was assessed in a validation data set (537 respondents). RESULTS Respondents were a median of 19 months from diagnosis, and 28.1% were receiving active treatment. The most relevant factors found to be associated with PCS were symptom severity, comorbidity scores, leisure-time physical activity, and having physical support needs. The most relevant factors for MCS were having emotional support needs, symptom severity score, and the number of financial hardship events. Results were consistent across modeling techniques. Symptoms found to be strongly associated with PCS included fatigue (adjusted proportion of summary score's variance [R2 ] = 0.34), pain (adjusted R2 = 0.32), disturbed sleep (adjusted R2 = 0.16), and drowsiness (adjusted R2 = 0.16). Symptoms found to be strongly associated with MCS included fatigue (adjusted R2 = 0.23), problems remembering things (adjusted R2 = 0.17), disturbed sleep (adjusted R2 = 0.16), and lack of appetite (adjusted R2 = 0.16). CONCLUSIONS The findings of the current study support the importance of addressing persistent symptoms, managing comorbidities, promoting leisure-time physical activity, and addressing financial challenges. A long-term comprehensive approach is needed to ensure the well-being of older adults with cancer. Cancer 2018;124:596-605. © 2017 American Cancer Society.
Collapse
Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Karina I Halilova
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Courtney P Williams
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kelly M Kenzik
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama.,Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth A Kvale
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama.,Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Grant R Williams
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama.,Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Karen Meneses
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama.,School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Margaret Sullivan
- Mitchell Cancer Institute, University of South Alabama, Mobile, Alabama
| | | | | | - Gabrielle B Rocque
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama.,Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
41
|
Almuwaqqat Z, Hung O, Parashar S. Statins and cancer survivors: the need for structured guidelines. Future Cardiol 2018; 14:5-8. [DOI: 10.2217/fca-2017-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Zakaria Almuwaqqat
- Department of Medicine, Emory School of Medicine, Atlanta, GA 30322, USA
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Olivia Hung
- Division of Cardiology, Department of Medicine, Emory School of Medicine, Atlanta, GA 30322, USA
| | - Susmita Parashar
- Division of Cardiology, Department of Medicine, Emory School of Medicine, Atlanta, GA 30322, USA
| |
Collapse
|
42
|
Igwebuike LT, Zhang X, Brown JC, Schmitz KH. Applying pre-participation exercise screening to breast cancer survivors: a cross-sectional study. Support Care Cancer 2017; 26:1825-1831. [PMID: 29260391 DOI: 10.1007/s00520-017-4020-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 12/10/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Clinical guidelines recommend that breast cancer (BrCa) survivors be prescribed exercise. However, clinicians often do not prescribe exercise citing the presence of multiple health issues found among cancer survivors. No study has examined the proportion of BrCa survivors that can be prescribed a community/home-based unsupervised exercise program safely and independently, without further medical investigations or supervision. METHODS Participants included BrCa survivors who received treatment at a university healthcare system between 2009 and 2014. We applied previously identified published guidelines for health conditions that may impede BrCa survivors from completing a community/home-based exercise program. Logistic regression models were used to quantify the magnitude of the association between demographic and clinical characteristics and the ability to perform community/home-based exercise. RESULTS Among 667 BrCa survivors, 65 to 75% was classified as able to complete community/home-based exercise as recommended by the clinical guidelines. Older age, black race, treatment with chemotherapy, and treatment with radiation were associated with the potential need for further medical evaluation prior to starting exercise. CONCLUSIONS A large proportion of BrCa survivors can be prescribed community/home-based exercise program safely and independently, without further medical investigations or supervision. Future research will be needed to determine how to identify the subset of BrCa survivors that may benefit from medical evaluation prior to starting exercise in a manner that does not interrupt clinical oncology workflow. Approximately 35% of BrCa survivors may benefit from medical evaluation prior to starting community/home-based exercise.
Collapse
Affiliation(s)
| | - Xiaochen Zhang
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Justin C Brown
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kathryn H Schmitz
- Public Health Science, Penn State College of Medicine, Penn State Cancer Institute, Room T3427, 500 University Drive, Mail code CH69, Hershey, PA, 17033, USA.
| |
Collapse
|
43
|
Jain R, Denlinger CS. Incorporating Weight Management into Clinical Care for Cancer Survivors: Challenges, Opportunities, and Future Directions. Obesity (Silver Spring) 2017; 25 Suppl 2:S27-S29. [PMID: 29086512 PMCID: PMC5744874 DOI: 10.1002/oby.22016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 08/22/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Rishi Jain
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | | |
Collapse
|
44
|
Basen-Engquist K, Alfano CM, Maitin-Shepard M, Thomson CA, Schmitz KH, Pinto BM, Stein K, Zucker DS, Syrjala KL, Fallon E, Doyle C, Demark-Wahnefried W. Agenda for Translating Physical Activity, Nutrition, and Weight Management Interventions for Cancer Survivors into Clinical and Community Practice. Obesity (Silver Spring) 2017; 25 Suppl 2:S9-S22. [PMID: 29086526 PMCID: PMC5683412 DOI: 10.1002/oby.22031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 08/23/2017] [Indexed: 12/11/2022]
Abstract
Evidence supporting physical activity, diet, and weight management for cancer survivors has grown, leading to the development of guidelines and interventions. The next step is to identify necessary practice and policy changes and to develop a research agenda to inform how interventions can be delivered to survivors most effectively and efficiently in health care settings and by community-based organizations. Here, an agenda is proposed for research, practice, and policy that incorporates recommendations for a range of programming options, a patient-centered, tailored screening and referral approach, and training needs for survivorship care providers and providers of exercise, nutrition, and weight management services. Research needs to focus on sustainability, dissemination, and implementation. Needed policy changes are presented, as well as opportunities to leverage current health care policies.
Collapse
Affiliation(s)
- Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | - Cynthia A Thomson
- Department of Health Promotion Sciences, University of Arizona, Tucson, Arizona, USA
| | - Kathryn H Schmitz
- Department of Public Health Science, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Bernardine M Pinto
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Kevin Stein
- Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Karen L Syrjala
- Biobehavioral Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Colleen Doyle
- American Cancer Society, Inc., Atlanta, Georgia, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, USA
| |
Collapse
|
45
|
Enhancing an oncologist's recommendation to exercise to manage fatigue levels in breast cancer patients: a randomized controlled trial. Support Care Cancer 2017; 26:905-912. [PMID: 28965138 DOI: 10.1007/s00520-017-3909-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/25/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Fatigue is a troublesome symptom for breast cancer patients, which might be mitigated with exercise. Cancer patients often prefer their oncologist recommend an exercise program, yet a recommendation alone may not be enough to change behavior. Our study determined whether adding an exercise DVD to an oncologist's recommendation to exercise led to better outcomes than a recommendation alone. METHODS Ninety breast cancer patients, at varying phases of treatment and stages of disease, were randomized to receive the following: an oncologist verbal recommendation to exercise (REC; n = 43) or REC plus a cancer-specific yoga DVD (REC + DVD; n = 47). Fatigue, vigor, and depression subscales of the Profile of Mood States, and physical activity levels (MET-min/week), exercise readiness, and self-efficacy were assessed at baseline, 4, and 8 weeks. Analyses controlled for age, time since diagnosis, and metastatic disease. RESULTS Over 8 weeks, women in REC + DVD used the DVD an average of twice per week. The REC + DVD group had greater reductions in fatigue (- 1.9 ± 5.0 vs. - 1.0 ± 3.5, p = 0.02), maintained exercise readiness (- 0.1 ± 1.1 vs. - 0.3 ± 1.3; p = 0.03), and reported less of a decrease in physical activity (- 420 ± 3075 vs. - 427 ± 5060 MET-min/week, p = 0.06) compared to REC only. CONCLUSIONS A low-cost, easily distributed, and scalable yoga-based DVD could be a simple booster to an oncologist's advice that motivates breast cancer patients, even those with advanced disease and/or in treatment, to engage in self-care, e.g., exercise, to manage fatigue. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03120819.
Collapse
|
46
|
Modifiable health-related factors (smoking, physical activity and body mass index) and health care use and costs among adult cancer survivors. J Cancer Res Clin Oncol 2017; 143:2469-2480. [DOI: 10.1007/s00432-017-2494-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/04/2017] [Indexed: 01/31/2023]
|
47
|
Christian AH, O'Malley D, Barac A, Miller SM, Hudson SV. Cardiovascular risk and communication among early stage breast cancer survivors. PATIENT EDUCATION AND COUNSELING 2017; 100:1360-1366. [PMID: 28215826 PMCID: PMC5568653 DOI: 10.1016/j.pec.2017.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/01/2017] [Accepted: 02/09/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE African American (AA) women have disproportionately high rates of cardiovascular (CV) risk factors that, coupled with potentially cardiotoxic breast cancer (BC) therapies, place them at risk of adverse CV outcomes. The purpose of this study was to assess CV risk factors among white and AA BC survivors and perceptions of patient-provider CV-related communication and post-treatment information needs. METHODS Early-stage, English-speaking BC survivors were recruited through community-based survivorship organizations/clinics in New Jersey. Qualitative, semi-structured interviews and a brief survey of socio-demographics and comorbidities were conducted. RESULTS BC survivors reported high rates of CV risk factors. Most reported their health as good/excellent despite their cancer history and CV risk profile. Approximately half of overweight/obese BC survivors reported no weight-related conversation with their health care team and, among those who reported discussion, 36% indicated it was self-initiated and dismissed. More than half of BC survivors' reported a desire for lifestyle-related information and guidance. CONCLUSION BC survivors may not understand how their separate, yet cumulative, health issues can impact their CV risk. PRACTICE IMPLICATIONS Patient-provider communication on behavioral risk factor modification and CV risk is needed, particularly among at-risk subgroups such as AA and obese BC survivors, to improve BC and CV outcomes.
Collapse
Affiliation(s)
- Allison H Christian
- Department of Health Education and Behavioral Science, Rutgers, The State University, School of Public Health, Piscataway, NJ, United States; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States.
| | | | - Ana Barac
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States
| | - Suzanne M Miller
- Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, United States
| | - Shawna V Hudson
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, United States
| |
Collapse
|
48
|
Development and validation of a screening instrument to identify cardiometabolic predictors of mortality in older individuals with cancer: Secondary analysis of the Australian Longitudinal Study of Ageing (ALSA). J Geriatr Oncol 2017. [PMID: 28642039 DOI: 10.1016/j.jgo.2017.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of this study was to identify significant cardiometabolic predictors of mortality among older cancer survivors and develop and validate a screening instrument to assess individual risk of mortality. MATERIALS AND METHODS Retrospective cohort study used collected data from the ALSA. Cox proportional hazards model was used to derive the risk equation for mortality that could be evaluated at 10years. Measures of discrimination and calibration were calculated in the validation cohort. RESULTS The equation was developed using 294 cancer survivors and validated in 127 different cancer survivors. Significant cardiometabolic predictors of mortality included in the final model are age, sex, history of cerebrovascular disease, non-adherence to exercise guidelines (150min moderate activity per week), and smoking. Discrimination and calibration were acceptable with minimal differences in C statistics (0.0442, 95% CI: -0.0149 to 0.103) and adjusted R2 values (0.0407, 95% CI: -0.181 to 0.0998) between the development and validation cohorts, respectively. CONCLUSION We have developed and validated the first screening tool to predict cardiometabolic risk of mortality in older cancer survivors and defined centile values for risk classification. Further validation and research on the usability and usefulness of the tool in clinical practice are recommended in order to target cancer survivors for interventions. Cost effectiveness of such an approach should also be examined.
Collapse
|
49
|
Tarasenko YN, Miller EA, Chen C, Schoenberg NE. Physical activity levels and counseling by health care providers in cancer survivors. Prev Med 2017; 99:211-217. [PMID: 28131780 DOI: 10.1016/j.ypmed.2017.01.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/21/2017] [Accepted: 01/21/2017] [Indexed: 01/30/2023]
Abstract
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.
Collapse
Affiliation(s)
- Yelena N Tarasenko
- Departments of Health Policy and Management and Epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, 501 Forest Drive 2012, Statesboro, GA 30458, USA.
| | | | - Chen Chen
- Department of Health Policy & Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, USA.
| | - Nancy E Schoenberg
- College of Public Health, University of Kentucky, Lexington, KY 40536-0086, USA.
| |
Collapse
|
50
|
Morton LM, Saber W, Baker KS, Barrett AJ, Bhatia S, Engels EA, Gadalla SM, Kleiner DE, Pavletic S, Burns LJ. National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Subsequent Neoplasms Working Group Report. Biol Blood Marrow Transplant 2017; 23:367-378. [PMID: 27634019 PMCID: PMC5285307 DOI: 10.1016/j.bbmt.2016.09.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 01/06/2023]
Abstract
Subsequent neoplasms (SN) after hematopoietic cell transplantation (HCT) cause significant patient morbidity and mortality. Risks for specific SN types vary substantially, with particularly elevated risks for post-transplantation lymphoproliferative disorders, myelodysplastic syndrome/acute myeloid leukemia, and squamous cell malignancies. This document provides an overview of the current state of knowledge regarding SN after HCT and recommends priorities and approaches to overcome challenges and gaps in understanding. Numerous factors have been suggested to affect risk, including patient-related (eg, age), primary disease-related (eg, disease type, pre-HCT therapies), and HCT-related characteristics (eg, type and intensity of conditioning regimen, stem cell source, development of graft-versus-host disease). However, gaps in understanding remain for each of these risk factors, particularly for patients receiving HCT in the current era because of substantial advances in clinical transplantation practices. Additionally, the influence of nontransplantation-related risk factors (eg, germline genetic susceptibility, oncogenic viruses, lifestyle factors) is poorly understood. Clarification of the magnitude of SN risks and identification of etiologic factors will require large-scale, long-term, systematic follow-up of HCT survivors with detailed clinical data. Most investigations of the mechanisms of SN pathogenesis after HCT have focused on immune drivers. Expansion of our understanding in this area will require interdisciplinary laboratory collaborations utilizing measures of immune function and availability of archival tissue from SN diagnoses. Consensus-based recommendations for optimal preventive, screening, and therapeutic approaches have been developed for certain SN after HCT, whereas for other SN, general population guidelines are recommended. Further evidence is needed to specifically tailor preventive, screening, and therapeutic guidelines for SN after HCT, particularly for unique patient populations. Accomplishment of this broad research agenda will require increased investment in systematic data collection with engagement from patients, clinicians, and interdisciplinary scientists to reduce the burden of SN in the rapidly growing population of HCT survivors.
Collapse
Affiliation(s)
- Lindsay M Morton
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - K Scott Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - A John Barrett
- Stem Cell Transplantation Section, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Eric A Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Shahinaz M Gadalla
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - David E Kleiner
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Steven Pavletic
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Linda J Burns
- National Marrow Donor Program/Be The Match and Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| |
Collapse
|