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Brown JC. Measures of physical function clarify the prognostic blur of cancer survivorship. J Natl Cancer Inst 2024:djae076. [PMID: 38630585 DOI: 10.1093/jnci/djae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Affiliation(s)
- Justin C Brown
- Department of Cancer Energetics, Pennington Biomedical Research Center, Baton Rouge, LA, USA
- Department of Genetics, Louisiana State University Health Sciences Center, New Orleans School of Medicine, New Orleans, LA, USA
- Department of Interdisciplinary Oncology, Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Population Sciences & Disparities Program, Louisiana Cancer Research Center, New Orleans, LA, USA
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Zhang T, Wakefield CE, Ren Z, Chen W, Du X, Shi C, Lai L, Zhao C, Gao Y, Chen Z, Zhou Y, Wu T, Cai M. Effects of digital psychological interventions on physical symptoms in cancer patients: A systematic review and meta-analysis. Gen Hosp Psychiatry 2023; 84:47-59. [PMID: 37385139 DOI: 10.1016/j.genhosppsych.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/12/2023] [Accepted: 05/25/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE This meta-analysis was to assess the efficacy of digital psychological interventions to improve physical symptoms (i.e., fatigue, pain, disturbed sleep, and physical well-being) among cancer patients, as well as to evaluate the variables that possibly moderate intervention effects. METHODS Nine databases were searched for the literature up to February 2023. Two reviewers independently conducted a quality assessment. Effect sizes were reported as the standardized mean difference (Hedge's g) and estimated using a random-effects model. RESULTS The meta-analysis included 44 randomized clinical trials comprising 7200 adults with cancer. Digital psychological interventions were associated with significant improvements in short-term fatigue (g = -0.33; 95% CI, -0.58 to -0.07) and disturbed sleep (g = -0.36; 95% CI, -0.57 to -0.15), but with non-significant changes in pain (g = -0.23; 95% CI, -0.68 to 0.21) and physical well-being (g = 0.31; 95% CI, -0.18 to 0.80). Additionally, no alleviation in long-term physical symptoms was observed. In subgroup analysis, results suggest that the country significantly moderated the effectiveness of digital psychological interventions in alleviating fatigue. CONCLUSIONS Digital psychological interventions can be effective for improving short-term fatigue and disturbed sleep in patients with cancer. Clinicians could consider digital psychological interventions as a possible and efficient addition to better manage some of the physical symptoms during and after cancer treatment.
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Affiliation(s)
- Tao Zhang
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Claire Elizabeth Wakefield
- School of Clinical Medicine, UNSW Medicine and Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Sydney, New South Wales, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Zhihong Ren
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China.
| | - Wenke Chen
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Xiayu Du
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Congrong Shi
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Lizu Lai
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Chunxiao Zhao
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Yujun Gao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhuang Chen
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Yubu Zhou
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Tong Wu
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Manqi Cai
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
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Trommer M, Marnitz S, Skoetz N, Rupp R, Niels T, Morgenthaler J, Theurich S, von Bergwelt-Baildon M, Baues C, Baumann FT. Exercise interventions for adults with cancer receiving radiation therapy alone. Cochrane Database Syst Rev 2023; 3:CD013448. [PMID: 36912791 PMCID: PMC10010758 DOI: 10.1002/14651858.cd013448.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND Radiation therapy (RT) is given to about half of all people with cancer. RT alone is used to treat various cancers at different stages. Although it is a local treatment, systemic symptoms may occur. Cancer- or treatment-related side effects can lead to a reduction in physical activity, physical performance, and quality of life (QoL). The literature suggests that physical exercise can reduce the risk of various side effects of cancer and cancer treatments, cancer-specific mortality, recurrence of cancer, and all-cause mortality. OBJECTIVES To evaluate the benefits and harms of exercise plus standard care compared with standard care alone in adults with cancer receiving RT alone. SEARCH METHODS We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid), CINAHL, conference proceedings and trial registries up to 26 October 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) that enrolled people who were receiving RT without adjuvant systemic treatment for any type or stage of cancer. We considered any type of exercise intervention, defined as a planned, structured, repetitive, objective-oriented physical activity programme in addition to standard care. We excluded exercise interventions that involved physiotherapy alone, relaxation programmes, and multimodal approaches that combined exercise with other non-standard interventions such as nutritional restriction. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology and the GRADE approach for assessing the certainty of the evidence. Our primary outcome was fatigue and the secondary outcomes were QoL, physical performance, psychosocial effects, overall survival, return to work, anthropometric measurements, and adverse events. MAIN RESULTS Database searching identified 5875 records, of which 430 were duplicates. We excluded 5324 records and the remaining 121 references were assessed for eligibility. We included three two-arm RCTs with 130 participants. Cancer types were breast and prostate cancer. Both treatment groups received the same standard care, but the exercise groups also participated in supervised exercise programmes several times per week while undergoing RT. Exercise interventions included warm-up, treadmill walking (in addition to cycling and stretching and strengthening exercises in one study), and cool-down. In some analysed endpoints (fatigue, physical performance, QoL), there were baseline differences between exercise and control groups. We were unable to pool the results of the different studies owing to substantial clinical heterogeneity. All three studies measured fatigue. Our analyses, presented below, showed that exercise may reduce fatigue (positive SMD values signify less fatigue; low certainty). • Standardised mean difference (SMD) 0.96, 95% confidence interval (CI) 0.27 to 1.64; 37 participants (fatigue measured with Brief Fatigue Inventory (BFI)) • SMD 2.42, 95% CI 1.71 to 3.13; 54 participants (fatigue measured with BFI) • SMD 1.44, 95% CI 0.46 to 2.42; 21 participants (fatigue measured with revised Piper Fatigue Scale) All three studies measured QoL, although one provided insufficient data for analysis. Our analyses, presented below, showed that exercise may have little or no effect on QoL (positive SMD values signify better QoL; low certainty). • SMD 0.40, 95% CI -0.26 to 1.05; 37 participants (QoL measured with Functional Assessment of Cancer Therapy-Prostate) • SMD 0.47, 95% CI -0.40 to 1.34; 21 participants (QoL measured with World Health Organization QoL questionnaire (WHOQOL-BREF)) All three studies measured physical performance. Our analyses of two studies, presented below, showed that exercise may improve physical performance, but we are very unsure about the results (positive SMD values signify better physical performance; very low certainty) • SMD 1.25, 95% CI 0.54 to 1.97; 37 participants (shoulder mobility and pain measured on a visual analogue scale) • SMD 3.13 (95% CI 2.32 to 3.95; 54 participants (physical performance measured with the six-minute walk test) Our analyses of data from the third study showed that exercise may have little or no effect on physical performance measured with the stand-and-sit test, but we are very unsure about the results (SMD 0.00, 95% CI -0.86 to 0.86, positive SMD values signify better physical performance; 21 participants; very low certainty). Two studies measured psychosocial effects. Our analyses (presented below) showed that exercise may have little or no effect on psychosocial effects, but we are very unsure about the results (positive SMD values signify better psychosocial well-being; very low certainty). • SMD 0.48, 95% CI -0.18 to 1.13; 37 participants (psychosocial effects measured on the WHOQOL-BREF social subscale) • SMD 0.29, 95% CI -0.57 to 1.15; 21 participants (psychosocial effects measured with the Beck Depression Inventory) Two studies recorded adverse events related to the exercise programmes and reported no events. We estimated the certainty of the evidence as very low. No studies reported adverse events unrelated to exercise. No studies reported the other outcomes we intended to analyse (overall survival, anthropometric measurements, return to work). AUTHORS' CONCLUSIONS There is little evidence on the effects of exercise interventions in people with cancer who are receiving RT alone. While all included studies reported benefits for the exercise intervention groups in all assessed outcomes, our analyses did not consistently support this evidence. There was low-certainty evidence that exercise improved fatigue in all three studies. Regarding physical performance, our analysis showed very low-certainty evidence of a difference favouring exercise in two studies, and very low-certainty evidence of no difference in one study. We found very low-certainty evidence of little or no difference between the effects of exercise and no exercise on quality of life or psychosocial effects. We downgraded the certainty of the evidence for possible outcome reporting bias, imprecision due to small sample sizes in a small number of studies, and indirectness of outcomes. In summary, exercise may have some beneficial outcomes in people with cancer who are receiving RT alone, but the evidence supporting this statement is of low certainty. There is a need for high-quality research on this topic.
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Affiliation(s)
- Maike Trommer
- Department of Radiation Oncology, Cyberknife and Radiotherapy, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Simone Marnitz
- Department of Radiation Oncology, Cyberknife and Radiotherapy, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Nicole Skoetz
- Cochrane Cancer, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ronja Rupp
- Internal Medicine I, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Timo Niels
- Internal Medicine I, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Janis Morgenthaler
- Department of Radiation Oncology, Cyberknife and Radiotherapy, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Sebastian Theurich
- Internal Medicine III - Hematology/Oncology, University Hospital Munich, Munich, Germany
| | | | - Christian Baues
- Department of Radiation Oncology, Cyberknife and Radiotherapy, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Freerk T Baumann
- Internal Medicine I, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Aune D, Markozannes G, Abar L, Balducci K, Cariolou M, Nanu N, Vieira R, Anifowoshe YO, Greenwood DC, Clinton SK, Giovannucci EL, Gunter MJ, Jackson A, Kampman E, Lund V, McTiernan A, Riboli E, Allen K, Brockton NT, Croker H, Katsikioti D, McGinley-Gieser D, Mitrou P, Wiseman M, Velikova G, Demark-Wahnefried W, Norat T, Tsilidis KK, Chan DSM. Physical Activity and Health-Related Quality of Life in Women With Breast Cancer: A Meta-Analysis. JNCI Cancer Spectr 2022; 6:pkac072. [PMID: 36474321 PMCID: PMC9727071 DOI: 10.1093/jncics/pkac072] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/27/2022] [Accepted: 09/16/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Physical activity (PA) is associated with improved health-related quality of life (HRQoL) among women with breast cancer; however, uncertainty remains regarding PA types and dose (frequency, duration, intensity) and various HRQoL measures. A systematic review and meta-analysis of randomized controlled trials was conducted to clarify whether specific types and doses of physical activity was related to global and specific domains of HRQoL, as part of the Global Cancer Update Programme, formerly known as the World Cancer Research Fund-American Institute for Cancer Research Continuous Update Project. METHODS PubMed and CENTRAL databases were searched up to August 31, 2019. Weighted mean differences (WMDs) in HRQoL scores were estimated using random effects models. An independent expert panel graded the evidence. RESULTS A total of 79 randomized controlled trials (14 554 breast cancer patients) were included. PA interventions resulted in higher global HRQoL as measured by the Functional Assessment of Cancer Therapy-Breast (WMD = 5.94, 95% confidence intervals [CI] = 2.64 to 9.24; I2 = 59%, n = 12), Functional Assessment of Cancer Therapy-General (WMD = 4.53, 95% CI = 1.94 to 7.13; I2 = 72%, n = 18), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (WMD = 6.78, 95% CI = 2.61 to 10.95; I2 = 76.3%, n = 17). The likelihood of causality was considered probable that PA improves HRQoL in breast cancer survivors. Effects were weaker for physical function and mental and emotional health. Evidence regarding dose and type of PA remains insufficient for firm conclusions. CONCLUSION PA results in improved global HRQoL in breast cancer survivors with weaker effects observed for physical function and mental and emotional health. Additional research is needed to define the impact of types and doses of activity on various domains of HRQoL.
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Affiliation(s)
- Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Georgios Markozannes
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Leila Abar
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Katia Balducci
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Margarita Cariolou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Neesha Nanu
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Rita Vieira
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Yusuf O Anifowoshe
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Darren C Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Steven K Clinton
- The Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA
| | - Marc J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer-World Health Organization, Lyon, France
| | - Alan Jackson
- National Institute for Health Research, Southampton Biomedical Research Centre, Southampton, UK
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Vivien Lund
- World Cancer Research Fund International, London, UK
| | - Anne McTiernan
- Division of Public Health Sciences, Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- School of Public Health, Department of Epidemiology, University of Washington, Seattle, WA, USA
- School of Medicine, Department of Medicine (Geriatrics), University of Washington, Seattle, WA, USA
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Kate Allen
- World Cancer Research Fund International, London, UK
| | | | - Helen Croker
- World Cancer Research Fund International, London, UK
| | | | | | | | | | - Galina Velikova
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | | | - Teresa Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Doris S M Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Adsul P, Schmitz K, Basen-Engquist KM, Rogers LQ. Studying the implementation of exercise oncology interventions: a path forward. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2022; 7:1-8. [PMID: 36407802 PMCID: PMC9674226 DOI: 10.1249/tjx.0000000000000208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction/Purpose Extensive scientific evidence supports exercise benefits after a cancer diagnosis and the field now needs to focus on elucidating effective strategies for implementing exercise evidence-based interventions (EBIs) for cancer survivors. Methods This paper brings together three implementation efforts to describe pragmatic observations and strategies when implementing exercise oncology EBIs in non-research settings. From these projects, we report on common implementation barriers and facilitators. We then mapped these observations and strategies on to the phases and processes described in the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework. Results The first implementation project used key stakeholders' perspectives to develop a toolkit to implement BEAT Cancer (Better Exercise Adherence after Treatment for Cancer), a self-managed intervention led by fitness professionals. The second project adapted a physical activity behavior change intervention (Active Living after Cancer) for use in the broader community. The third project adapted an in-person exercise intervention in a community setting (Physical Activity and Lymphedema) into an out-patient rehabilitation setting, including home-based intervention elements (Strength After Breast Cancer). We retrospectively collated and operationalized the implementation strategies based on the Experts Recommending Implementation Change (ERIC) study. The most common implementation barriers were related to funding, organizational capacity and training, relationship building, patient referral, and engagement with patients. Conclusions These implementation strategies provide initial starting points for the implementation of exercise oncology EBIs in clinical and community settings while also serving as examples for future implementation research to advance the translation of exercise oncology evidence.
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Affiliation(s)
- Prajakta Adsul
- Department of Internal Medicine, University of New Mexico,
Albuquerque, NM, USA
| | - Kathryn Schmitz
- Department of Public Health Sciences, Penn State College
of Medicine, Hershey, PA, USA
| | - Karen M. Basen-Engquist
- Department of Behavioral Science, The University of Texas
MD Anderson Cancer Center, Houston, TX, USA
| | - Laura Q. Rogers
- Department of Medicine, University of Alabama at
Birmingham, Birmingham, AL, USA
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Fraser SF, Gardner JR, Dalla Via J, Daly RM. The Effect of Exercise Training on Lean Body Mass in Breast Cancer Patients: A Systematic Review and Meta-analysis. Med Sci Sports Exerc 2022; 54:211-219. [PMID: 34559724 DOI: 10.1249/mss.0000000000002792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Reduced lean body mass (LBM) is common during and after treatment for breast cancer, and it is associated with increased treatment-induced toxicity, shorter time to tumor progression, and decreased survival. Exercise training is a potential intervention for maintaining or increasing LBM. We conducted a systematic review and a meta-analysis to investigate the effects of exercise training on LBM in breast cancer. METHODS A comprehensive search was performed to November 2020 for randomized controlled trials reporting the effects of structured exercise training on LBM compared with control in women with breast cancer during or after cancer treatment. A random-effects meta-analysis was completed using the absolute net difference in the change in LBM between intervention and control groups as the outcome measure. Sensitivity and subgroup analyses were also performed. RESULTS Data from 17 studies involving 1743 breast cancer survivors were included in the meta-analysis. Overall, there was a significant benefit of exercise training compared with control on LBM (0.58 kg, 95% confidence interval = 0.27 to 0.88, P < 0.001). Subgroup analysis showed positive effects for resistance training (0.59 kg) and aerobic training (0.29 kg), and for exercise training conducted during (0.47 kg) or after (0.66 kg) cancer treatment. Exercise training was beneficial in studies enrolling postmenopausal women (0.58 kg) as well as in those with participants of mixed menopausal status (1.46 kg). CONCLUSIONS Compared with usual care, exercise training has a beneficial effect on LBM in women with breast cancer, both during and after cancer treatment. Given the physiological and functional importance of LBM in women with breast cancer, oncologists should encourage their patients to engage in regular exercise training, with particular emphasis on resistance training.
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Affiliation(s)
- Steve F Fraser
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, AUSTRALIA
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Zhang X, Pennell ML, Bernardo BM, Clark J, Krok-Schoen JL, Focht BC, Crane TE, Shadyab AH, Paskett ED. Body image, physical activity and psychological health in older female cancer survivors. J Geriatr Oncol 2021; 12:1059-1067. [PMID: 33967023 DOI: 10.1016/j.jgo.2021.04.007] [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: 12/01/2020] [Revised: 04/08/2021] [Accepted: 04/29/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To determine the association of physical activity and body image with psychological health outcomes and whether body image mediates the association of physical activity with psychological health among older female cancer survivors. MATERIALS AND METHODS Data from the Women's Health Initiative (WHI) Life and Longevity after Cancer (LILAC) Study were used. Surveys assessed body image (appearance, attractiveness, scars), moderate-strenuous physical activity (min/week), and psychological health (depression, anxiety, distress). A mediation analysis was conducted to estimate the percentage of the total effect of physical activity on psychological health mediated by body image concerns. RESULTS Among 4567 female cancer survivors aged 66-98 years, the average time since cancer diagnosis was 9.2 years. Approximately 50% reported no moderate-strenuous physical activity; 15% reported depressive symptoms, 6% reported anxiety, and 5% reported psychological distress; 3% had concerns with appearance, 20% had concerns with attractiveness, and 21% had concerns with scars. When unadjusted for body image concerns, every 30 min/week increase in physical activity was associated with lower risk of depressive symptoms (RR = 0.93, 95%CI: 0.90-0.96), anxiety (RR = 0.92, 95%CI: 0.87-0.97), and distress (RR = 0.92, 95%CI: 0.87-0.98). Body image concerns with appearance mediated 7%, 8.8%, and 14.5% of the association between physical activity and depressive symptoms, anxiety, and distress, respectively. CONCLUSION Older female cancer survivors reported body image concerns, which were associated with both physical activity and psychological health. Our findings suggest that interventions designed to address body image concerns in older female cancer survivors could serve to improve the benefit of physical activity on psychological health.
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Affiliation(s)
- Xiaochen Zhang
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States of America
| | - Michael L Pennell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Brittany M Bernardo
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States of America
| | - Justin Clark
- Department of Mathematics and Statistics, Kenyon College, Gambier, OH, United States of America
| | - Jessica L Krok-Schoen
- Division of Health Sciences and Medical Dietetics, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, United States of America
| | - Brian C Focht
- Kinesiology, Department of Human Sciences, The Ohio State University, Columbus, OH, United States of America
| | - Tracy E Crane
- Biobehavioral Health Sciences Division, College of Nursing, University of Arizona, Tucson, AZ, United States of America
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, United States of America
| | - Electra D Paskett
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States of America.
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Montaño-Rojas LS, Romero-Pérez EM, Medina-Pérez C, Reguera-García MM, de Paz JA. Resistance Training in Breast Cancer Survivors: A Systematic Review of Exercise Programs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186511. [PMID: 32906761 PMCID: PMC7558202 DOI: 10.3390/ijerph17186511] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/29/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022]
Abstract
The aim of this study was to identify the characteristics of resistance training (RT) programs for breast cancer survivors (BCS). A systematic review of the literature was performed using PubMed, Medline, Science Direct, the Cochrane Breast Cancer Specialised Register of the Cochrane Library, the Physiotherapy Evidence Database (PEDro), and Scopus, with the aim of identifying all published studies on RT and BCS from 1 January 1990 to 6 December 2019, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias in the studies was assessed using the revised Cochrane Risk of Bias tool (RoB 2.0). Sixteen trials were included for qualitative analysis. More than half of the trials do not adequately report the characteristics that make up the exercise program. The maximal strength was the most frequently monitored manifestation of strength, evaluated mainly as one-repetition maximum (1RM). Resistance training was performed on strength-training machines, twice a week, using a load between 50% and 80% of 1RM. The trials reported significant improvement in muscle strength, fatigue, pain, quality of life, and minor changes in aerobic capacity.
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Affiliation(s)
- Leidy Sofía Montaño-Rojas
- Escuela Normal Superior of Pitalito, 417037 Pitalito, Colombia
- Correspondence: (L.S.M.-R.); (E.M.R.-P.)
| | - Ena Monserrat Romero-Pérez
- Department of Sports Science and Physical Activity, University of Sonora, 83000 Hermosillo, Mexico
- Correspondence: (L.S.M.-R.); (E.M.R.-P.)
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Ligibel JA, Schmitz KH, Berger NA. Sarcopenia in aging, obesity, and cancer. Transl Cancer Res 2020; 9:5760-5771. [PMID: 33163373 PMCID: PMC7643855 DOI: 10.21037/tcr-2019-eaoc-05] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/03/2020] [Indexed: 12/25/2022]
Abstract
Sarcopenia, defined as loss of muscle mass, strength and physical performance, is a hallmark of aging and is invariably associated with perturbation of amino acid metabolism, increased muscle protein catabolism relative to anabolism, and loss of muscle fibers. Sarcopenia may be associated with general loss of body mass, or it may also occur along with obesity [sarcopenic obesity (SO)]. Although sarcopenia is associated with multiple comorbidities in older adults, its effects may even be more severe in patients with malignant disease where it has been shown to contribute to poor surgical outcomes, increased chemotherapy toxicity associated with both cytotoxic and targeted agents, as well as adversely impacting survival. While development of sarcopenia is a common age-related phenomenon, the associated catabolic processes appear to be promoted by physical inactivity, inadequate nutrition, and systemic low-grade inflammation, as well as intrinsic muscle and molecular changes, including mitochondrial dysfunction and impaired muscle stem cell regenerative capacity. Increased physical activity and adequate protein intake can reduce incidence and severity of sarcopenia in cancer patients, but many older cancer patients do not meet physical activity and nutrition recommendations, and cancer treatment can make it more difficult to make favorable lifestyle changes. Sarcopenia is discussed in terms of its adverse clinical consequences in older subjects and particularly, in older patients with cancer. Contributions of lifestyle, molecular, and cellular factors are likewise reviewed with suggestions for interventions to improve sarcopenia and its comorbid sequalae.
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Affiliation(s)
- Jennifer A. Ligibel
- Division of Women’s Cancers, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Kathryn H. Schmitz
- Department Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Nathan A. Berger
- Department Medicine, Biochemistry, Oncology, Genetics & Genome Sciences, Center for Science, Health and Society, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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10
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Calo WA, Doerksen SE, Spanos K, Pergolotti M, Schmitz KH. Implementing Strength after Breast Cancer (SABC) in outpatient rehabilitation clinics: mapping clinician survey data onto key implementation outcomes. Implement Sci Commun 2020; 1:69. [PMID: 32885221 PMCID: PMC7427930 DOI: 10.1186/s43058-020-00060-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 07/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background While 3.5 million breast cancer survivors in the USA are indicative of promising disease-free survival, many experience adverse effects in recovering from treatment. Evidence-based exercise programs may be a low-cost, easily disseminable solution to the challenge of recovering from adverse treatment affects. Therefore, after establishing efficacy in a large randomized controlled trial, we developed the Strength after Breast Cancer (SABC) program and the accompanying online course for clinicians interested in physical therapy to learn to deliver this rehabilitative exercise program to individuals with breast cancer. We surveyed clinicians who took the course to assess implementation of the program in outpatient rehabilitation clinics. Methods Ninety-six clinicians completed the survey between June and December, 2017 (24% response). Guided by Proctor's implementation outcomes framework, the respondents were asked if they had implemented (adoption) and are still implementing the program (sustainability), and which programmatic components they implemented (fidelity). Respondents were asked how many patients completed the program (reach), how patients got into the program (reach), the program's delivery format (appropriateness), and whether clinics were reimbursed by third-party payers (cost). Finally, respondents were asked what barriers they faced in delivery of SABC (feasibility) and whether others in the clinic completed the course (penetration). Results Seventy-six percent of respondents implemented SABC and among those, 93% (68/73) were still delivering it. All programmatic components were implemented by over two thirds of respondents (67-95%). On average, the program was delivered to 13 patients per clinic by the time respondents took the survey. Most patient referrals were from oncology clinics (50%). The majority of clinicians delivered SABC one-on-one (96%) and 72% of clinics were compensated via third-party payers. Major barriers were lack of referrals from oncologists (40%) and clinic's competing demands (33%). We found no differences (Fisher's exact test p > .05) in reported barriers between those who implemented the program and those who did not. Conclusion Our findings suggest that the online training was sufficient to successfully implement the SABC program in outpatient rehabilitation clinics with high levels of adoption, fidelity, reach, and capacity for sustainability. Information on patient acceptability, cost-effectiveness, and how to overcome implementation barriers are still needed.
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Affiliation(s)
- William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, 500 University Drive, Mail Code CH69, Hershey, PA 17033 USA.,Penn State Cancer Institute, Hershey, PA USA
| | - Shawna E Doerksen
- Department of Public Health Sciences, Penn State College of Medicine, 500 University Drive, Mail Code CH69, Hershey, PA 17033 USA
| | - Katherine Spanos
- Department of Public Health Sciences, Penn State College of Medicine, 500 University Drive, Mail Code CH69, Hershey, PA 17033 USA.,Dartmouth College, Hanover, NH USA
| | - Mackenzi Pergolotti
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA USA.,Department of Occupational Therapy, Colorado State University, Fort Collins, CO USA
| | - Kathryn H Schmitz
- Department of Public Health Sciences, Penn State College of Medicine, 500 University Drive, Mail Code CH69, Hershey, PA 17033 USA.,Penn State Cancer Institute, Hershey, PA USA
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11
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Boing L, Vieira MDCS, Moratelli J, Bergmann A, Guimarães ACDA. Effects of exercise on physical outcomes of breast cancer survivors receiving hormone therapy - A systematic review and meta-analysis. Maturitas 2020; 141:71-81. [PMID: 33036706 DOI: 10.1016/j.maturitas.2020.06.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/14/2020] [Accepted: 06/24/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Side-effects of hormone therapy can impair the physical health of breast cancer survivors. Exercise has been clearly shown to improve the quality of life of breast cancer survivors. Less is known about the effects of exercise on physical outcomes for breast cancer survivors receiving hormone therapy. OBJECTIVE To investigate the effects of exercise on physical outcomes of breast cancer survivors receiving hormone therapy. METHODS Five electronic databases were searched by two authors using the terms "Breast Neoplasms" [MeSH] and "Tamoxifen" [MeSH] and "Aromatase Inhibitors" [MeSH] and "Exercise" [MeSH]. Randomized and non-randomized clinical trials were included. Risk of bias was assessed by the Cochrane Collaboration tool and ROBINS-I, and the quality of evidence was evaluated using GRADE. Pooled effects were reported as standardized mean differences (SMDs) and 95 % confidence intervals (CIs) using a random effects model. RESULTS Eleven studies were included in the meta-analysis. Two hundred and fourteen breast cancer survivors receiving hormone therapy, tamoxifen, or aromatase inhibitors participated in interventions based on aerobic plus resistance exercise or walking activity. The physical outcomes reported in the articles were: cardiorespiratory fitness, pain, bone mineral density, grip strength, and body fat percentage. Exercise effects were found only for cardiorespiratory fitness (SMD = 0.37; 95 % CI: 0.11; 0.63; I2 = 93 %) and pain (SMD = -0.55; IC95 % -1.11; -0.00; I2 = 80 %), with low quality of evidence. No effects were observed for the other variables. CONCLUSIONS Aerobic plus resistance exercise had positive effects on cardiorespiratory fitness and pain in breast cancer survivors receiving hormone therapy. However, high-quality randomized clinical trials are required to confirm this finding.
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Affiliation(s)
- Leonessa Boing
- College of Health and Sport Science, Santa Catarina State University, Brazil.
| | | | - Jéssica Moratelli
- College of Health and Sport Science, Santa Catarina State University, Brazil
| | - Anke Bergmann
- Clinical Research Program, National Cancer Institute, Brazil
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12
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Resistance exercise and breast cancer-related lymphedema-a systematic review update and meta-analysis. Support Care Cancer 2020; 28:3593-3603. [PMID: 32415386 PMCID: PMC7316683 DOI: 10.1007/s00520-020-05521-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/06/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND The purpose of this systematic review update and meta-analysis was to analyze resistance exercise (RE) intervention trials in breast cancer survivors (BCS) regarding their effect on breast cancer-related lymphedema (BCRL) status and upper and lower extremity strength. METHODS Systematic literature search was conducted utilizing PubMed, MEDLINE, and Embase databases. Any exercise intervention studies-both randomized controlled and uncontrolled-which assessed the effects of RE on BCRL in BCS in at least one intervention group published between 1966 and 31st January 2020 were included. Included articles were analyzed regarding their level of evidence and their methodological quality using respective tools for randomized and nonrandomized trials of the Cochrane collaboration. Meta-analysis for bioimpedance spectroscopy (BIS) values as well as upper and lower extremity strength was conducted. RESULTS Altogether, 29 studies were included in the systematic review. Results of six studies with altogether twelve RE intervention groups could be pooled for meta-analysis of the BCRL. A significant reduction of BCRL after RE was seen in BIS values (95% CI - 1.10 [- 2.19, - 0.01] L-Dex score). Furthermore, strength results of six studies could be pooled and meta-analysis showed significant improvements of muscular strength in the upper and lower extremities (95% CI 8.96 [3.42, 14.51] kg and 95% CI 23.42 [11.95, 34.88] kg, respectively). CONCLUSION RE does not have a systematic negative effect on BCRL and, on the contrary, potentially decreases it.
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13
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Roberts KE, Rickett K, Feng S, Vagenas D, Woodward NE. Exercise therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer. Cochrane Database Syst Rev 2020; 1:CD012988. [PMID: 31994181 PMCID: PMC6987034 DOI: 10.1002/14651858.cd012988.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Survival for stage I to III, hormone receptor-positive, breast cancer has substantially improved over time due to advances in screening, surgery and adjuvant therapy. However many adjuvant therapies have significant treatment-related toxicities, which worsen quality of life for breast cancer survivors. Postmenopausal women with hormone receptor-positive breast cancer are now prescribed aromatase inhibitors (AI) as standard, with longer durations of therapy, up to 10 years, being considered for certain women. AI treatment is associated with a high incidence of AI-induced musculoskeletal symptoms (AIMSS), often described as symmetrical pain and soreness in the joints, musculoskeletal pain and joint stiffness. AIMSS reduces compliance with AI therapy in up to one half of women undergoing adjuvant AI therapy, potentially compromising breast cancer outcomes. Exercise has been investigated for the prevention and treatment of AIMSS but the effect of this intervention remains unclear. OBJECTIVES To assess the effects of exercise therapies on the prevention or management of aromatase inhibitor-induced musculoskeletal symptoms (AIMSS) in women with stage I to III hormone receptor-positive breast cancer. SEARCH METHODS We searched Cochrane Breast Cancer's Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases up to 13 December 2018. We also searched two conference proceedings portals and two clinical trials registries for ongoing studies or unpublished trials, or both, in August 2019. We also reviewed reference lists of the included studies. SELECTION CRITERIA We included randomised controlled trials that compared exercise versus a comparator arm. We did not impose any restriction on the comparator arm, which could include an alternative type of exercise, no exercise or a waiting list control. Both published and non-peer-reviewed studies were eligible. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data, assessed risk of bias and certainty of the evidence using the GRADE approach. The outcomes investigated were pain, joint stiffness, grip strength, health-related quality of life, cancer-specific quality of life, adherence to AI therapy, adverse events, incidence of AIMSS, breast cancer-specific survival and overall survival. For continuous outcomes that were assessed with the same instrument, we used the mean difference (MD); for those outcomes that used different instruments, we used the standardised mean difference (SMD) for the analysis. For dichotomous outcomes, we reported outcomes as an odds ratio (OR). MAIN RESULTS We included seven studies with 400 randomised participants; one study assessed exercise for preventing AIMSS and six studies assessed treating AIMSS. For preventing AIMSS, the single study reported no difference in pain scores, grip strength or compliance to taking AI medication between groups. Data values were not provided in the study and no other outcomes were reported. For managing AIMSS, we found that the evidence for the effect of exercise therapies on overall change in worst pain scores was very uncertain (SMD -0.23, 95% confidence interval (CI) -0.78 to 0.32; 4 studies, 284 women; very low-certainty evidence). The evidence suggested that exercise therapies result in little to no difference in overall change in stiffness scores (Western Ontario McMasters Universities Osteoarthritis Index (WOMAC) stiffness score MD -0.76, 95% CI -1.67 to 0.15 and Visual Analogues Scale (VAS) stiffness score MD -0.42, 95% CI -2.10 to 1.26; 1 study, 53 women; low-certainty evidence). The evidence was very uncertain for the outcomes of overall change in grip strength (MD 0.30, 95% CI -0.55 to 1.15; 1 study, 83 women; very low-certainty evidence); overall change in health-related quality of life (subscales of SF-36 tool ranged from least benefit of MD 1.88, 95% CI -2.69 to 6.45 to most benefit of MD 9.70, 95% CI 1.67 to 17.73; 2 studies, 123 women, very low-certainty evidence); overall change in cancer-specific quality of life (MD 4.58, 95% CI -0.61 to 9.78; 2 studies, 136 women; very low-certainty evidence); and adherence to aromatase inhibitors (OR 2.43, 95% CI 0.41 to 14.63; 2 studies, 224 women; very low-certainty evidence). There were no adverse events identified across four studies in either arm (0 events reported; 4 studies; 331 participants; low-certainty evidence). There were no data reported on incidence of AIMSS, breast cancer-specific survival or overall survival. AUTHORS' CONCLUSIONS Given the wide-ranging benefits of exercise for people affected by cancer, it was surprising that this review provided no clear evidence of benefit for exercise therapies in women with early breast cancer with AIMSS. This review only yielded seven eligible studies with 400 participants, which is likely to have underpowered the findings. The meta-analysis was challenging due to the considerable heterogeneity amongst the trials, with a wide range of exercise regimens and follow-up periods. Despite these inconclusive findings, exercise needs to be part of routine care for women with breast cancer due to its wide-ranging benefits. Future research in this area would be enhanced with further understanding of the mechanism of AIMSS, a single clear definition of the condition, and phase III randomised controlled trials that are adequately powered to test targeted exercise interventions on the key clinical outcomes in this condition.
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Affiliation(s)
- Kate E Roberts
- Princess Alexandra HospitalDepartment of Medical OncologyIpswich RoadWoolloongabbaQueenslandAustralia
- Mater Hospital, University of QueenslandSchool of Clinical Medicine, Mater Clinical UnitSouth BrisbaneAustralia4101
| | - Kirsty Rickett
- UQ/Mater McAuley LibraryThe University of Queensland LibraryRaymond TerraceBrisbaneQueenslandAustralia4101
| | - Sophie Feng
- Mater Misericordiae LtdDepartment of Medical Oncology1 Raymond TceSouth BrisbaneQueenslandAustralia4101
| | - Dimitrios Vagenas
- Queensland University of TechnologyInstitute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - Natasha E Woodward
- Mater Hospital, University of QueenslandSchool of Clinical Medicine, Mater Clinical UnitSouth BrisbaneAustralia4101
- Mater Misericordiae LtdDepartment of Medical Oncology1 Raymond TceSouth BrisbaneQueenslandAustralia4101
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Introduction of the Lymphedema Action Plan (LeAP): Clinical Advancement in Proactive Lymphedema Care. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Sturgeon KM, Mathis KM, Rogers CJ, Schmitz KH, Waning DL. Cancer- and Chemotherapy-Induced Musculoskeletal Degradation. JBMR Plus 2019; 3:e10187. [PMID: 30918923 PMCID: PMC6419610 DOI: 10.1002/jbm4.10187] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/31/2019] [Accepted: 02/06/2019] [Indexed: 12/14/2022] Open
Abstract
Mobility in advanced cancer patients is a major health care concern and is often lost in advanced metastatic cancers. Erosion of mobility is a major component in determining quality of life but also starts a process of loss of muscle and bone mass that further devastates patients. In addition, treatment options become limited in these advanced cancer patients. Loss of bone and muscle occurs concomitantly. Advanced cancers that are metastatic to bone often lead to bone loss (osteolytic lesions) but may also lead to abnormal deposition of new bone (osteoblastic lesions). However, in both cases there is a disruption to normal bone remodeling and radiologic evidence of bone loss. Many antitumor therapies can also lead to loss of bone in cancer survivors. Bone loss releases cytokines (TGFβ) stored in the mineralized matrix that can act on skeletal muscle and lead to weakness. Likewise, loss of skeletal muscle mass leads to reduced bone mass and quality via mechanical and endocrine signals. Collectively these interactions are termed bone-muscle cross-talk, which has garnered much attention recently as a prime target for musculoskeletal health. Pharmacological approaches as well as nutrition and exercise can improve muscle and bone but have fallen short in the context of advanced cancers and cachexia. This review highlights our current knowledge of these interventions and discusses the difficulties in treating severe musculoskeletal deficits with the emphasis on improving not only bone mass and muscle size but also functional outcomes. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Kathleen M Sturgeon
- Department of Public Health SciencePenn State College of MedicineHersheyPAUSA
- Penn State Cancer InstituteHersheyPAUSA
| | - Katlynn M Mathis
- Department of Public Health SciencePenn State College of MedicineHersheyPAUSA
| | - Connie J Rogers
- Penn State Cancer InstituteHersheyPAUSA
- Department of Nutritional SciencesPenn State College of Health and Human DevelopmentUniversity ParkPAUSA
| | - Kathryn H Schmitz
- Department of Public Health SciencePenn State College of MedicineHersheyPAUSA
- Penn State Cancer InstituteHersheyPAUSA
- Department of Physical Medicine and RehabilitationPenn State College of MedicineHersheyPAUSA
| | - David L Waning
- Penn State Cancer InstituteHersheyPAUSA
- Department of Cellular and Molecular PhysiologyPenn State College of MedicineHersheyPAUSA
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16
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Hasenoehrl T, Keilani M, Palma S, Crevenna R. Resistance exercise and breast cancer related lymphedema - a systematic review update. Disabil Rehabil 2019; 42:26-35. [PMID: 30638093 DOI: 10.1080/09638288.2018.1514663] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Purpose of this systematic review update was analyzing resistance exercise (RE) intervention trials in breast cancer survivors (BCS) regarding their effect on breast cancer-related lymphedema (BCRL) status. Articles published until 31 September 2017 were included.Methods: A systematic literature search was conducted utilizing PubMed, MEDLINE, and EMBASE databases. Included articles were analyzed regarding their level of evidence and their methodological quality using the Cochrane risk of bias tool.Results: Altogether, 23 articles could be included of which 16 were independent RE intervention studies and seven additional articles. Lymphedema assessment was so heterogeneous that conduction of a thorough meta-analysis regarding lymphedema status was still impossible. In all but one study, which reported a small but methodologically weak increase in arm volume, no negative effects of RE on BCRL was recorded.Conclusions: RE seems to be a safe exercise intervention for BCS and not to be harmful concerning the risk of lymphedema. Lymphedema assessment methods that allow for a qualitative analysis of arm tissue composition should be favored.Implications for rehabilitationBreast cancer-related lymphedema affects a considerable proportion of breast cancer patients and is debilitating on the physical, functional, social, and psychological domain.At the current time breast cancer related lymphedema is incurable but well manageable by a number of physical therapy modalities, especially complete decongestive therapy (CDT).One of the encouraging treatment methods is resistance exercise.
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Affiliation(s)
- Timothy Hasenoehrl
- Department of Physical Medicine Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Mohammad Keilani
- Department of Physical Medicine Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Stefano Palma
- Department of Physical Medicine Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
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17
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Hagstrom AD, Shorter KA, Marshall PWM. Changes in Unilateral Upper Limb Muscular Strength and Electromyographic Activity After a 16-Week Strength Training Intervention in Survivors of Breast Cancer. J Strength Cond Res 2018; 33:225-233. [PMID: 30562305 DOI: 10.1519/jsc.0000000000001890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hagstrom, AD, Shorter, KA, and Marshall, PWM. Changes in unilateral upper limb muscular strength and Electroymographic activity after a 16-week strength training intervention in survivors of breast cancer. J Strength Cond Res 33(1): 225-233, 2019-Upper limb strength deficits are frequently observed following breast cancer (BC) and its treatments. It is currently unknown whether these unilateral deficits can be corrected by a standard bilateral strength training intervention. Twenty-three survivors of BC were included in this analysis. Fourteen performed a 16-week resistance training (RT) intervention, 9 were assigned to a usual care waitlist control group. Electromyographic analysis of the pectoralis major and triceps brachii were monitored during 3 maximal isometric contractions and a fatiguing endurance task. Muscular strength was significantly different between limbs at the start of the intervention (p = 0.02). Electromyographic amplitude and median frequency did not differ between limbs at the start of the intervention. Muscular strength was significantly different between limbs in the RT group at the end of the intervention (p = 0.01). Electromyographic amplitude did not differ between limbs or groups at the end of the intervention. Bilateral strength training did not correct the unilateral strength deficit observed in this group of survivors of breast cancer. Periods of unilateral strength training should be implemented into periodized RT programs in this cohort.
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Affiliation(s)
- Amanda D Hagstrom
- School of Science and Technology, Department of Sport and Exercise Science University of New England, Armidale, Australia.,School of Science and Health, Department of Sport and Exercise Science Western Sydney University, Campbelltown, Australia
| | - Kathleen A Shorter
- School of Science and Technology, Department of Sport and Exercise Science University of New England, Armidale, Australia
| | - Paul W M Marshall
- School of Science and Health, Department of Sport and Exercise Science Western Sydney University, Campbelltown, Australia
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Brown JC, Cespedes Feliciano EM, Caan BJ. The evolution of body composition in oncology-epidemiology, clinical trials, and the future of patient care: facts and numbers. J Cachexia Sarcopenia Muscle 2018; 9:1200-1208. [PMID: 30637983 PMCID: PMC6351674 DOI: 10.1002/jcsm.12379] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
There is growing interest from the oncology community to understand how body composition measures can be used to improve the delivery of clinical care for the 18.1 million individuals diagnosed with cancer annually. Methods that distinguish muscle from subcutaneous and visceral adipose tissue, such as computed tomography (CT), may offer new insights of important risk factors and improved prognostication of outcomes over alternative measures such as body mass index. In a meta-analysis of 38 studies, low muscle area assessed from clinically acquired CT was observed in 27.7% of patients with cancer and associated with poorer overall survival [hazard ratio: 1.44, 95% CI: 1.32-1.56]. Therapeutic interventions such as lifestyle and pharmacotherapy that modify all aspects of body composition and reduce the incidence of poor clinical outcomes are needed in patients with cancer. In a meta-analysis of six randomized trials, resistance training exercise increased lean body mass assessed from dual-energy X-ray absorptiometry [mean difference (MD): +1.07 kg, 95% CI: 0.76-1.37; P < 0.001] and walking distance [MD: +143 m, 95% CI: 70-216; P < 0.001] compared with usual care control in patients with non-metastatic cancer. In a meta-analysis of five randomized trials, anamorelin (a ghrelin agonist) significantly increased lean body mass [MD: +1.10 kg, 95% CI: 0.35-1.85; P = 0.004] but did not improve handgrip strength [MD: 0.52 kg, 95% CI: -0.09-1.13; P = 0.09] or overall survival compared with placebo [HR: 0.99, 95% CI: 0.85-1.14; P = 0.84] in patients with advanced or metastatic cancer. Early screening to identify individuals with occult muscle loss, combined with multimodal interventions that include lifestyle therapy with resistance exercise training and dietary supplementation combined with pharmacotherapy, may be necessary to provide a sufficient stimulus to prevent or slow the cascade of tissue wasting. Rapid, cost-efficient, and feasible methods to quantify muscle and adipose tissue distribution are needed if body composition assessment is to be integrated into large-scale clinical workflows. Fully automated analysis of body composition from clinically acquired imaging is one example. The study of body composition is one of the most provocative areas in oncology that offers tremendous promise to help patients with cancer live longer and healthier lives.
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Affiliation(s)
- Justin C Brown
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.,Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | | | - Bette J Caan
- Kaiser Permanente Northern California, Oakland, CA, USA
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19
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Williams AD, Bird ML, Hardcastle SG, Kirschbaum M, Ogden KJ, Walters JA. Exercise for reducing falls in people living with and beyond cancer. Cochrane Database Syst Rev 2018; 10:CD011687. [PMID: 30320433 PMCID: PMC6517115 DOI: 10.1002/14651858.cd011687.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Current treatment modalities for cancer have been successful in achieving improved survivorship; however, they come with a number of long-term adverse effects. Accidental falls are a common and clinically significant adverse event in people living with and beyond cancer and rates are higher than in the rest of the population. OBJECTIVES To assess the effects of prescribed or provided exercise for reducing accidental falls, and falls risk factors of strength, flexibility and balance, in people living with and beyond cancer. SEARCH METHODS We searched the following electronic databases from inception to 10 July 2018, with no restrictions: CENTRAL, MEDLINE, Embase, and seven other databases. We searched clinicaltrials.gov and the World Health Organization International Clinical Trials Registry Platform (ICTRP) for ongoing trials, and reference lists of reviews and retrieved articles for additional studies. SELECTION CRITERIA We included all randomised controlled trials investigating exercise interventions versus no treatment, usual care or non-exercise interventions on falls incidence or falls risk factors in adults living with and beyond cancer (18 years of age or older at diagnosis). We excluded cross-over studies and studies in acute or inpatient hospice care. DATA COLLECTION AND ANALYSIS At least two review authors independently completed data extraction for included papers. We used Covidence software to manage screening, data collection and extraction. We assessed evidence using GRADE and presented results in a 'Summary of findings' table. MAIN RESULTS Eleven studies (835 participants) compared exercise to usual care. No studies compared exercise with no treatment or non-exercise interventions. The quality of the evidence was very low for the primary outcome rates of falls, and very low to low for the secondary outcomes. We downgraded the evidence due to study limitations (risk of bias), and issues of imprecision due to small sample sizes, inconsistency and indirectness. All studies were at high risk of bias for blinding of participants and personnel due to inability to blind participants to an exercise intervention. Risk of bias was generally low or unclear for other categories.There was generally little information on the important outcomes comparing exercise to usual care.Rates of falls and number of fallers: one study (223 participants) measured accidental falls, but reported neither the rate of falls or the number of fallers; there was no difference in the number of falls between exercise and usual care (very low-quality evidence).Strength: 10 studies (813 participants) reported on strength outcomes. Two analyses favoured exercise over usual care: quadriceps strength (2 studies, 72 participants; mean difference (MD) 8.99 kg, 95% confidence interval (CI) 1.29 to 16.70; low-quality evidence), and leg press (4 studies, 388 participants; MD 21.1 kg, 95% CI 8.47 to 33.74; low-quality evidence). In one analysis of the Sit-to-Stand Test, there was no difference between exercise and usual care (4 studies, 214 participants; standardised mean difference (SMD) -0.45, 95% CI -1.05 to 0.14; very low-quality evidence).Flexibility: one study (21 participants) reported on flexibility for Sit-and-Reach Distance (MD 2.05 cm, 95% CI 0.59 to 3.51; very low-quality evidence).Balance: five studies (350 participants) measured three different balance outcomes. Two analyses favoured exercise over usual care: postural balance (4 studies, 127 participants; standardised mean difference (SMD) 0.44, 95% CI 0.08 to 0.79; very low-quality evidence), and Backward Walk Test (2 studies, 280 participants; SMD -0.24, 95% CI -0.48 to -0.01; low-quality evidence). There was no difference between exercise and usual care for the Timed Up-and-Go Test (1 study, 15 participants; MD -0.35 seconds, 95% CI -1.47 to 0.77; low-quality evidence).Number of people sustaining a fall-related fracture: the quality of the evidence for exercise reducing fall-related fractures was very low.Adverse events: a single study (223 participants) noted some temporary muscle soreness on initiation of exercise or when there was an increase in the weight lifted. As no occurrence data were reported, we could not assess this variable further. No studies reported musculoskeletal injury. Analysis indicated that there was very low-quality evidence that exercise did not increase fatigue. AUTHORS' CONCLUSIONS There is a paucity of evidence for exercise training to reduce fall rates in people living with and beyond cancer. Exercise training may improve strength, flexibility and balance for people in this population, but the evidence is very low quality.
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Affiliation(s)
- Andrew D Williams
- School of Health Sciences, University of Tasmania, Launceston, Australia
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Davidson NE, Armstrong SA, Coussens LM, Cruz-Correa MR, DeBerardinis RJ, Doroshow JH, Foti M, Hwu P, Kensler TW, Morrow M, Mulligan CG, Pao W, Platz EA, Smith TJ, Willman CL. AACR Cancer Progress Report 2016. Clin Cancer Res 2018; 22 Suppl 19:S1-S137. [PMID: 27697776 DOI: 10.1158/1078-0432.ccr-16-1993] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Brown JC, Harhay MO, Harhay MN. Self-reported major mobility disability and mortality among cancer survivors. J Geriatr Oncol 2018; 9:459-463. [PMID: 29550343 PMCID: PMC6113100 DOI: 10.1016/j.jgo.2018.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/22/2018] [Accepted: 03/06/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To quantify the prevalence of self-reported major mobility disability (SR-MMD) and its association with mortality in a nationally-representative sample of cancer survivors. MATERIALS AND METHODS This study included patients with a history of cancer who participated in the National Health and Nutrition Examination Survey 19992010. SR-MMD was defined as self-reported difficulty or inability to walk a quarter of a mile. Vital status through December 15, 2011 was ascertained from the United States National Center for Health Statistics. Multivariable-adjusted Cox regression models were used to quantify the hazard ratio (HR) and 95% confidence interval (CI) between SR-MMD and mortality. RESULTS The study included 1458 cancer survivors who averaged 67.1 years of age. At baseline, 201 (13.7%) participants had SR-MMD. During a median follow-up of 4.7 years, 434 (29.8%) participants died. SR-MMD was independently associated with a higher risk of all-cause mortality [HR: 2.15 (95% CI: 1.56-2.97); P < 0.001] and cancer-specific mortality [HR: 2.49 (95% CI: 1.53-4.07); P < 0.001]. The association between SR-MMD and all-cause mortality was not modified by age, sex, time since cancer diagnosis, body mass index, or comorbid health conditions. CONCLUSION SR-MMD is an easily ascertainable metric of physical function that is associated with a higher risk of mortality among cancer survivors. Integrating measures of physical function may help to guide clinical decision-making and improve long-term prognostication in this population. Interventions that prevent the development of SR-MDD, such as physical activity, should be evaluated in this population.
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Affiliation(s)
- Justin C Brown
- Division of Population Science, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Michael O Harhay
- Pallaitive and Advanced Illness Research Center, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Meera N Harhay
- Division of Nephrology, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
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Brown JC, Damjanov N, Courneya KS, Troxel AB, Zemel BS, Rickels MR, Ky B, Rhim AD, Rustgi AK, Schmitz KH. A randomized dose-response trial of aerobic exercise and health-related quality of life in colon cancer survivors. Psychooncology 2018; 27:1221-1228. [PMID: 29388275 PMCID: PMC5895514 DOI: 10.1002/pon.4655] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the dose-response effects of aerobic exercise on health-related quality of life (HRQoL) among colon cancer survivors. METHODS Thirty-nine stage I to III colon cancer survivors were randomized to 1 of 3 groups: usual-care control, 150 min·wk-1 of aerobic exercise (low-dose) and 300 min·wk-1 of aerobic exercise (high-dose) for 6 months. HRQoL outcomes included the Short Form (SF)-36 physical and mental component summary, Functional Assessment of Cancer Therapy-Colorectal, Pittsburgh Sleep Quality Index, Fear of Cancer Recurrence Inventory, Fatigue Symptom Inventory, and North Central Cancer Treatment Group bowel function questionnaire, assessed at baseline and post intervention. The primary hypothesis was that exercise would improve HRQoL outcomes in a dose-response fashion, such that high-dose aerobic exercise would yield the largest improvements in HRQoL outcomes. RESULTS Over 6 months, the low-dose group completed 141 ± 10 min·wk-1 of aerobic exercise, and the high-dose group completed 247 ± 11 min·wk-1 of aerobic exercise. Over 6 months, exercise improved the physical component summary score of the SF-36 (Ptrend = 0.002), the Functional Assessment of Cancer Therapy-Colorectal (Ptrend = 0.025), the Pittsburgh Sleep Quality Index (Ptrend = 0.049), and the Fatigue Symptom Inventory (Ptrend = 0.045) in a dose-response fashion. Between-group standardized mean difference effects sizes for the above-described findings were small to moderate in magnitude (0.35-0.75). No dose-response effects were observed for the mental component summary score of the SF-36, the Fear of Cancer Recurrence Inventory, or bowel function. CONCLUSION Higher doses of aerobic exercise, up to 300 min·wk-1 , improve multiple HRQoL outcomes among stage I to III colon cancer survivors. These findings provide evidence that aerobic exercise may provide multiple health benefits for colon cancer survivors.
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Affiliation(s)
| | | | | | | | - Babette S. Zemel
- University of Pennsylvania, Philadelphia, PA, USA, 19104
- Childrens Hospital of Philadelphia, Philadelphia, PA, USA, 19104
| | | | - Bonnie Ky
- University of Pennsylvania, Philadelphia, PA, USA, 19104
| | | | - Anil K. Rustgi
- University of Pennsylvania, Philadelphia, PA, USA, 19104
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Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity for women with breast cancer after adjuvant therapy. Cochrane Database Syst Rev 2018; 1:CD011292. [PMID: 29376559 PMCID: PMC6491330 DOI: 10.1002/14651858.cd011292.pub2] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Women with a diagnosis of breast cancer may experience short- and long-term disease and treatment-related adverse physiological and psychosocial outcomes. These outcomes can negatively impact prognosis, health-related quality of life (HRQoL), and psychosocial and physical function. Physical activity may help to improve prognosis and may alleviate the adverse effects of adjuvant therapy. OBJECTIVES To assess effects of physical activity interventions after adjuvant therapy for women with breast cancer. SEARCH METHODS We searched the Cochrane Breast Cancer Group (CBCG) Specialised Registry, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Physiotherapy Evidence Database (PEDro), SPORTDiscus, PsycINFO, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform, on 18 September 2015. We also searched OpenGrey and Healthcare Management Information Consortium databases. SELECTION CRITERIA We searched for randomised and quasi-randomised trials comparing physical activity interventions versus control (e.g. usual or standard care, no physical activity, no exercise, attention control, placebo) after adjuvant therapy (i.e. after completion of chemotherapy and/or radiation therapy, but not hormone therapy) in women with breast cancer. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed risk of bias, and extracted data. We contacted trial authors to ask for additional information when needed. We calculated an overall effect size with 95% confidence intervals (CIs) for each outcome and used GRADE to assess the quality of evidence for the most important outcomes. MAIN RESULTS We included 63 trials that randomised 5761 women to a physical activity intervention (n = 3239) or to a control (n = 2524). The duration of interventions ranged from 4 to 24 months, with most lasting 8 or 12 weeks (37 studies). Twenty-eight studies included aerobic exercise only, 21 involved aerobic exercise and resistance training, and seven used resistance training only. Thirty studies described the comparison group as usual or standard care, no intervention, or control. One-fifth of studies reported at least 20% intervention attrition and the average physical activity adherence was approximately 77%.No data were available on effects of physical activity on breast cancer-related and all-cause mortality, or on breast cancer recurrence. Analysis of immediately postintervention follow-up values and change from baseline to end of intervention scores revealed that physical activity interventions resulted in significant small-to-moderate improvements in HRQoL (standardised mean difference (SMD) 0.39, 95% CI 0.21 to 0.57, 22 studies, 1996 women; SMD 0.78, 95% CI 0.39 to 1.17, 14 studies, 1459 women, respectively; low-quality evidence), emotional function (SMD 0.21, 95% CI 0.10 to 0.32, 26 studies, 2102 women, moderate-quality evidence; SMD 0.31, 95% CI 0.09 to 0.53, 15 studies, 1579 women, respectively; low-quality evidence), perceived physical function (SMD 0.33, 95% CI 0.18 to 0.49, 25 studies, 2129 women; SMD 0.60, 95% CI 0.23 to 0.97, 13 studies, 1433 women, respectively; moderate-quality evidence), anxiety (SMD -0.57, 95% CI -0.95 to -0.19, 7 studies, 326 women; SMD -0.37, 95% CI -0.63 to -0.12, 4 studies, 235 women, respectively; low-quality evidence), and cardiorespiratory fitness (SMD 0.44, 95% CI 0.30 to 0.58, 23 studies, 1265 women, moderate-quality evidence; SMD 0.83, 95% CI 0.40 to 1.27, 9 studies, 863 women, respectively; very low-quality evidence).Investigators reported few minor adverse events.Small improvements in physical activity interventions were sustained for three months or longer postintervention in fatigue (SMD -0.43, 95% CI -0.60 to -0.26; SMD -0.47, 95% CI -0.84 to -0.11, respectively), cardiorespiratory fitness (SMD 0.36, 95% CI 0.03 to 0.69; SMD 0.42, 95% CI 0.05 to 0.79, respectively), and self-reported physical activity (SMD 0.44, 95% CI 0.17 to 0.72; SMD 0.51, 95% CI 0.08 to 0.93, respectively) for both follow-up values and change from baseline scores.However, evidence of heterogeneity across trials was due to variation in intervention components (i.e. mode, frequency, intensity, duration of intervention and sessions) and measures used to assess outcomes. All trials reviewed were at high risk of performance bias, and most were also at high risk of detection, attrition, and selection bias. In light of the aforementioned issues, we determined that the evidence was of very low, low, or moderate quality. AUTHORS' CONCLUSIONS No conclusions regarding breast cancer-related and all-cause mortality or breast cancer recurrence were possible. However, physical activity interventions may have small-to-moderate beneficial effects on HRQoL, and on emotional or perceived physical and social function, anxiety, cardiorespiratory fitness, and self-reported and objectively measured physical activity. The positive results reported in the current review must be interpreted cautiously owing to very low-to-moderate quality of evidence, heterogeneity of interventions and outcome measures, imprecision of some estimates, and risk of bias in many trials. Future studies with low risk of bias are required to determine the optimal combination of physical activity modes, frequencies, intensities, and durations needed to improve specific outcomes among women who have undergone adjuvant therapy.
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Affiliation(s)
- Ian M Lahart
- University of WolverhamptonFaculty of Education, Health and WellbeingGorway RoadWalsallWest MidlandsUKWS1 3BD
| | - George S Metsios
- University of WolverhamptonFaculty of Education, Health and WellbeingGorway RoadWalsallWest MidlandsUKWS1 3BD
| | - Alan M Nevill
- University of WolverhamptonFaculty of Education, Health and WellbeingGorway RoadWalsallWest MidlandsUKWS1 3BD
| | - Amtul R Carmichael
- Queen's HospitalDepartment of SurgeryBelvedere RoadBurton on TrentStaffordshireUK
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Demark-Wahnefried W, Schmitz KH, Alfano CM, Bail JR, Goodwin PJ, Thomson CA, Bradley DW, Courneya KS, Befort CA, Denlinger CS, Ligibel JA, Dietz WH, Stolley MR, Irwin ML, Bamman MM, Apovian CM, Pinto BM, Wolin KY, Ballard RM, Dannenberg AJ, Eakin EG, Longjohn MM, Raffa SD, Adams-Campbell LL, Buzaglo JS, Nass SJ, Massetti GM, Balogh EP, Kraft ES, Parekh AK, Sanghavi DM, Morris GS, Basen-Engquist K. Weight management and physical activity throughout the cancer care continuum. CA Cancer J Clin 2018; 68:64-89. [PMID: 29165798 PMCID: PMC5766382 DOI: 10.3322/caac.21441] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 12/20/2022] Open
Abstract
Mounting evidence suggests that weight management and physical activity (PA) improve overall health and well being, and reduce the risk of morbidity and mortality among cancer survivors. Although many opportunities exist to include weight management and PA in routine cancer care, several barriers remain. This review summarizes key topics addressed in a recent National Academies of Science, Engineering, and Medicine workshop entitled, "Incorporating Weight Management and Physical Activity Throughout the Cancer Care Continuum." Discussions related to body weight and PA among cancer survivors included: 1) current knowledge and gaps related to health outcomes; 2) effective intervention approaches; 3) addressing the needs of diverse populations of cancer survivors; 4) opportunities and challenges of workforce, care coordination, and technologies for program implementation; 5) models of care; and 6) program coverage. While more discoveries are still needed for the provision of optimal weight-management and PA programs for cancer survivors, obesity and inactivity currently jeopardize their overall health and quality of life. Actionable future directions are presented for research; practice and policy changes required to assure the availability of effective, affordable, and feasible weight management; and PA services for all cancer survivors as a part of their routine cancer care. CA Cancer J Clin 2018;68:64-89. © 2017 American Cancer Society.
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Affiliation(s)
| | - Kathryn H Schmitz
- Professor of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Catherine M Alfano
- Vice President, Survivorship, American Cancer Society, Inc., Washington, DC
| | - Jennifer R Bail
- Post-Doctoral Fellow, Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Pamela J Goodwin
- Professor of Medicine, Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute at the University of Toronto, Toronto, Ontario, Canada
| | - Cynthia A Thomson
- Professor of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Don W Bradley
- Associate Consulting Professor, Community and Family Medicine, Duke School of Medicine, Durham, NC
| | - Kerry S Courneya
- Professor of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Christie A Befort
- Associate Professor of Preventive Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Crystal S Denlinger
- Associate Professor of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - William H Dietz
- Chair, Redstone Global Center for Prevention and Wellness, George Washington University, Washington, DC
| | | | - Melinda L Irwin
- Professor of Epidemiology, Yale School of Public Health, New Haven, CT
| | - Marcas M Bamman
- Professor of Cell Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | - Rachel M Ballard
- Director, Prevention Research Coordination, Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD
| | | | - Elizabeth G Eakin
- Professor and Director, Cancer Prevention Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Matt M Longjohn
- Vice President and National Health Officer, YMCA of the USA, Chicago, IL
| | - Susan D Raffa
- National Program Director for Weight Management, Veterans Health Administration, Durham, NC
| | | | - Joanne S Buzaglo
- Senior Vice President, Research and Training Institute, Cancer Support Community, Philadelphia, PA
| | - Sharyl J Nass
- Director, National Cancer Policy Forum and Board on Health Care Services, Health and Medicine Division, National Academies of Science, Engineering, and Medicine, Washington, DC
| | - Greta M Massetti
- Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Erin P Balogh
- Senior Program Officer, National Cancer Policy Forum, Health and Medicine Division, National Academies of Science, Engineering, and Medicine, Washington, DC
| | | | - Anand K Parekh
- Chief Medical Advisor, Bipartisan Policy Center, Washington, DC
| | - Darshak M Sanghavi
- Chief Medical Officer, Senior Vice President, Translation, Optum Labs, Cambridge, MA
| | | | - Karen Basen-Engquist
- Professor of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
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Igwebuike LT, Zhang X, Brown JC, Schmitz KH. Applying pre-participation exercise screening to breast cancer survivors: a cross-sectional study. Support Care Cancer 2017; 26:1825-1831. [PMID: 29260391 DOI: 10.1007/s00520-017-4020-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 12/10/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Clinical guidelines recommend that breast cancer (BrCa) survivors be prescribed exercise. However, clinicians often do not prescribe exercise citing the presence of multiple health issues found among cancer survivors. No study has examined the proportion of BrCa survivors that can be prescribed a community/home-based unsupervised exercise program safely and independently, without further medical investigations or supervision. METHODS Participants included BrCa survivors who received treatment at a university healthcare system between 2009 and 2014. We applied previously identified published guidelines for health conditions that may impede BrCa survivors from completing a community/home-based exercise program. Logistic regression models were used to quantify the magnitude of the association between demographic and clinical characteristics and the ability to perform community/home-based exercise. RESULTS Among 667 BrCa survivors, 65 to 75% was classified as able to complete community/home-based exercise as recommended by the clinical guidelines. Older age, black race, treatment with chemotherapy, and treatment with radiation were associated with the potential need for further medical evaluation prior to starting exercise. CONCLUSIONS A large proportion of BrCa survivors can be prescribed community/home-based exercise program safely and independently, without further medical investigations or supervision. Future research will be needed to determine how to identify the subset of BrCa survivors that may benefit from medical evaluation prior to starting exercise in a manner that does not interrupt clinical oncology workflow. Approximately 35% of BrCa survivors may benefit from medical evaluation prior to starting community/home-based exercise.
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Affiliation(s)
| | - Xiaochen Zhang
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Justin C Brown
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kathryn H Schmitz
- Public Health Science, Penn State College of Medicine, Penn State Cancer Institute, Room T3427, 500 University Drive, Mail code CH69, Hershey, PA, 17033, USA.
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Neil-Sztramko SE, Winters-Stone KM, Bland KA, Campbell KL. Updated systematic review of exercise studies in breast cancer survivors: attention to the principles of exercise training. Br J Sports Med 2017; 53:504-512. [PMID: 29162619 DOI: 10.1136/bjsports-2017-098389] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To update our previous evaluation of the exercise interventions used in randomised controlled trials of breast cancer survivors in relation to (1) the application of the principles of exercise training in the exercise prescription; (2) the reporting of the components of the exercise prescription; and (3) the reporting of adherence of participants to the prescribed interventions. DESIGN Systematic review. DATA SOURCES The OVID Medline, Embase, CINAHL and SPORTDiscus electronic databases were searched from January 2010 to January 2017. ELIGIBILITY CRITERIA Randomised controlled trials of at least 4 weeks of aerobic and/or resistance exercise in women diagnosed with breast cancer, reporting on physical fitness or body composition outcomes. RESULTS Specificity was appropriately applied by 84%, progression by 29%, overload by 38% and initial values by 67% of newly identified studies. Reversibility was reported by 3% anddiminishing returns by 22% of newly identified studies. No studies reported all components of the exercise prescription in the methods, or adherence to the prescribed intervention in the results. Reporting of reversibility has increased from 2010, but no other improvements in reporting were noted from the previous review. SUMMARY/CONCLUSION No studies of exercise in women with breast cancer attended to all principles of exercise training, or reported all components of the exercise prescription in the methods, or adherence to the prescription in the results. Full reporting of the exercise prescribed and completed is essential for study replication in research and translating research findings into the community, and should be prioritised in future trials.
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Affiliation(s)
| | - Kerri M Winters-Stone
- School of Nursing and Knight Cancer Institute, Oregon Health Sciences University, Portland, Oregon, USA
| | - Kelcey A Bland
- Rehabilitation Sciences Graduate Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kristin L Campbell
- Rehabilitation Sciences Graduate Program, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Schmitz KH. Incorporating Strength Training into Cancer Care: Translating PAL into the Strength After Breast Cancer Program. Obesity (Silver Spring) 2017; 25 Suppl 2:S32-S33. [PMID: 29086524 DOI: 10.1002/oby.22018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 08/14/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Kathryn H Schmitz
- Penn State Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Swartz MC, Lewis ZH, Lyons EJ, Jennings K, Middleton A, Deer RR, Arnold D, Dresser K, Ottenbacher KJ, Goodwin JS. Effect of Home- and Community-Based Physical Activity Interventions on Physical Function Among Cancer Survivors: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2017; 98:1652-1665. [PMID: 28427925 DOI: 10.1016/j.apmr.2017.03.017] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 01/11/2017] [Accepted: 03/18/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine the effect of home- and community-based physical activity interventions on physical functioning among cancer survivors based on the most prevalent physical function measures, randomized trials were reviewed. DATA SOURCES Five electronic databases-Medline Ovid, PubMed, CINAHL, Web of Science, and PsycINFO-were searched from inception to March 2016 for relevant articles. STUDY SELECTION Search terms included community-based interventions, physical functioning, and cancer survivors. A reference librarian trained in systematic reviews conducted the final search. DATA EXTRACTION Four reviewers evaluated eligibility and 2 reviewers evaluated methodological quality. Data were abstracted from studies that used the most prevalent physical function measurement tools-Medical Outcomes Study 36-Item Short-Form Health Survey, Late-Life Function and Disability Instrument, European Organisation for the Research and Treatment of Cancer Quality-of-Life Questionnaire, and 6-minute walk test. Random- or fixed-effects models were conducted to obtain overall effect size per physical function measure. DATA SYNTHESIS Fourteen studies met inclusion criteria and were used to compute standardized mean differences using the inverse variance statistical method. The median sample size was 83 participants. Most of the studies (n=7) were conducted among breast cancer survivors. The interventions produced short-term positive effects on physical functioning, with overall effect sizes ranging from small (.17; 95% confidence interval [CI], .07-.27) to medium (.45; 95% CI, .23-.67). Community-based interventions that met in groups and used behavioral change strategies produced the largest effect sizes. CONCLUSIONS Home and community-based physical activity interventions may be a potential tool to combat functional deterioration among aging cancer survivors. More studies are needed among other cancer types using clinically relevant objective functional measures (eg, gait speed) to accelerate translation into the community and clinical practice.
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Affiliation(s)
- Maria C Swartz
- Division of Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX.
| | - Zakkoyya H Lewis
- Division of Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX; Fitness & Nutrition Results, Beachbody, Santa Monica, CA
| | - Elizabeth J Lyons
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX
| | - Kristofer Jennings
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX
| | - Addie Middleton
- Division of Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX
| | - Rachel R Deer
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX
| | - Demi Arnold
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX
| | - Kaitlin Dresser
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX
| | - James S Goodwin
- Division of Geriatric Medicine, The University of Texas Medical Branch, Galveston, TX
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Han CJ, Korde LA, Reding S, Allott K, Van Doren M, Schwarz Y, Vaughan C, Reding KW. Investigation of a Lifestyle Intervention in Women at High Risk of Breast Cancer. West J Nurs Res 2017; 40:976-996. [PMID: 28335697 DOI: 10.1177/0193945917697227] [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] [Indexed: 02/06/2023]
Abstract
One fourth of breast cancer can be attributed to sedentary lifestyles and being overweight or obese. This pilot study was conducted to explore whether a 6-month lifestyle intervention affected body composition and obesity-related biomarkers among women at high risk of breast cancer. Overweight/obese women at high risk of breast cancer were randomized to the control group or to the intervention. The intervention was an individually tailored, cognitive-behavioral therapy program that assists women in identifying strategies to improve their nutrition and physical activity habits with the goal of reduced adiposity. We compared changes in body composition and plasma biomarkers from baseline to 6 months. Body weight, adiposity, leptin, insulin resistance, and C-reactive protein were significantly reduced in the intervention group versus controls. No significant differences were observed in adiponectin, insulin, glucose, or interleukin-6. Our findings suggest that this intervention improves the metabolic and inflammatory profiles of overweight/obese women at risk of breast cancer.
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Affiliation(s)
| | | | - Scott Reding
- 2 Integrative Counseling Services, Seattle, WA, USA
| | | | - Matt Van Doren
- 4 Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Yvonne Schwarz
- 4 Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Kerryn W Reding
- 1 University of Washington, Seattle, USA.,4 Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Burns TC, Awad AJ, Li MD, Grant GA. Radiation-induced brain injury: low-hanging fruit for neuroregeneration. Neurosurg Focus 2017; 40:E3. [PMID: 27132524 DOI: 10.3171/2016.2.focus161] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Brain radiation is a fundamental tool in neurooncology to improve local tumor control, but it leads to profound and progressive impairments in cognitive function. Increased attention to quality of life in neurooncology has accelerated efforts to understand and ameliorate radiation-induced cognitive sequelae. Such progress has coincided with a new understanding of the role of CNS progenitor cell populations in normal cognition and in their potential utility for the treatment of neurological diseases. The irradiated brain exhibits a host of biochemical and cellular derangements, including loss of endogenous neurogenesis, demyelination, and ablation of endogenous oligodendrocyte progenitor cells. These changes, in combination with a state of chronic neuroinflammation, underlie impairments in memory, attention, executive function, and acquisition of motor and language skills. Animal models of radiation-induced brain injury have demonstrated a robust capacity of both neural stem cells and oligodendrocyte progenitor cells to restore cognitive function after brain irradiation, likely through a combination of cell replacement and trophic effects. Oligodendrocyte progenitor cells exhibit a remarkable capacity to migrate, integrate, and functionally remyelinate damaged white matter tracts in a variety of preclinical models. The authors here critically address the opportunities and challenges in translating regenerative cell therapies from rodents to humans. Although valiant attempts to translate neuroprotective therapies in recent decades have almost uniformly failed, the authors make the case that harnessing human radiation-induced brain injury as a scientific tool represents a unique opportunity to both successfully translate a neuroregenerative therapy and to acquire tools to facilitate future restorative therapies for human traumatic and degenerative diseases of the central nervous system.
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Affiliation(s)
- Terry C Burns
- Department of Neurosurgery and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California
| | - Ahmed J Awad
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York;,Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; and
| | - Matthew D Li
- Stanford University School of Medicine, Stanford, California
| | - Gerald A Grant
- Department of Neurosurgery and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California
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Şener HÖ, Malkoç M, Ergin G, Karadibak D, Yavuzşen T. Effects of Clinical Pilates Exercises on Patients Developing Lymphedema after Breast Cancer Treatment: A Randomized Clinical Trial. THE JOURNAL OF BREAST HEALTH 2017; 13:16-22. [PMID: 28331763 PMCID: PMC5351459 DOI: 10.5152/tjbh.2016.3136] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 07/18/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The aim of the present study was to compare the effects of clinical Pilates exercises with those of the standard lymphedema exercises on lymphedema developing after breast cancer treatment. MATERIALS AND METHODS The study comprised 60 female patients with a mean age of 53.2±7.7 years who developed lymphedema after having breast cancer treatment. The patients were randomized into two groups: the clinical Pilates exercise group (n=30), and the control group (n=30). Before, and at the 8th week of treatment, the following parameters were measured: the severity of lymphedema, limb circumferences, body image using the Social Appearance Anxiety Scale, quality of life with the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-BR23), and upper extremity function using the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure. Both groups performed one-hour exercises three days a week for 8 weeks. RESULTS After treatment, the symptoms recovered significantly in both groups. Reductions in the severity of lymphedema, improvements in the social appearance anxiety scale scores, quality of life scores, and upper extremity functions scores in the clinical Pilates exercise group were greater than those in the control group. Clinical Pilates exercises were determined to be more effective on the symptoms of patients with lymphedema than were standard lymphedema exercises. CONCLUSIONS Clinical Pilates exercises could be considered a safe model and would contribute to treatment programs.
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Affiliation(s)
- Hülya Özlem Şener
- Department of Physiotherapy and Rehabilitation, İzmir University School of Health Sciences, İzmir, Turkey
| | - Mehtap Malkoç
- Department Physical Therapy and Rehabilitation, Eastern Mediterranean University School of Health Sciences, Cyprus
| | - Gülbin Ergin
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Didem Karadibak
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Tuğba Yavuzşen
- Department of Clinical Oncology, Dokuz Eylül University Institute of Oncology, İzmir, Turkey
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Atkinson TM, Stover AM, Storfer DF, Saracino RM, D'Agostino TA, Pergolizzi D, Matsoukas K, Li Y, Basch E. Patient-Reported Physical Function Measures in Cancer Clinical Trials. Epidemiol Rev 2017; 39:59-70. [PMID: 28453627 PMCID: PMC5858035 DOI: 10.1093/epirev/mxx008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 12/22/2022] Open
Abstract
Patient-reported outcomes (PROs) are increasingly used to monitor treatment-related symptoms and physical function decrements in cancer clinical trials. As more patients enter survivorship, it is important to capture PRO physical function throughout trials to help restore pretreatment levels of function. We completed a systematic review of PRO physical function measures used in cancer clinical trials and evaluated their psychometric properties on the basis of guidelines from the US Food and Drug Administration. Five databases were searched through October 2015: PubMed/MEDLINE, EMBASE, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Health and Psychosocial Instruments, and Cochrane. From an initial total of 10,233 articles, we identified 108 trials that captured PRO physical function. Within these trials, approximately 67% used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and 25% used the Medical Outcomes Study Short Form 36. Both the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and Medical Outcomes Study Short Form 36 instruments generically satisfy most Food and Drug Administration requirements, although neither sought direct patient input as part of item development. The newer Patient-Reported Outcomes Measurement Information System physical function short form may be a brief, viable alternative. Clinicians should carefully consider the psychometric properties of these measures when incorporating PRO instrumentation into clinical trial design to provide a more comprehensive understanding of patient function.
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Affiliation(s)
- Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Angela M Stover
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Daniel F Storfer
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thomas A D'Agostino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Denise Pergolizzi
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Konstantina Matsoukas
- Information Systems, Memorial Sloan Kettering Library, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
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Zhang X, Brown JC, Schmitz KH. Association between Body Mass Index and Physical Function among Endometrial Cancer Survivors. PLoS One 2016; 11:e0160954. [PMID: 27529546 PMCID: PMC4986945 DOI: 10.1371/journal.pone.0160954] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/27/2016] [Indexed: 01/04/2023] Open
Abstract
Objectives We sought to quantify the relationship between body mass index (BMI) and physical function among endometrial cancer survivors. Understanding this relationship would help healthcare providers target efforts to refer obese endometrial cancer survivors to weight loss and exercise interventions. Methods We conducted a survey of 213 endometrial cancer survivors who received cancer care at an academic l health system between 2006 and 2010. Physical function subscale was quantified using physical functional component score from the SF-12 questionnaire. We compared physical function of endometrial cancer survivors to population-based age-standardized normative values. Results Among the 213 patients, 16% were normal weight (BMI ≤25 kg/m2), and 52% were obese (≥30 kg/m2). Higher BMI categories were associated with lower physical function (Ptrend = 0.003), as a continuous variable each 5kg/m2 higher BMI, physical function score was lower by 0.15 points (β = -0.15; P = 0.045). Compared to population-based age-standardized normative values, patients <75yrs reported lower physical function, whereas patients ≥75yrs reported better physical function. BMI was the only covariate associated with differences in physical function between survivors and age-standardized normative values (P = 0.039). Conclusions Among endometrial cancer survivors, higher BMI is associated with lower physical function. Younger endometrial cancer survivors report lower physical function compared to age-standardized normative values. Healthcare providers should be aware that younger, obese endometrial cancer survivors may particularly benefit from interventions such as exercise and weight loss to increase or preserve physical function.
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Affiliation(s)
- Xiaochen Zhang
- Public Health Science, Penn State College of Medicine, Hershey, PA, United States of America
| | - Justin C. Brown
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States of America
| | - Kathryn H. Schmitz
- Public Health Science, Penn State College of Medicine, Hershey, PA, United States of America
- * E-mail:
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Association Between Maximal Bench Press Strength and Isometric Handgrip Strength Among Breast Cancer Survivors. Arch Phys Med Rehabil 2016; 98:264-269. [PMID: 27543047 DOI: 10.1016/j.apmr.2016.07.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/28/2016] [Accepted: 07/13/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To characterize the relationship between 1-repetition maximum (1-RM) bench press strength and isometric handgrip strength among breast cancer survivors. DESIGN Cross-sectional study. SETTING Laboratory. PARTICIPANTS Community-dwelling breast cancer survivors (N=295). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE 1-RM bench press strength was measured with a barbell and exercise bench. Isometric handgrip strength was measured using an isometric dynamometer, with 3 maximal contractions of the left and right hands. All measures were conducted by staff with training in clinical exercise testing. RESULTS Among 295 breast cancer survivors, 1-RM bench press strength was 18.2±6.1kg (range, 2.2-43.0kg), and isometric handgrip strength was 23.5±5.8kg (range, 9.0-43.0kg). The strongest correlate of 1-RM bench press strength was the average isometric handgrip strength of both hands (r=.399; P<.0001). Mean difference analysis suggested that the average isometric handgrip strength of both hands overestimated 1-RM bench press strength by 4.7kg (95% limits of agreement, -8.2 to 17.6kg). In a multivariable linear regression model, the average isometric handgrip strength of both hands (β=.31; P<.0001) and age (β=-.20; P<.0001) were positively correlated with 1-RM bench press strength (R2=.23). CONCLUSIONS Isometric handgrip strength is a poor surrogate for 1-RM bench press strength among breast cancer survivors. 1-RM bench press strength and isometric handgrip strength quantify distinct components of muscular strength.
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Brown JC, Harhay MO, Harhay MN. Sarcopenia and mortality among a population-based sample of community-dwelling older adults. J Cachexia Sarcopenia Muscle 2016; 7:290-8. [PMID: 27239410 PMCID: PMC4864252 DOI: 10.1002/jcsm.12073] [Citation(s) in RCA: 204] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/02/2015] [Accepted: 08/16/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Sarcopenia is a risk-factor for all-cause mortality among older adults, but it is unknown if sarcopenia predisposes older adults to specific causes of death. Further, it is unknown if the prognostic role of sarcopenia differs between males and females, and obese and non-obese individuals. METHODS A population-based cohort study among 4425 older adults from the Third National Health and Nutrition Survey (1988-1994). Muscle mass was quantified using bioimpedance analysis, and muscle function was quantified using gait speed. Multivariable-adjusted Cox regression analysis examined the relationship between sarcopenia and mortality outcomes. RESULTS The mean age of study participants was 70.1 years. The prevalence of sarcopenia was 36.5%. Sarcopenia associated with an increased risk of all-cause mortality [hazard ratio (HR): 1.29 (95% confidence interval (95% CI): 1.13-1.47); P < 0.001] among males and females. Sarcopenia associated with an increased risk of cardiovascular-specific mortality among females [HR: 1.61 (95% CI: 1.22-2.12); P = 0.001], but not among males [HR: 1.07 (95% CI: 0.81-1.40; P = .643); P interaction = 0.079]. Sarcopenia was not associated with cancer-specific mortality among males and females [HR: 1.07 (95% CI: 0.78-1.89); P = 0.672]. Sarcopenia associated with an increased risk of mortality from other causes (i.e. non-cardiovascular and non-cancer) among males and females [HR: 1.32 (95% CI: 1.07-1.62); P = 0.008]. Obesity, defined using body mass index (P interaction = 0.817) or waist circumference (P interaction = 0.219) did not modify the relationship between sarcopenia and all-cause mortality. CONCLUSIONS Sarcopenia is a prevalent syndrome that is associated with premature mortality among community-dwelling older adults. The prognostic value of sarcopenia may vary by cause-specific mortality and differ between males and females.
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Affiliation(s)
- Justin C. Brown
- Center for Clinical Epidemiology and BiostatisticsUniversity of Pennsylvania School of MedicinePhiladelphiaPAUSA
| | - Michael O. Harhay
- Center for Clinical Epidemiology and BiostatisticsUniversity of Pennsylvania School of MedicinePhiladelphiaPAUSA
| | - Meera N. Harhay
- Division of Nephrology, Department of MedicineDrexel University College of MedicinePhiladelphiaPAUSA
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Brown JC, Harhay MO, Harhay MN. Patient-reported versus objectively-measured physical function and mortality risk among cancer survivors. J Geriatr Oncol 2016; 7:108-15. [PMID: 26907563 DOI: 10.1016/j.jgo.2016.01.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/28/2015] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study aimed to characterize the relationship of patient-reported functional limitations, gait speed, and mortality risk among cancer survivors. MATERIALS AND METHODS This study included cancer survivors from the Third National Health and Nutrition Survey. Patient-reported functional limitations were quantified by asking participants to assess their ability to complete five tasks: (1) walking 1/4 mi, (2) walking up 10 steps, (3) stooping, crouching, or kneeling, (4) lifting or carrying an object of 10 lb, and (5) standing up from an armless chair. Gait speed was quantified using a 2.4-meter walk. Vital status was obtained through the United States National Center for Health Statistics. RESULTS The study sample included 428 cancer survivors who averaged 72.1 years of age. The average number of patient-reported functional limitations was 1.8 (out of 5) and 66% of participants reported ≥1 functional limitation. Patient-reported functional limitations and gait speed were related, such that each functional limitation associated with a -0.08m/s slower gait speed (95% confidence interval: -0.10 to -0.06; P<0.001). During a median follow-up of 11years, 329 (77%) participants died. In multivariable-adjusted analysis, patient-reported functional limitations and survival were related, such that each additional reported functional limitation was associated with a 19% increase in the risk of death (95% confidence interval: 9% to 29%; P<0.001). CONCLUSION Patient-reported functional limitations are prevalent among cancer survivors, and associate with slower gait speeds and shorter survival. These data may provide increased insight on long-term prognosis and inform clinical decision-making by identifying subgroups of cancer survivors who may benefit from rehabilitative intervention.
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Affiliation(s)
- Justin C Brown
- Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania, USA
| | - Michael O Harhay
- Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania, USA
| | - Meera N Harhay
- Division of Nephrology, Department of Medicine, Drexel University College of Medicine, USA
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Mahadevan A, Sampson C, LaRosa S, Floyd SR, Wong ET, Uhlmann EJ, Sengupta S, Kasper EM. Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy. Radiat Oncol 2015; 10:245. [PMID: 26611656 PMCID: PMC4662000 DOI: 10.1186/s13014-015-0555-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whole brain radiation therapy (WBRT) is widely used for the treatment of brain metastases. Cognitive decline and alopecia are recognized adverse effects of WBRT. Recently hippocampus sparing whole brain radiation therapy (HS-WBRT) has been shown to reduce the incidence of memory loss. In this study, we found that multi-field intensity modulated radiation therapy (IMRT), with strict constraints to the brain parenchyma and to the hippocampus, reduces follicular scalp dose and prevents alopecia. METHODS Suitable patients befitting the inclusion criteria of the RTOG 0933 trial received Hippocampus sparing whole brain radiation. On follow up, they were noticed to have full scalp hair preservation. 5 mm thickness of follicle bearing scalp in the radiation field was outlined in the planning CT scans. Conventional opposed lateral WBRT radiation fields were applied to these patient-specific image sets and planned with the same nominal dose of 30 Gy in 10 fractions. The mean and maximum dose to follicle bearing skin and Dose Volume Histogram (DVH) data were analyzed for conventional and HS-WBRT. Paired t-test was used to compare the means. RESULTS All six patients had fully preserved scalp hair and remained clinically cognitively intact 1-3 months after HS-WBRT. Compared to conventional WBRT, in addition to the intended sparing of the Hippocampus, HS-WBRT delivered significantly lower mean dose (22.42 cGy vs. 16.33 cGy, p < 0.0001), V24 (9 cc vs. 44 cc, p < 0.0000) and V30 (9 cc vs. 0.096 cc, p = 0.0106) to follicle hair bearing scalp and prevented alopecia. There were no recurrences in the Hippocampus area. CONCLUSIONS HS-WBRT, with an 11-field set up as described, while attempting to conserve hippocampus radiation and maintain radiation dose to brain inadvertently spares follicle-bearing scalp and prevents alopecia.
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Affiliation(s)
- Anand Mahadevan
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
| | - Carrie Sampson
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
| | - Salvatore LaRosa
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
| | - Scott R Floyd
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
| | - Eric T Wong
- Department of Neuro-Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
| | - Erik J Uhlmann
- Department of Neuro-Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
| | - Soma Sengupta
- Department of Neuro-Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
| | - Ekkehard M Kasper
- Department of Neurosurgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
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Brown JC, Harhay MO, Harhay MN. The Prognostic Importance of Frailty in Cancer Survivors. J Am Geriatr Soc 2015; 63:2538-2543. [PMID: 26566767 DOI: 10.1111/jgs.13819] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To quantify the prognostic importance of prefrailty and frailty in a population-based sample of cancer survivors. DESIGN The Third National Health and Nutrition Examination Survey mortality-linked prospective cohort study. SETTING Eighty-nine survey locations across the United States. PARTICIPANTS Population-based sample of older adults (average age 72.2) with a self-reported diagnosis of non-skin-related cancer (N = 416). MEASUREMENTS The primary outcome was all-cause mortality. Frailty components included low weight for height, slow walking, weakness, exhaustion, and low physical activity. Participants with none of the five criteria were classified as nonfrail, those with one or two as prefrail, and those with three or more as frail. RESULTS The prevalence of prefrailty was 37.3% and of frailty was 9.1%. During a median follow-up of 11.2 years, 319 (76.7%) participants died. Median survival was 13.9 years for participants classified as nonfrail, 9.5 years for those classified as prefrail, and 2.5 years for those classified as frail. Cancer survivors classified as prefrail (hazard ratio (HR) = 1.84, 95% confidence interval (CI) = 1.28-2.65, P = .001) or frail (HR = 2.79, 95% CI = 1.34-5.81, P = .006) had a higher risk of premature mortality than those classified as nonfrail. CONCLUSION Prefrailty and frailty are prevalent clinical syndromes that may confer greater risk of premature mortality in older adult cancer survivors. Identifying frail cancer survivors and targeting interventions for them may be a strategy to improve survival after cancer.
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Affiliation(s)
- Justin C Brown
- Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael O Harhay
- Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Meera N Harhay
- Division of Nephrology, Department of Medicine, College of Medicine, Drexel University, Philadelphia, Pennsylvania
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Baselga J, Bhardwaj N, Cantley LC, DeMatteo R, DuBois RN, Foti M, Gapstur SM, Hahn WC, Helman LJ, Jensen RA, Paskett ED, Lawrence TS, Lutzker SG, Szabo E. AACR Cancer Progress Report 2015. Clin Cancer Res 2015; 21:S1-128. [PMID: 26429991 PMCID: PMC5001568 DOI: 10.1158/1078-0432.ccr-15-1846] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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40
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Zhang X, Haggerty AF, Brown JC, Giuntoli R, Lin L, Simpkins F, Dean LT, Ko E, Morgan MA, Schmitz KH. The prescription or proscription of exercise in endometrial cancer care. Gynecol Oncol 2015; 139:155-9. [PMID: 26307400 PMCID: PMC4915365 DOI: 10.1016/j.ygyno.2015.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/11/2015] [Accepted: 08/14/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the proportion of endometrial cancer patients who can be safely prescribed community/home based unsupervised exercise. A better understanding of the physical dysfunction secondary to comorbidities among endometrial cancer patients would assist clinicians in delineating which patients to send to medically-based supervised rehabilitation versus a community/home based unsupervised exercise program. METHODS A literature review identified health issues which could impede patients from successfully completing an unsupervised exercise program after a cancer diagnosis. The charts of 479 endometrial cancer patients treated between 2006 and 2010 were reviewed to determine the health status at the time of diagnosis and the type and percentage of health-issues that could preclude an unsupervised exercise program in this population. Univariable modeling and multivariable modeling were used to evaluate the association of demographic, cancer-related characteristics and clinical variables with ability to participate in unsupervised exercise. RESULTS We determined that 14.2% of endometrial cancer patients were able to exercise without supervision based on their health status at the time of diagnosis. After excluding common comorbidities (hypertension, diabetes and morbid obesity) from the identified health-issues, the proportion increased to 20.5%. Older at diagnosis (P=0.007) and higher BMI (P<0.001) are more likely to exclude patients from community/home based unsupervised exercise program. CONCLUSIONS Only 14.2% to 20.5% of endometrial cancer patients were deemed able to exercise without supervision based on their health status at diagnosis. Our data suggest that approximately 80% of endometrial cancer patients would benefit from a referral to a medically-based supervised exercise program.
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Affiliation(s)
- Xiaochen Zhang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, United States; Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania Perelman School of Medicine, United States
| | - Ashley F Haggerty
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, United States
| | - Justin C Brown
- Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania Perelman School of Medicine, United States
| | - Robert Giuntoli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, United States
| | - Lilie Lin
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, United States
| | - Fiona Simpkins
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, United States
| | - Lorraine T Dean
- Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania Perelman School of Medicine, United States
| | - Emily Ko
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, United States
| | - Mark A Morgan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, United States
| | - Kathryn H Schmitz
- Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania Perelman School of Medicine, United States.
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