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Akingbesote ND, Owusu D, Liu R, Cartmel B, Ferrucci LM, Zupa M, Lustberg MB, Sanft T, Blenman KRM, Irwin ML, Perry RJ. A review of the impact of energy balance on triple-negative breast cancer. J Natl Cancer Inst Monogr 2023; 2023:104-124. [PMID: 37139977 DOI: 10.1093/jncimonographs/lgad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 05/05/2023] Open
Abstract
Cancer cells cannot proliferate without sufficient energy to generate biomass for rapid cell division, as well as to fuel their functions at baseline. For this reason, many recent observational and interventional studies have focused on increasing energy expenditure and/or reducing energy intake during and after cancer treatment. The impact of variance in diet composition and in exercise on cancer outcomes has been detailed extensively elsewhere and is not the primary focus of this review. Instead, in this translational, narrative review we examine studies of how energy balance impacts anticancer immune activation and outcomes in triple-negative breast cancer (TNBC). We discuss preclinical, clinical observational, and the few clinical interventional studies on energy balance in TNBC. We advocate for the implementation of clinical studies to examine how optimizing energy balance-through changes in diet and/or exercise-may optimize the response to immunotherapy in people with TNBC. It is our conviction that by taking a holistic approach that includes energy balance as a key factor to be considered during and after treatment, cancer care may be optimized, and the detrimental effects of cancer treatment and recovery on overall health may be minimized.
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Affiliation(s)
- Ngozi D Akingbesote
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Department of Cellular & Molecular Physiology, Yale University, New Haven, CT, USA
| | - Dennis Owusu
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Department of Cellular & Molecular Physiology, Yale University, New Haven, CT, USA
- Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti Region, Ghana
| | - Ryan Liu
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Department of Cellular & Molecular Physiology, Yale University, New Haven, CT, USA
- Cedar Park High School, Cedar Park, TX, USA
| | - Brenda Cartmel
- Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Leah M Ferrucci
- Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | | | - Maryam B Lustberg
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Tara Sanft
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Kim R M Blenman
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
- Department of Computer Science, Yale University, New Haven, CT, USA
| | - Melinda L Irwin
- Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Rachel J Perry
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Department of Cellular & Molecular Physiology, Yale University, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
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Owusu C, Margevicius S, Nock NL, Austin K, Bennet E, Cerne S, Hergenroeder P, Moore HCF, Petkac J, Schluchter M, Schmitz KH, Webb Hooper M, Wimbley L, Berger NA. A randomized controlled trial of the effect of supervised exercise on functional outcomes in older African American and non-Hispanic White breast cancer survivors: Are there racial differences in the effects of exercise on functional outcomes? Cancer 2022; 128:2320-2338. [PMID: 35289926 DOI: 10.1002/cncr.34184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The objective of this study was to test the hypothesis that exercise would be more effective than a support group plus Fitbit (SG+Fitbit) program in improving functional outcomes in older breast cancer survivors (BCSs) and that race would moderate the exercise effect on outcomes. METHODS Older African American (AA) and non-Hispanic White (NHW) BCSs were purposively recruited and enrolled into the 52-week randomized controlled trial. The interventions included 20 weeks of supervised moderate-intensity aerobic and resistance training followed by 32 weeks of unsupervised exercise called IMPROVE (n = 108) and a 20-week SG+Fitbit program followed by 32 weeks of unsupervised activity (n = 105). Study outcomes were assessed at 20 and 52 weeks. The primary outcome was the change in Short Physical Performance Battery (SPPB) scores 20 weeks from the baseline between arms. Secondary outcomes included change in the 6-Minute Walk Test (6MWT) in meters 20 weeks from the baseline between arms. General linear regression and multivariable logistic regression analyses were used. RESULTS The mean age was 71.9 years (SD, 5.9 years), and 44% were AA. SPPB scores did not differ between arms (adjusted difference in mean change, 0.13; 95% CI, -0.28 to 0.55; P = .53). However, the exercise arm (vs the SG+Fitbit arm) improved on the 6MWT (21.6 m; 95% CI, 2.5-40.6 m; P = .03). Race moderated the exercise effect on the 6MWT (adjusted interaction effect, 43.3 m; 95% CI, 6.3-80.2 m; P = .02); this implied that the change in the adjusted mean for the 6MWT at 20 weeks from the baseline was 43.3 m higher in AA exercise participants versus NHW exercise participants. CONCLUSIONS Combined aerobic and resistance exercise appears to improve physical performance in older BCSs, and the exercise effect might be moderated by race, with AAs appearing to derive larger benefits in comparison with NHWs. Larger studies are warranted to confirm the study findings.
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Affiliation(s)
- Cynthia Owusu
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Seunghee Margevicius
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio.,Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Nora L Nock
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio.,Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Kristina Austin
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | | | | | | | - Halle C F Moore
- Department of Hematology/Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Jean Petkac
- University Hospitals of Cleveland, Cleveland, Ohio
| | - Mark Schluchter
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio.,Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | | | - Monica Webb Hooper
- National Institute on Minority Health and Disparities, National Institutes of Health, Bethesda, Maryland
| | - Leonard Wimbley
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Nathan A Berger
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
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3
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Neil-Sztramko SE, Smith-Turchyn J, Fong A, Kauffeldt K, Tomasone JR. Community-based exercise programs for cancer survivors: A scoping review of program characteristics using the Consolidated Framework for Implementation Research. Arch Phys Med Rehabil 2021; 103:542-558.e10. [PMID: 34375631 DOI: 10.1016/j.apmr.2021.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/10/2021] [Accepted: 06/16/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the characteristics of exercise programs for cancer survivors conducted outside of a research laboratory (i.e., home-based, or community-based settings). DATA SOURCES A systematic search of published literature was conducted using Medline, Pubmed, CINAHL, PsychINFO, SPORTdiscus, and Embase from 1980 to January 2021. Where conference abstracts were identified, authors were contacted for other articles. STUDY SELECTION Two independent reviewers screened titles and abstracts, and full texts of potentially relevant studies with discrepancies resolved by discussion. Included studies were reports of exercise programs or interventions in which participants exercise at home, or in a community-based setting, and including individuals diagnosed with cancer either undergoing treatment or who had completed treatment. DATA EXTRACTION Data were extracted using the Oxford Implementation Index and coded under the five domains of the Consolidated Framework for Implementation Research (CFIR). Extraction and coding were completed by two independent reviewers, with discrepancies resolved through discussion. Data were synthesized narratively according to CFIR. DATA SYNTHESIS A total of 58 publications describing 34 individual programs from around the world were included. Of these, only 14 publications had the specific goal of reporting on program implementation and development. A variety of intervention characteristics and characteristics of individuals involved in the intervention were described. Reporting of factors related to the CFIR domains of inner setting, outer setting and implementation process were minimal. CONCLUSIONS This review summarizes the characteristics of existing programs that have been reported in the literature and finds that partnerships and collaboration in the inner and outer setting, and as part of the process of implementation. This review highlights key knowledge gaps to be answered in order to support the development of future community-based interventions.
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Affiliation(s)
| | | | - Angela Fong
- School of Kinesiology and Health Studies, Queens University
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4
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Burse NR, Bhuiyan N, Mama SK, Schmitz KH. Physical activity barriers and resources among black women with a history of breast and endometrial cancer: a systematic review. J Cancer Surviv 2020; 14:556-577. [PMID: 32240461 PMCID: PMC8258672 DOI: 10.1007/s11764-020-00873-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 03/04/2020] [Indexed: 12/31/2022]
Abstract
Physical inactivity is a significant public health problem among black women. However, there is limited evidence regarding barriers to physical activity and the availability of opportunities to engage in physical activity, specifically for posttreatment black women with a history of cancer. PURPOSE The purpose of this paper was to systematically review, summarize, and synthesize findings on physical activity-related research including barriers, facilitators, and resources for physical activity among posttreatment black women with a history of breast and endometrial cancer. METHODS We developed a comprehensive search strategy and conducted searches in the following databases: PsycINFO, Web of Science, Cochrane, PubMed, and Sociological Abstracts. Summary measures were described qualitatively (e.g., themes) and quantitatively (e.g., frequencies). RESULTS This review identified 35 eligible articles describing 12 intervention and 23 observational studies. We described intervention preferences (e.g., resistance activities), beliefs about physical activity, and benefits of physical activity for quality of life (e.g., improvements in social wellbeing) in black cancer survivors. In addition, very few studies identified barriers to physical activity (n = 7) and focused on increasing physical activity (n = 12) among black women with a history of cancer. The most common reported barriers among the target population were fatigue, lack of social support, weather, illness/health issues, cost, time constraints, living too far away, and inability/unwillingness to obtain physician clearance, whereas the most common facilitators were faith, other health concerns, and social support. CONCLUSIONS/IMPLICATIONS Future studies should target barriers, facilitators, and culturally adapted strategies for physical activity at all levels of influence to develop multi-level interventions to engage and improve physical activity among black women with a history of breast and endometrial cancer. PROTOCOL REGISTRATION NUMBER CRD42018110008.
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Affiliation(s)
- Natasha R Burse
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA.
| | - Nishat Bhuiyan
- Department of Kinesiology, The Pennsylvania State University, University Park, State College, PA, USA
| | - Scherezade K Mama
- Department of Kinesiology, The Pennsylvania State University, University Park, State College, PA, USA
| | - Kathryn H Schmitz
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
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5
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Paxton RJ, Garner W, Dean LT, Logan G, Allen-Watts K. Health Behaviors and Lifestyle Interventions in African American Breast Cancer Survivors: A Review. Front Oncol 2019; 9:3. [PMID: 30723698 PMCID: PMC6349825 DOI: 10.3389/fonc.2019.00003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 01/02/2019] [Indexed: 11/13/2022] Open
Abstract
Background: African American breast cancer survivors have a higher incidence of estrogen receptor negative and basal-like (e.g., triple negative) tumors, placing them at greater risk for poorer survival when compared to women of other racial and ethnic groups. While access to equitable care, late disease stage at diagnosis, tumor biology, and sociodemographic characteristics contribute to health disparities, poor lifestyle characteristics (i.e., inactivity, obesity, and poor diet) contribute equally to these disparities. Lifestyle interventions hold promise in shielding African American survivors from second cancers, comorbidities, and premature mortality, but they are often underrepresented in studies promoting positive behaviors. This review examined the available literature to document health behaviors and lifestyle intervention (i.e., obesity, physical activity, and sedentary behavior) studies in African American breast cancer survivors. Methods: We used PubMed, Academic Search Premier, and Scopus to identify cross-sectional and intervention studies examining the lifestyle behaviors of African American breast cancer survivors. Identified intervention studies were assessed for risk of bias. Other articles were identified and described to provide context for the review. Results: Our systematic review identified 226 relevant articles. The cross-sectional articles indicated poor adherence to physical activity and dietary intake and high rates of overweight and obesity. The 16 identified intervention studies indicated reasonable to modest study adherence rates (>70%), significant reductions in weight (range -1.9 to -3.6%), sedentary behavior (-18%), and dietary fat intake (range -13 to -33%) and improvements in fruit and vegetable intake (range +25 to +55%) and physical activity (range +13 to +544%). The risk of bias for most studies were rated as high (44%) or moderate (44%). Conclusions: The available literature suggests that African American breast cancer survivors adhere to interventions of various modalities and are capable of making modest to significant changes. Future studies should consider examining (a) mediators and moderators of lifestyle behaviors and interventions, (b) biological outcomes, and (c) determinants of enhanced survival in this population.
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Affiliation(s)
- Raheem J Paxton
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
| | - William Garner
- Department of Life and Health Sciences, University of North Texas at Dallas, Dallas, TX, United States
| | - Lorraine T Dean
- Department of Epidemiology, John Hopkins School of Public Health, Baltimore, MD, United States
| | - Georgiana Logan
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
| | - Kristen Allen-Watts
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
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6
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Piacentine LB, Robinson KM, Waltke LJ, Tjoe JA, Ng AV. Promoting Team-Based Exercise Among African American Breast Cancer Survivors. West J Nurs Res 2018; 40:1885-1902. [PMID: 30129907 DOI: 10.1177/0193945918795313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Physical activity benefits the health and well-being of breast cancer survivors (BCS). Yet, many African American survivors do not routinely exercise and have increased risk of poor outcomes. The purpose of this mixed-method study was to identify motivational factors compelling African American BCS to participate in a 14-week team walking program and to intend to continue exercise after the intervention concluded. Focus groups were held with participants ( n = 12) before and after training. Content analysis discovered themes before the intervention: Not wanting to go at it alone, exercise not a life or treatment priority, cancer treatment affected activity, advocates to exercise, and can exercise really help? Four themes postintervention themes included: In the same boat, changed mind-set, improved weight and activity, and overcoming barriers. Physical data verified improvements. Results suggest that a team-based exercise training program may assist in overcoming a sedentary behavior tendency and subsequently improve health among survivors.
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7
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Foley MP, Hasson SM, Kendall E. Effects of a Translational Community-Based Multimodal Exercise Program on Quality of Life and the Influence of Start Delay on Physical Function and Quality of Life in Breast Cancer Survivors: A Pilot Study. Integr Cancer Ther 2018; 17:337-349. [PMID: 28929821 PMCID: PMC6041921 DOI: 10.1177/1534735417731514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/06/2017] [Accepted: 08/12/2017] [Indexed: 12/20/2022] Open
Abstract
The purpose of this investigation was 2-fold: (1) to investigate the effects of a translational 12-week community-based multimodal exercise program on quality of life (QoL) in breast cancer survivors (BCS) and (2) to examine the influence of a start delay on physical function and QoL in BCS. Fifty-two female BCS completed a 12-week program consisting of 90-minute supervised exercise sessions at a frequency of 2 supervised sessions per week. Exercise sessions consisted of three 30-minute components: (1) aerobic conditioning, (2) resistance exercise training, and (3) balance and flexibility training. Significant ( P < .05) improvements in QoL were identified post-program completion. Cohort stratification comparison between the early start (<1 year since completion of oncologic treatment) and late start (>1 year since completion of oncologic treatment) revealed no significant ( P > .05) differences between the early start and late start groups on improvements in physical function. Regarding the influence of start delay on QoL, the early start group showed significant ( P < .05) improvement in emotional well-being. No other significant differences in improvement in QoL were detected between the early start and late start groups. Regardless of start delay, meaningful improvements in physical function and QoL were found after completing the community-based multimodal exercise program. Early participation in community-based exercise programming may benefit BCS' emotional well-being compared to later participation.
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8
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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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Kim TH, Chang JS, Kong ID. Effects of Exercise Training on Physical Fitness and Biomarker Levels in Breast Cancer Survivors. J Lifestyle Med 2017; 7:55-62. [PMID: 29026725 PMCID: PMC5618735 DOI: 10.15280/jlm.2017.7.2.55] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 06/13/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Exercise has been identified as a beneficial intervention to enhance quality of life in breast cancer survivors. In addition, there has been a noteworthy increase in studies emphasizing the benefits of exercise in cancer. We sought to summarize the empirical literature concerning the effects of exercise on physical fitness and biomarker levels in breast cancer survivors according to the type of exercise. METHODS We searched PubMed and PubMed Central for studies on the association of exercise with the levels of various biomarkers and physical fitness in breast cancer survivors. We investigated the effects of different types of exercise (aerobic, resistance, or combined) on breast cancer survivors, with changes in physical fitness and biomarker levels as the primary outcomes. RESULTS In total, 118 research papers published from 2012 to July 2016 were retrieved from PubMed and PubMed Central. Of these, 24 papers met our inclusion criteria. All types of exercise were found to improve physical fitness in breast cancer survivors. However, the results with regard to biomarkers were controversial. CONCLUSION The findings of this review suggest that combined exercise is associated with better outcomes than aerobic or resistance exercise alone in breast cancer survivors.
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Affiliation(s)
- Tae Ho Kim
- Department of Physiology, Yonsei University Wonju College of Medicine, Yonsei Institute of Sports Science & Exercise Medicine, Wonju, Korea
| | - Jae Seung Chang
- Department of Physiology, Yonsei University Wonju College of Medicine, Yonsei Institute of Sports Science & Exercise Medicine, Wonju, Korea
| | - In Deok Kong
- Department of Physiology, Yonsei University Wonju College of Medicine, Yonsei Institute of Sports Science & Exercise Medicine, Wonju, Korea
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10
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Vadaparampil ST, Christie J, Donovan KA, Kim J, Augusto B, Kasting ML, Holt CL, Ashing K, Halbert CH, Pal T. Health-related quality of life in Black breast cancer survivors with and without triple-negative breast cancer (TNBC). Breast Cancer Res Treat 2017; 163:331-342. [PMID: 28258353 PMCID: PMC5568024 DOI: 10.1007/s10549-017-4173-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/21/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Black women are more likely to develop early-onset (≤50 years) breast cancer (BC) and have the lowest five-year, cause-specific survival rate of any United States (U.S.) racial or ethnic group. These disparities can be attributed partially to the higher rate of triple-negative BC (TNBC) in Blacks. Yet, little is known about health-related quality of life (HRQOL) among Black women with TNBC. METHODS Black women with invasive BC ≤ 50 years were recruited via the Florida Cancer Data System as part of a population-based case-only study of etiology and outcomes of early-onset invasive BC. Of 460 consented participants, a subset of 355 self-reported sociodemographic, clinical, and psychosocial variables. Descriptive analyses included participants with known TNBC (n = 85) or non-TNBC (n = 245) disease. Univariable and multivariable analyses were conducted to examine differences in factors associated with HRQOL. RESULTS In unadjusted analyses, TNBC participants had significantly lower FACT-B total scores (90.1 ± 27.9) compared to non-TNBC (98.5 ± 27.6) participants (p < 0.05). For the TNBC group, multivariable analyses indicated five individual-level, and three systemic-level factors explain 80% of the response variation in HRQOL. For the non-TNBC group, seven individual-level factors and three systemic-level factors account for 76% of the variation in HRQOL scores. CONCLUSIONS Compared to Black women with non-TNBC, TNBC women have worse HRQOL. There are key individual and systemic-level factors that are unique to both groups. Findings can inform future HRQOL interventions to support young Black BC survivors.
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Affiliation(s)
- Susan T Vadaparampil
- Moffitt Cancer Center, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612, USA.
| | - Juliette Christie
- University of Maryland, 4200 Valley Drive, Room 1242W, College Park, MD, 20742, USA
| | - Kristine A Donovan
- Moffitt Cancer Center, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612, USA
| | - Jongphil Kim
- Moffitt Cancer Center, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612, USA
| | - Bianca Augusto
- Moffitt Cancer Center, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612, USA
| | - Monica L Kasting
- Moffitt Cancer Center, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612, USA
| | - Cheryl L Holt
- University of Maryland, 4200 Valley Drive, Room 1242W, College Park, MD, 20742, USA
| | - Kimlin Ashing
- City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | | | - Tuya Pal
- Moffitt Cancer Center, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612, USA
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11
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Leach HJ, Danyluk JM, Nishimura KC, Culos-Reed SN. Benefits of 24 versus 12 weeks of exercise and wellness programming for women undergoing treatment for breast cancer. Support Care Cancer 2016; 24:4597-606. [PMID: 27312845 DOI: 10.1007/s00520-016-3302-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 06/06/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE Community exercise programs can help maintain or improve health in cancer survivors. However, the most effective and feasible duration of a community exercise program for breast cancer survivors who are undergoing treatment is not known. This pre-post-design study evaluated the effects of the "Breast cancer patients Engaging in Activity while Undergoing Treatment" (BEAUTY) program on physical and psychosocial outcomes after 12 and 24 weeks. METHODS BEAUTY is an ongoing community exercise and wellness program for breast cancer patients who are undergoing, or within 3 months of completing chemotherapy and radiation. Participants completed assessments at baseline, 12 weeks, and 24 weeks to measure body composition, hand-grip dynamometry, aerobic fitness, and flexibility. Self-report questionnaires assessed fatigue (FACIT-fatigue), cognitive function (FACT-cog), quality of life (QOL) (FACT-B), and depressive symptoms (CES-D). Main analyses were repeated measures general linear model for all outcomes. RESULTS Assessments at all three time points were completed by N = 63 participants. At 24 weeks, waist to hip ratio (p = .019), duration of the submaximal treadmill test (p = .013), and estimated VO2max (p = .018) improved compared to baseline. Fatigue improved at 24 compared to 12 weeks (p = .002). FACT-B scores improved at 24 weeks when compared to both baseline (p = .002) and 12 weeks (p = .001). Depressive symptoms improved compared to baseline (p = .05) and 12 weeks (p = .009). CONCLUSIONS Additional benefits were seen after 24 versus 12 weeks, suggesting that a longer duration exercise program during, or shortly after completing treatments for breast cancer, may be necessary to see improvements in fitness and psychosocial outcomes. Findings can be applied to community exercise and rehabilitation programs for breast cancer survivors.
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Affiliation(s)
- Heather J Leach
- Department of Health and Exercise Science, Colorado State University, 951 Plum Street, Moby Complex B, Office 205D, Ft. Collins, CO, 80523, USA.
| | - Jessica M Danyluk
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N-1N4, Canada
| | - Kathryn C Nishimura
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 8205 114St 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N-1N4, Canada.,Department of Oncology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada
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Nock NL, Owusu C, Flocke S, Krejci SA, Kullman EL, Austin K, Bennett B, Cerne S, Harmon C, Moore H, Vargo M, Hergenroeder P, Malone H, Rocco M, Tracy R, Lazarus HM, Kirwan JP, Heyman E, Berger NA. A Community-Based Exercise and Support Group Program Improves Quality of Life in African-American Breast Cancer Survivors: A Quantitative and Qualitative Analysis. ACTA ACUST UNITED AC 2015; 1. [PMID: 26640827 DOI: 10.23937/2469-5718/1510020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
African-American (AA) breast cancer (BCa) survivors have higher mortality rates, more comorbidities and are less likely to meet national physical activity guidelines after diagnosis compared to Caucasian BCa survivors. We previously reported that a 20-week resistance exercise intervention coupled with a support group and home walking program, conducted using facilities and personnel at a community cancer support center, in Stage I-III AA BCa survivors improved strength, fitness and circulating C-peptide levels. Here, we report our findings on changes in quality of life (QoL) and other behavioral measures associated with this 20-week intervention and, discuss findings from a qualitative analysis of semi-structured patient interviews. We found a clinically relevant improvement in QoL using the Functional Assessment of Cancer Therapy for Breast Cancer (FACT-B) (Baseline, B: 101.1 ± 21.5; End-of-Intervention, EOI: 108.5 ± 21.6; p = 0.05) and, a significant decrease in depression using the Beck Depression Inventory-II (B: 11.9 ± 8.1; EOI: 9.0 ± 5.5; p = 0.03). Our analysis of the patient interviews support improvements in these behavioral measures in that participants stated that they "feel better", were "more motivated" and "uplifted" after the program. The patient interviews also provided insights to the primary motivators (e.g., social support, improvements in strength and function, weight loss) and barriers (e.g., family and health issues) in adhering to the program and provided suggestions for improving the program (e.g., incorporating nutritional and treatment related side-effect discussions). Our results suggest that community-based lifestyle interventions may improve QoL and depression in AA BCa survivors and lend insights for improving future programs.
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Affiliation(s)
- Nora L Nock
- Department of Epidemiology and Biostatistics, Case Western Reserve University, USA
| | | | - Susan Flocke
- Family Medicine and Community Health, Case Western Reserve University, USA
| | - Susan A Krejci
- Case Comprehensive Cancer Center, University Hospitals Case Medical Center, USA
| | | | | | | | - Stephen Cerne
- Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, USA
| | | | - Halle Moore
- Cardiovascular Medicine, Cleveland Clinic, USA
| | - Mary Vargo
- Department of Pathology and Biochemistry, University of Vermont, USA
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