Patient-Reported Outcomes of Regular Aerobic Exercise in Gastric Cancer

Immunomodulatory effects of exercise in cancer prevention and adjuvant therapy: a narrative review

Successful application of cancer immunotherapy has rekindled hope in cancer patients. However, a number of patients are unresponsive to immunotherapy and related treatments. This unresponsiveness in cancer patients toward different treatment regimens can be mainly attributed to severe immune dysfunction in such patients. Several reports indicate that physical exercise can significantly lead to improved cancer patient outcomes. Since exercise gets immense response from the immune system, it can be utilized to improve immune function. Leukocytes with enhanced functions are substantially mobilized into the circulation by a single bout of intense physical exercise. Chronic physical exercise results in greater muscle endurance and strength and improved cardiorespiratory function. This exercise regime is also useful in improving T-cell abundance and reducing dysfunctional T cells. The current available data strongly justify for future clinical trials to investigate physical exercise use as an adjuvant in cancer therapy; however, optimal parameters using exercise for a defined outcome are yet to be established. The components of the immune system associate with almost every tumorigenesis step. The inter-relationship between inflammation, cancer, and innate immunity has recently gained acceptance; however, the underlying cellular and molecular mechanisms behind this relationship are yet to be solved. Several studies suggest physical exercise-mediated induction of immune cells to elicit anti-tumorigenic effects. This indicates the potential of exercising in modulating the behavior of immune cells to inhibit tumor progression. However, further mechanistic details behind physical exercise-driven immunomodulation and anticancer effects have to be determined. This review aims to summarize and discuss the association between physical exercise and immune function modulation and the potential of exercise as an adjuvant therapy in cancer prevention and treatment.

Exercise as a Promising Agent against Cancer: Evaluating Its Anti-Cancer Molecular Mechanisms

BACKGROUND

Cancer cases are continuously increasing, while the prevalence rates of physical inactivity are also continuously increasing. Physical inactivity is a causative factor in non-communicable diseases, including cancer. However, the potential beneficial effects of exercise on cancer treatment have not received much attention so far. The aim of this study was to highlight the relationship between cancer and exercise on a molecular basis.

METHODS

Comprehensive and in-depth research was conducted in the most accurate scientific databases by using relevant and effective keywords.

RESULTS

The mechanisms by which exercise may reduce cancer risk and/or progression may include the metabolic profile of hormones, systemic inflammation reduction, insulin sensitivity increase, antioxidant capacity augmentation, the boost to the immune system, and the direct effect on the tumor. There is currently substantial evidence that the effect of exercise may predict a stronger association with cancer and could supplementarily be embedded in cancer clinical practice to improve disease progression and prognosis.

CONCLUSION

The field of this study requires interconnecting the overall knowledge of exercise physiology with cancer biology and cancer clinical oncology to provide the basis for personalized targeting strategies that can be merged with training as a component of a holistic co-treatment approach to optimize cancer healthcare.

Lower risk of depression after smoking cessation and alcohol abstinence in patients with gastric cancer who underwent gastrectomy: A population-based, nationwide cohort study

BACKGROUND

Although depression is associated with poor treatment outcomes in patients with cancer, little is known about whether lifestyle modifications could help prevent depression. The authors aimed to identify the effect of lifestyle modifications, including smoking cessation, alcohol abstinence, and starting regular physical activity, on new-onset depression in patients with gastric cancer who underwent surgery.

METHODS

By using the Korean National Health Insurance Service database, patients with gastric cancer who underwent surgery between 2010 and 2017 were identified. Self-reported lifestyle behaviors within 2 years before and after surgery were analyzed using the health examination database. Patients were classified according to changes in lifestyle behaviors, and their risk of new-onset depression was compared.

RESULTS

Among 18,902 patients, 2302 (12.19%) developed depression (26.00 per 1000 person-years). Smoking cessation (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.66-0.91) and alcohol abstinence (HR, 0.79; 95% CI, 0.69-0.90) were associated with reduced risk of depression development compared with persistent smoking and persistent drinking, respectively. Starting regular physical activity was not associated with risk of depression. When lifestyle behaviors after gastrectomy were scored from 0 to 3 points (1 point each for not smoking, not drinking, and being physically active), the risk of depression tended to decrease as lifestyle scores increased from 0 points (reference) to 1 point (HR, 0.69; 95% CI, 0.55-0.83), 2 points (HR, 0.60; 95% CI, 0.50-0.76), and 3 points (HR, 0.55; 95% CI, 0.45-0.68).

CONCLUSIONS

Smoking cessation and alcohol abstinence are associated with reduced risk of developing depression in patients with gastric cancer who undergo surgery.

Effects of physical exercise on body fat and laboratory biomarkers in cancer patients: a meta-analysis of 35 randomized controlled trials

BACKGROUND

A growing number of articles had reported the beneficial effects of physical exercise on reduced risks of cancer recurrence and mortality. However, the associations between physical exercise and laboratory biomarkers still had controversy. As we knew, this meta-analysis of randomized controlled trials (RCTs) was the first time for us to comprehensively clarify their relationships in cancer patients.

METHODS

We comprehensively searched the PubMed, Cochrane Central, EMBASE, Web of Science, and SportDiscus online databases to identify eligible articles, up to June 1, 2021. Pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were utilized to clarify their associations. Sensitivity analysis was performed to assess the impact of the individual on overall and Begg's/Egger's plot was utilized to evaluate potential publication bias.

RESULTS

Finally, 35 randomized controlled trials (RCTs) were finally enrolled in this meta-analysis. Our results indicated that physical exercise could significantly reduce BMI (pooled SMD = -0.32 - 0.56 to -0.09)), body weight (pooled SMD = -0.31 (-0.54 to -0.08)), body fat (pooled SMD = -0.44 (-0.70 to -0.18)), waist circumference (pooled SMD = -0.50 (-0.76 to -0.23)), hip circumference (pooled SMD = -0.54 (-0.80 to -0.28)), triglyceride (pooled SMD = -0.35 (-0.69 to -0.02)), fasting insulin (pooled SMD = -0.38 (-0.54 to -0.22)), glucose (pooled SMD = -0.56 (-0.84 to -0.28)), insulin resistance (pooled SMD = -0.40 (-0.72 to -0.07)), CRP (pooled SMD = -0.97 (-1.48 to -0.46)), IGF-1 levels (pooled SMD = -0.56 (-0.83 to -0.29)) and remarkably increase IGFBP-3 levels (pooled SMD = 0.81 (0.45 to 1.17)). Further sensitivity analysis and Begg's or Egger's test suggested that our results were robust with no significant publication bias.

CONCLUSIONS

Our results shed light on the beneficial effects of physical exercise on cancer patients by means of BMI/weight change and various biomarkers alteration (insulin-glucose pathways or inflammatory biomarkers). Our results were anticipated for clinical application to improve cancer patients' prognosis.

Effect of HCH Nutrition Management Combined with Early Exercise Nursing on Nutrition Status and Postoperative Rehabilitation of Patients after Gastric Cancer Surgery

Objective

The study aimed to analyze the effect of hospital-community-family (HCH) nutrition management combined with early exercise nursing on nutrition status and postoperative rehabilitation of patients after gastric cancer surgery.

Methods

A total of 80 patients with gastric cancer admitted from January 2019 to June 2021 were selected and divided by the odd-even grouping method into two groups, i.e., 40 cases in the control group adopting routine nursing combined with early exercise nursing and 40 cases in the study group adopting HCH nutrition management; the nutrition status and postoperative rehabilitation of the two groups were compared.

Results

The times of feeding, bowel sound, anal exhaust, and defecation in the study group after surgery were shorter than those in the control group, with a difference of statistical significance (P < 0.05). 3 months after discharge, the scores of Patient-Generated Subjective Global Assessment (PG-SAG) in the study group were lower than those in the control group, while the body mass index (BMI), prealbumin, albumin, hemoglobin, and the score of the Gastrointestinal Quality of Life Index (GIQLI) were higher than those of the control group (P < 0.05).

Conclusion

Hospital-community-family nutrition management combined with early exercise nursing can improve the postoperative nutrition status of patients undergoing gastric cancer surgery and advance the time of postoperative exhaust and defecation.

Patient reported outcomes in oncology: changing perspectives-a systematic review

In public health context, oncology is associated with severe negative impact on patients and on their relatives’ quality of life. Over the last decades, survival has remained at 50% worldwide for some tumor locations. Patient reported outcomes (PROs) assessment and, the corresponding use in clinical practice, help establishing patient individualized profiling involving caregivers. The purpose of this systematic review was to examine critical success factors for PROs assessment in daily clinical oncology practice. Additionally, we investigated how PROs collection can change oncology perspectives for patients and caregivers. According to PRISMA guidelines, 83 studies were included in this systematic review, whether related with implementation in daily clinical practice or associated with its use in oncology. PROs assessment gathers multi-professional teams, biomedical and clinical expertise, patients, families and caregivers. Institutional involvement, first line for caregiver’s adherence, team continuous formation, encompassing training and support, design of clear workflows, continuous monitoring, and data analysis are crucial for implementation. PROs measures are decisive in oncology. Several items were improved, including caregiver–patient–physician communication, patient risk groups identification, unmet problems and needs detection, disease course and treatment tracking, prognostic markers, cost-effectiveness measurement and comfort/support provision for both patients and caregivers. Routine assessment and implementation of PROs in clinical practice are a major challenge and a paradigm transformation for future.