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Fricke B, Orr C, Alfano C, Schmitz K, Maltser S, Smith S. Advocacy in Cancer Rehabilitation-A Beginner's Guide to Effecting Change. Am J Phys Med Rehabil 2024; 103:S5-S9. [PMID: 38364023 DOI: 10.1097/phm.0000000000002422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Affiliation(s)
- Brian Fricke
- From the Department of Rehabilitation Medicine, UT Health San Antonio, San Antonio, Texas (BF); Goldstein & Orr, San Antonio, Texas (CO); Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (CA); Moving Through Cancer Program, Pittsburgh, PA (KS); Department of Physical Medicine and Rehabilitation, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (SM); and Department of Physical Medicine and Rehabilitation, University of Michigan Health, Ann Arbor, Michigan (SS)
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Sturgeon KM, Kok DE, Kleckner IR, Guertin KA, McNeil J, Parry TL, Ehlers DK, Hamilton A, Schmitz K, Campbell KL, Winters‐Stone K. Updated systematic review of the effects of exercise on understudied health outcomes in cancer survivors. Cancer Med 2023; 12:22278-22292. [PMID: 38018376 PMCID: PMC10757127 DOI: 10.1002/cam4.6753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023] Open
Abstract
INTRODUCTION The American College of Sports Medicine provided guidelines for exercise prescriptions in cancer survivors for specific cancer- and treatment-related health outcomes. However, there was insufficient evidence to generate exercise prescriptions for 10 health outcomes of cancer treatment. We sought to update the state of evidence. METHODS We conducted a systematic review of these 10 understudied health outcomes (bone health, sleep, cardiovascular function, chemotherapy-induced peripheral neuropathy (CIPN), cognitive function, falls and balance, nausea, pain, sexual function, and treatment tolerance) and provided an update of evidence. RESULTS While the evidence base for each outcome has increased, there remains insufficient evidence to generate exercise prescriptions. Common limitations observed across outcomes included: variability in type and quality of outcome measurement tools, variability in definitions of the health outcomes, a lack of phase III trials, and a majority of trials investigating breast or prostate cancer survivors only. CONCLUSION We identified progress in the field of exercise oncology for several understudied cancer- and treatment-related health outcomes. However, we were not able to generate exercise prescriptions due to continued insufficient evidence base. More work is needed to prescribe exercise as medicine for these understudied health outcomes, and our review highlights several strategies to aid in research acceleration within these areas of exercise oncology.
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Affiliation(s)
- Kathleen M. Sturgeon
- Department of Public Health SciencesCollege of Medicine, Penn State UniversityHersheyPennsylvaniaUSA
| | - Dieuwertje E. Kok
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Ian R. Kleckner
- Department of Pain & Translational Symptom Science, School of NursingUniversity of Maryland BaltimoreBaltimoreMarylandUSA
| | - Kristin A. Guertin
- Department of Public Health SciencesUniversity of Connecticut HealthStorrsConnecticutUSA
| | - Jessica McNeil
- Department of Kinesiology, School of Health and Human SciencesUniversity of North Carolina at GreensboroGreensboroNorth CarolinaUSA
| | - Traci L. Parry
- Department of Kinesiology, School of Health and Human SciencesUniversity of North Carolina at GreensboroGreensboroNorth CarolinaUSA
| | - Diane K. Ehlers
- Division of Epidemiology, Department of Quantitative Health SciencesMayo Clinic ArizonaPhoenixArizonaUSA
| | - Andrew Hamilton
- Oregon Health & Science University, LibraryPortlandOregonUSA
| | - Kathryn Schmitz
- Division of Hematology/Oncology, University of Pittsburgh School of MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Kristin L. Campbell
- Department of Physical TherapyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Kerri Winters‐Stone
- Division of Oncological Sciences, School of MedicineOregon Health & Science UniversityPortlandOregonUSA
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Gell NM, Bae M, Patel KV, Schmitz K, Dittus K, Toth M. Physical function in older adults with and without a cancer history: Findings from the National Health and Aging Trends Study. J Am Geriatr Soc 2023; 71:3498-3507. [PMID: 37431861 PMCID: PMC10782821 DOI: 10.1111/jgs.18508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/26/2023] [Accepted: 06/18/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Previous studies identified physical function limitations in older cancer survivors, but few have included objective measures and most focused on breast and prostate cancer survivors. The current study compared patient-reported and objective physical function measures between older adults with and without a cancer history. METHODS Our cross-sectional study used a nationally representative sample of community-dwelling, Medicare beneficiaries from the 2015 National Health and Aging Trends Study (n = 7495). Data collected included patient-reported physical function, including a composite physical capacity score and limitations in strength, mobility, and balance, and objectively measured physical performance metrics, including gait speed, five time sit-to-stand, tandem stand, and grip strength. All analyses were weighted to account for the complex sampling design. RESULTS Thirteen percent of participants (n = 829) reported a history of cancer, of which more than half (51%) reported a diagnosis other than breast or prostate cancer. In models adjusted for demographics and health history, older cancer survivors had lower Short Physical Performance Battery scores (unstandardized beta [B] = -0.36; 95% CI: -0.64, -0.08), slower gait speed (B = -0.03; 95% CI: -0.05, -0.01), reduced grip strength (B = -0.86; 95% CI: -1.44, -0.27), worse patient-reported composite physical capacity (B = -0.43; 95% CI: -0.67, -0.18) and patient-reported upper extremity strength (B = 1.27; 95% CI: 1.07, 1.50) compared to older adults without cancer. Additionally, the burden of physical function limitations was greater in women than in men, which may be explained by cancer type. CONCLUSIONS Our results extend studies in breast and prostate cancer to show worse objective and patient-reported physical function outcomes in older adults with a range of cancer types compared to those without a cancer history. Moreover, these burdens seem to disproportionately affect older adult women, underscoring the need for interventions to address functional limitations and prevent further health consequences of cancer and its treatment.
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Affiliation(s)
- Nancy M. Gell
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT
- University of Vermont Cancer Center, Burlington, VT
| | - Myeongjin Bae
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT
| | - Kushang V. Patel
- Department of Anesthesiology and Pain Medicine, University of Washington
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington
| | - Kathryn Schmitz
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA
| | - Kim Dittus
- University of Vermont Cancer Center, Burlington, VT
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT
| | - Michael Toth
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT
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Wonders K, Schmitz K, Harness JK, Lerner A, Hale ER. The Impact of Supervised, Individualized Exercise on Fatigue and Quality of Life during Adjuvant Radiotherapy for Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e267. [PMID: 37785014 DOI: 10.1016/j.ijrobp.2023.06.1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Adjuvant radiation therapy in treatment for breast cancer has been shown to improve patient outcomes and reduce mortality rates. However, many patients experience debilitating fatigue as a result. Currently, there are limited treatment options for fatigue in cancer survivors. Options include pharmaceutical agents, psychological interventions, or nutrition strategies, all of which have limited efficacy. Exercise is recommended in survivorship care plans, but it not widely implemented beyond the use of generalized statements or resource guides given to patients. Therefore, the purpose of this study was the examine the impact of an individualized exercise program on fatigue, quality of life, and physical functioning during radiation therapy for breast cancer. MATERIALS/METHODS This multi-institutional prospective trial evaluated the effects of supervised, individualized exercise therapy in 422 patients undergoing adjuvant radiotherapy for breast cancer. Following a comprehensive fitness assessment and the completion of the Brief Fatigue Instrument (BFI) questionnaire, each participant participated in a 12-week individualized exercise program offered through Maple Tree Cancer Alliance. At its conclusion, the patients repeated the assessment and questionnaire. RESULTS Individualized exercise had a positive impact on fitness parameters and severity of fatigue. Specifically, cardiovascular endurance, muscular strength, muscular endurance, and flexibility all significantly improved following the exercise intervention (p<0.05). On average, patients fatigue levels decreased by 31.1% (P<0.01). CONCLUSION These results signify that fatigue levels are positively impacted by exercise among patients with breast cancer.
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Affiliation(s)
- K Wonders
- Maple Tree Cancer Alliance, Dayton, OH; Wright State University, Dayton, OH
| | - K Schmitz
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - A Lerner
- Maple Tree Cancer Alliance, Dayton, OH
| | - E R Hale
- Kettering Health Cancer Center, Kettering, OH
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Dahmus J, Hummer B, Rivas G, Schmitz K, Caldwell SH, Argo CK, Schreibman I, Stine JG. Patients with Nonalcoholic Steatohepatitis and Advanced Liver Disease Have the Lowest Cardiorespiratory Fitness. Dig Dis Sci 2023; 68:2695-2703. [PMID: 36692803 PMCID: PMC10566537 DOI: 10.1007/s10620-022-07809-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/20/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND & AIMS Cardiorespiratory fitness and liver fibrosis are independently associated with poor outcomes in patients with nonalcoholic steatohepatitis (NASH), however, conflicting reports exist about their relationship. We aimed to better characterize the relationship between cardiorespiratory fitness and liver histology in a cross-sectional study of patients with biopsy-proven NASH. METHODS Participants aged 18-75 years completed VO2peak fitness assessment using symptom-limited graded exercise testing. Participants were compared by liver fibrosis stage and NAFLD Activity Score (NAS). Multivariable models were constructed to assess factors related to relative VO2peak, including liver fibrosis and NAS. RESULTS Thirty-five participants with mean age 48 ± 12 years and body mass index 33.5 ± 7.6 kg/m2 were enrolled. Seventy-four percent of participants were female and 49% had diabetes. A dose-dependent relationship was found between relative VO2peak and liver fibrosis. Relative VO2peak was significantly lower in participants with advanced fibrosis (F3 disease- 15.7 ± 5.3 vs. ≤ F2 disease- 20.7 ± 5.9 mL/kg/min, p = 0.027). NAS > 5 was also associated with lower relative VO2peak (22.6 ± 5.7 vs. 16.5 ± 5.1 mL/kg/min, p = 0.012) compared to NAS ≤ 5. With multivariable modeling, advanced fibrosis remained independently predictive of relative VO2peak while NAS trended towards significance. DISCUSSION AND CONCLUSIONS Advanced liver fibrosis is independently associated with cardiorespiratory fitness in patients with NASH. This may explain the incremental increase in mortality as liver fibrosis stage increases. Further research is needed to determine if exercise training can improve cardiorespiratory fitness across multiple stages of liver fibrosis and directly reduce morbidity and mortality in patients with NASH.
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Affiliation(s)
- Jessica Dahmus
- Division of Gastroenterology & Hepatology, Department of Medicine, The Pennsylvania State University - Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Breianna Hummer
- Division of Gastroenterology & Hepatology, Department of Medicine, The Pennsylvania State University - Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Gloriany Rivas
- Division of Gastroenterology & Hepatology, Department of Medicine, The Pennsylvania State University - Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Kathryn Schmitz
- Department of Public Health Sciences, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
- Cancer Institute, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Kinesiology, The Pennsylvania State University - College of Medicine, Hershey, PA, USA
- Department of Physical Medicine & Rehabilitation, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Stephen H Caldwell
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Curtis K Argo
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Ian Schreibman
- Division of Gastroenterology & Hepatology, Department of Medicine, The Pennsylvania State University - Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
- Liver Center, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jonathan G Stine
- Division of Gastroenterology & Hepatology, Department of Medicine, The Pennsylvania State University - Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
- Department of Public Health Sciences, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA.
- Cancer Institute, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA.
- Liver Center, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA.
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Wonders KY, Schmitz K, Harness J. Dose Delays, Dose Reductions, and Relative Total Dose Intensity in Patients With Advanced Cancer Who Exercised During Neoadjuvant Chemotherapy Treatment. Integr Cancer Ther 2023; 22:15347354231168368. [PMID: 37077136 PMCID: PMC10126785 DOI: 10.1177/15347354231168368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND When it comes to chemotherapy, maintaining the dose and schedule of treatment are of vital importance, as clinical evidence suggests that dose intensity is associated with optimal treatment outcomes for various tumors. Yet, reduced dose intensity is a common method of mitigating the chemotherapy-induced side effects. Exercise has been shown to attenuate chemotherapy-related symptoms that frequently cluster together. Understanding this, we conducted a retrospective analysis in patients with advanced disease treated with adjuvant or neoadjuvant chemotherapy regimens and who completed exercise training during treatment. METHODS Data were collected retrospectively in a chart review of 184 patients, aged 18 years or older and treated for Stage IIIA-IV cancer. Data collection included baseline patient demographics and clinical characteristics, including age at diagnosis, cancer stage at initial diagnosis, chemotherapy regimen, and planned dose and schedule. Cancer types included brain (6.5%), breast (35.9%), colorectal (8.7%), non-Hodgkin's lymphoma (7.6%), Hodgkin's lymphoma (11.4%), non-small cell lung (16.8%), ovarian (10.9%), and pancreatic (2.2%). All patients completed at least 12 weeks of prescribed, individualized exercise. Each program included cardiovascular, resistance training, and flexibility components, under the supervision of a certified exercise oncology trainer once a week. RESULTS RDI was measured for each myelosuppressive agent in a regimen over the entire chemotherapy course and then averaged across the myelosuppressive agents in a regimen. An RDI of less than 85% was designated as the clinically meaningful threshold for reduction in RDI based on previously published studies. CONCLUSIONS A considerable proportion of patients across regimens had dose delays (18.3%-74.3%) and dose reductions (18.1%-84.6%). Between 12% and 83.9% of patients missed at least 1 dose of a myelosuppressive agent that was part of their standard regimen. Overall, 50.8% of patients received less than 85% of the RDI. In short, patients with advanced cancer and an exercise adherence above 84.3% saw fewer chemotherapy dose delays and dose reductions. These delays and reductions occurred significantly less frequently compared to the published norms in the sedentary population (P < .05).
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Affiliation(s)
- Karen Y Wonders
- Wright State University, Dayton, OH, USA
- Maple Tree Cancer Alliance, Dayton, OH, USA
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Harada T, Schmitz K, Helsper CW, Campbell G, Nekhlyudov L. Long-COVID and long-term cancer survivorship-Shared lessons and opportunities. Eur J Cancer Care (Engl) 2022; 31:e13712. [PMID: 36151916 PMCID: PMC9539058 DOI: 10.1111/ecc.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 12/04/2022]
Abstract
As of 2022, close to 90 million persons in the United States, 243 million persons in Europe and 585 million worldwide have been infected with the novel SARS‐CoV‐2 (COVID‐19) virus and survived. Estimates vary but suggest that up to 50% may experience long‐term sequelae, termed ‘Long‐COVID’. While Long‐COVID is a new condition, the phenomenon of disabling long‐term effects following an illness requiring ongoing surveillance and management is not. In this commentary, we discuss how Long‐COVID parallels the experiences of long‐term cancer survivors, highlight shared challenges and offer opportunities to improve research and clinical care for both growing populations of patients as well as other long‐term chronic, disabling conditions.
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Affiliation(s)
- Taku Harada
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathryn Schmitz
- College of Medicine, Penn State University, Hershey, Pennsylvania, USA
| | - Charles W Helsper
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Grace Campbell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Duquesne University School of Nursing and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Gordon B, Abdullah S, Doerksen S, Lorenzo A, Kanski B, Qiu L, Schmitz K. Comparing Two Delivery Modes Of A Supportive Care Platform For Metastatic Breast Cancer Patients. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000879068.43957.d0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Adsul P, Schmitz K, Basen-Engquist KM, Rogers LQ. Studying the implementation of exercise oncology interventions: a path forward. Transl J Am Coll Sports Med 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Proietti M, Romiti GF, Vitolo M, Harrison SL, Lane DA, Fauchier L, Marin F, Näbauer M, Potpara TS, Dan GA, Maggioni AP, Cesari M, Boriani G, Lip GYH, Ekmekçiu U, Paparisto V, Tase M, Gjergo H, Dragoti J, Goda A, Ciutea M, Ahadi N, el Husseini Z, Raepers M, Leroy J, Haushan P, Jourdan A, Lepiece C, Desteghe L, Vijgen J, Koopman P, Van Genechten G, Heidbuchel H, Boussy T, De Coninck M, Van Eeckhoutte H, Bouckaert N, Friart A, Boreux J, Arend C, Evrard P, Stefan L, Hoffer E, Herzet J, Massoz M, Celentano C, Sprynger M, Pierard L, Melon P, Van Hauwaert B, Kuppens C, Faes D, Van Lier D, Van Dorpe A, Gerardy A, Deceuninck O, Xhaet O, Dormal F, Ballant E, Blommaert D, Yakova D, Hristov M, Yncheva T, Stancheva N, Tisheva S, Tokmakova M, Nikolov F, Gencheva D, Shalganov T, Kunev B, Stoyanov M, Marchov D, Gelev V, Traykov V, Kisheva A, Tsvyatkov H, Shtereva R, Bakalska-Georgieva S, Slavcheva S, Yotov Y, Kubíčková M, Marni Joensen A, Gammelmark A, Hvilsted Rasmussen L, Dinesen P, Riahi S, Krogh Venø S, Sorensen B, Korsgaard A, Andersen K, Fragtrup Hellum C, Svenningsen A, Nyvad O, Wiggers P, May O, Aarup A, Graversen B, Jensen L, Andersen M, Svejgaard M, Vester S, Hansen S, Lynggaard V, Ciudad M, Vettus R, Muda P, Maestre A, Castaño S, Cheggour S, Poulard J, Mouquet V, Leparrée S, Bouet J, Taieb J, Doucy A, Duquenne H, Furber A, Dupuis J, Rautureau J, Font M, Damiano P, Lacrimini M, Abalea J, Boismal S, Menez T, Mansourati J, Range G, Gorka H, Laure C, Vassalière C, Elbaz N, Lellouche N, Djouadi K, Roubille F, Dietz D, Davy J, Granier M, Winum P, Leperchois-Jacquey C, Kassim H, Marijon E, Le Heuzey J, Fedida J, Maupain C, Himbert C, Gandjbakhch E, Hidden-Lucet F, Duthoit G, Badenco N, Chastre T, Waintraub X, Oudihat M, Lacoste J, Stephan C, Bader H, Delarche N, Giry L, Arnaud D, Lopez C, Boury F, Brunello I, Lefèvre M, Mingam R, Haissaguerre M, Le Bidan M, Pavin D, Le Moal V, Leclercq C, Piot O, Beitar T, Martel I, Schmid A, Sadki N, Romeyer-Bouchard C, Da Costa A, Arnault I, Boyer M, Piat C, Fauchier L, Lozance N, Nastevska S, Doneva A, Fortomaroska Milevska B, Sheshoski B, Petroska K, Taneska N, Bakrecheski N, Lazarovska K, Jovevska S, Ristovski V, Antovski A, Lazarova E, Kotlar I, Taleski J, Poposka L, Kedev S, Zlatanovik N, Jordanova S, Bajraktarova Proseva T, Doncovska S, Maisuradze D, Esakia A, Sagirashvili E, Lartsuliani K, Natelashvili N, Gumberidze N, Gvenetadze R, Etsadashvili K, Gotonelia N, Kuridze N, Papiashvili G, Menabde I, Glöggler S, Napp A, Lebherz C, Romero H, Schmitz K, Berger M, Zink M, Köster S, Sachse J, Vonderhagen E, Soiron G, Mischke K, Reith R, Schneider M, Rieker W, Boscher D, Taschareck A, Beer A, Oster D, Ritter O, Adamczewski J, Walter S, Frommhold A, Luckner E, Richter J, Schellner M, Landgraf S, Bartholome S, Naumann R, Schoeler J, Westermeier D, William F, Wilhelm K, Maerkl M, Oekinghaus R, Denart M, Kriete M, Tebbe U, Scheibner T, Gruber M, Gerlach A, Beckendorf C, Anneken L, Arnold M, Lengerer S, Bal Z, Uecker C, Förtsch H, Fechner S, Mages V, Martens E, Methe H, Schmidt T, Schaeffer B, Hoffmann B, Moser J, Heitmann K, Willems S, Willems S, Klaus C, Lange I, Durak M, Esen E, Mibach F, Mibach H, Utech A, Gabelmann M, Stumm R, Ländle V, Gartner C, Goerg C, Kaul N, Messer S, Burkhardt D, Sander C, Orthen R, Kaes S, Baumer A, Dodos F, Barth A, Schaeffer G, Gaertner J, Winkler J, Fahrig A, Aring J, Wenzel I, Steiner S, Kliesch A, Kratz E, Winter K, Schneider P, Haag A, Mutscher I, Bosch R, Taggeselle J, Meixner S, Schnabel A, Shamalla A, Hötz H, Korinth A, Rheinert C, Mehltretter G, Schön B, Schön N, Starflinger A, Englmann E, Baytok G, Laschinger T, Ritscher G, Gerth A, Dechering D, Eckardt L, Kuhlmann M, Proskynitopoulos N, Brunn J, Foth K, Axthelm C, Hohensee H, Eberhard K, Turbanisch S, Hassler N, Koestler A, Stenzel G, Kschiwan D, Schwefer M, Neiner S, Hettwer S, Haeussler-Schuchardt M, Degenhardt R, Sennhenn S, Steiner S, Brendel M, Stoehr A, Widjaja W, Loehndorf S, Logemann A, Hoskamp J, Grundt J, Block M, Ulrych R, Reithmeier A, Panagopoulos V, Martignani C, Bernucci D, Fantecchi E, Diemberger I, Ziacchi M, Biffi M, Cimaglia P, Frisoni J, Boriani G, Giannini I, Boni S, Fumagalli S, Pupo S, Di Chiara A, Mirone P, Fantecchi E, Boriani G, Pesce F, Zoccali C, Malavasi VL, Mussagaliyeva A, Ahyt B, Salihova Z, Koshum-Bayeva K, Kerimkulova A, Bairamukova A, Mirrakhimov E, Lurina B, Zuzans R, Jegere S, Mintale I, Kupics K, Jubele K, Erglis A, Kalejs O, Vanhear K, Burg M, Cachia M, Abela E, Warwicker S, Tabone T, Xuereb R, Asanovic D, Drakalovic D, Vukmirovic M, Pavlovic N, Music L, Bulatovic N, Boskovic A, Uiterwaal H, Bijsterveld N, De Groot J, Neefs J, van den Berg N, Piersma F, Wilde A, Hagens V, Van Es J, Van Opstal J, Van Rennes B, Verheij H, Breukers W, Tjeerdsma G, Nijmeijer R, Wegink D, Binnema R, Said S, Erküner Ö, Philippens S, van Doorn W, Crijns H, Szili-Torok T, Bhagwandien R, Janse P, Muskens A, van Eck M, Gevers R, van der Ven N, Duygun A, Rahel B, Meeder J, Vold A, Holst Hansen C, Engset I, Atar D, Dyduch-Fejklowicz B, Koba E, Cichocka M, Sokal A, Kubicius A, Pruchniewicz E, Kowalik-Sztylc A, Czapla W, Mróz I, Kozlowski M, Pawlowski T, Tendera M, Winiarska-Filipek A, Fidyk A, Slowikowski A, Haberka M, Lachor-Broda M, Biedron M, Gasior Z, Kołodziej M, Janion M, Gorczyca-Michta I, Wozakowska-Kaplon B, Stasiak M, Jakubowski P, Ciurus T, Drozdz J, Simiera M, Zajac P, Wcislo T, Zycinski P, Kasprzak J, Olejnik A, Harc-Dyl E, Miarka J, Pasieka M, Ziemińska-Łuć M, Bujak W, Śliwiński A, Grech A, Morka J, Petrykowska K, Prasał M, Hordyński G, Feusette P, Lipski P, Wester A, Streb W, Romanek J, Woźniak P, Chlebuś M, Szafarz P, Stanik W, Zakrzewski M, Kaźmierczak J, Przybylska A, Skorek E, Błaszczyk H, Stępień M, Szabowski S, Krysiak W, Szymańska M, Karasiński J, Blicharz J, Skura M, Hałas K, Michalczyk L, Orski Z, Krzyżanowski K, Skrobowski A, Zieliński L, Tomaszewska-Kiecana M, Dłużniewski M, Kiliszek M, Peller M, Budnik M, Balsam P, Opolski G, Tymińska A, Ozierański K, Wancerz A, Borowiec A, Majos E, Dabrowski R, Szwed H, Musialik-Lydka A, Leopold-Jadczyk A, Jedrzejczyk-Patej E, Koziel M, Lenarczyk R, Mazurek M, Kalarus Z, Krzemien-Wolska K, Starosta P, Nowalany-Kozielska E, Orzechowska A, Szpot M, Staszel M, Almeida S, Pereira H, Brandão Alves L, Miranda R, Ribeiro L, Costa F, Morgado F, Carmo P, Galvao Santos P, Bernardo R, Adragão P, Ferreira da Silva G, Peres M, Alves M, Leal M, Cordeiro A, Magalhães P, Fontes P, Leão S, Delgado A, Costa A, Marmelo B, Rodrigues B, Moreira D, Santos J, Santos L, Terchet A, Darabantiu D, Mercea S, Turcin Halka V, Pop Moldovan A, Gabor A, Doka B, Catanescu G, Rus H, Oboroceanu L, Bobescu E, Popescu R, Dan A, Buzea A, Daha I, Dan G, Neuhoff I, Baluta M, Ploesteanu R, Dumitrache N, Vintila M, Daraban A, Japie C, Badila E, Tewelde H, Hostiuc M, Frunza S, Tintea E, Bartos D, Ciobanu A, Popescu I, Toma N, Gherghinescu C, Cretu D, Patrascu N, Stoicescu C, Udroiu C, Bicescu G, Vintila V, Vinereanu D, Cinteza M, Rimbas R, Grecu M, Cozma A, Boros F, Ille M, Tica O, Tor R, Corina A, Jeewooth A, Maria B, Georgiana C, Natalia C, Alin D, Dinu-Andrei D, Livia M, Daniela R, Larisa R, Umaar S, Tamara T, Ioachim Popescu M, Nistor D, Sus I, Coborosanu O, Alina-Ramona N, Dan R, Petrescu L, Ionescu G, Popescu I, Vacarescu C, Goanta E, Mangea M, Ionac A, Mornos C, Cozma D, Pescariu S, Solodovnicova E, Soldatova I, Shutova J, Tjuleneva L, Zubova T, Uskov V, Obukhov D, Rusanova G, Soldatova I, Isakova N, Odinsova S, Arhipova T, Kazakevich E, Serdechnaya E, Zavyalova O, Novikova T, Riabaia I, Zhigalov S, Drozdova E, Luchkina I, Monogarova Y, Hegya D, Rodionova L, Rodionova L, Nevzorova V, Soldatova I, Lusanova O, Arandjelovic A, Toncev D, Milanov M, Sekularac N, Zdravkovic M, Hinic S, Dimkovic S, Acimovic T, Saric J, Polovina M, Potpara T, Vujisic-Tesic B, Nedeljkovic M, Zlatar M, Asanin M, Vasic V, Popovic Z, Djikic D, Sipic M, Peric V, Dejanovic B, Milosevic N, Stevanovic A, Andric A, Pencic B, Pavlovic-Kleut M, Celic V, Pavlovic M, Petrovic M, Vuleta M, Petrovic N, Simovic S, Savovic Z, Milanov S, Davidovic G, Iric-Cupic V, Simonovic D, Stojanovic M, Stojanovic S, Mitic V, Ilic V, Petrovic D, Deljanin Ilic M, Ilic S, Stoickov V, Markovic S, Kovacevic S, García Fernandez A, Perez Cabeza A, Anguita M, Tercedor Sanchez L, Mau E, Loayssa J, Ayarra M, Carpintero M, Roldán Rabadan I, Leal M, Gil Ortega M, Tello Montoliu A, Orenes Piñero E, Manzano Fernández S, Marín F, Romero Aniorte A, Veliz Martínez A, Quintana Giner M, Ballesteros G, Palacio M, Alcalde O, García-Bolao I, Bertomeu Gonzalez V, Otero-Raviña F, García Seara J, Gonzalez Juanatey J, Dayal N, Maziarski P, Gentil-Baron P, Shah D, Koç M, Onrat E, Dural IE, Yilmaz K, Özin B, Tan Kurklu S, Atmaca Y, Canpolat U, Tokgozoglu L, Dolu AK, Demirtas B, Sahin D, Ozcan Celebi O, Diker E, Gagirci G, Turk UO, Ari H, Polat N, Toprak N, Sucu M, Akin Serdar O, Taha Alper A, Kepez A, Yuksel Y, Uzunselvi A, Yuksel S, Sahin M, Kayapinar O, Ozcan T, Kaya H, Yilmaz MB, Kutlu M, Demir M, Gibbs C, Kaminskiene S, Bryce M, Skinner A, Belcher G, Hunt J, Stancombe L, Holbrook B, Peters C, Tettersell S, Shantsila A, Lane D, Senoo K, Proietti M, Russell K, Domingos P, Hussain S, Partridge J, Haynes R, Bahadur S, Brown R, McMahon S, Y H Lip G, McDonald J, Balachandran K, Singh R, Garg S, Desai H, Davies K, Goddard W, Galasko G, Rahman I, Chua Y, Payne O, Preston S, Brennan O, Pedley L, Whiteside C, Dickinson C, Brown J, Jones K, Benham L, Brady R, Buchanan L, Ashton A, Crowther H, Fairlamb H, Thornthwaite S, Relph C, McSkeane A, Poultney U, Kelsall N, Rice P, Wilson T, Wrigley M, Kaba R, Patel T, Young E, Law J, Runnett C, Thomas H, McKie H, Fuller J, Pick S, Sharp A, Hunt A, Thorpe K, Hardman C, Cusack E, Adams L, Hough M, Keenan S, Bowring A, Watts J, Zaman J, Goffin K, Nutt H, Beerachee Y, Featherstone J, Mills C, Pearson J, Stephenson L, Grant S, Wilson A, Hawksworth C, Alam I, Robinson M, Ryan S, Egdell R, Gibson E, Holland M, Leonard D, Mishra B, Ahmad S, Randall H, Hill J, Reid L, George M, McKinley S, Brockway L, Milligan W, Sobolewska J, Muir J, Tuckis L, Winstanley L, Jacob P, Kaye S, Morby L, Jan A, Sewell T, Boos C, Wadams B, Cope C, Jefferey P, Andrews N, Getty A, Suttling A, Turner C, Hudson K, Austin R, Howe S, Iqbal R, Gandhi N, Brophy K, Mirza P, Willard E, Collins S, Ndlovu N, Subkovas E, Karthikeyan V, Waggett L, Wood A, Bolger A, Stockport J, Evans L, Harman E, Starling J, Williams L, Saul V, Sinha M, Bell L, Tudgay S, Kemp S, Brown J, Frost L, Ingram T, Loughlin A, Adams C, Adams M, Hurford F, Owen C, Miller C, Donaldson D, Tivenan H, Button H, Nasser A, Jhagra O, Stidolph B, Brown C, Livingstone C, Duffy M, Madgwick P, Roberts P, Greenwood E, Fletcher L, Beveridge M, Earles S, McKenzie D, Beacock D, Dayer M, Seddon M, Greenwell D, Luxton F, Venn F, Mills H, Rewbury J, James K, Roberts K, Tonks L, Felmeden D, Taggu W, Summerhayes A, Hughes D, Sutton J, Felmeden L, Khan M, Walker E, Norris L, O’Donohoe L, Mozid A, Dymond H, Lloyd-Jones H, Saunders G, Simmons D, Coles D, Cotterill D, Beech S, Kidd S, Wrigley B, Petkar S, Smallwood A, Jones R, Radford E, Milgate S, Metherell S, Cottam V, Buckley C, Broadley A, Wood D, Allison J, Rennie K, Balian L, Howard L, Pippard L, Board S, Pitt-Kerby T. Epidemiology and impact of frailty in patients with atrial fibrillation in Europe. Age Ageing 2022; 51:6670566. [PMID: 35997262 DOI: 10.1093/ageing/afac192] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. OBJECTIVES We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. METHODS A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. RESULTS Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. CONCLUSIONS In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
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Affiliation(s)
- Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Francisco Marin
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CV, Murcia, Spain
| | - Michael Näbauer
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Center of Serbia, Belgrade, Serbia
| | - Gheorghe-Andrei Dan
- University of Medicine, 'Carol Davila', Colentina University Hospital, Bucharest, Romania
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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11
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Wonders KY, Schmitz K, Wise R, Hale R. Cost-Savings Analysis of an Individualized Exercise Oncology Program in Early-Stage Breast Cancer Survivors: A Randomized Clinical Control Trial. JCO Oncol Pract 2022; 18:e1170-e1180. [PMID: 35363502 PMCID: PMC9287397 DOI: 10.1200/op.21.00690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/07/2022] [Accepted: 03/01/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In an attempt to promote the integration of exercise oncology as a standard part of clinical practice, economic evaluations are warranted. Thus, the purpose of this study was to prospectively analyze cost savings of an individualized exercise oncology program when patients were randomly assigned. METHODS For this open-label, randomized, prospective, comparative clinical trial, patients with early-stage breast cancer (stage I-II) were randomly assigned into two groups: the control group (CG, n = 120) and the exercise training group (EX, n = 123). Patients in the exercise intervention group completed 12 weeks of prescribed, individualized exercise that aligned with ACSM exercise guidelines for cancer survivors. The CG received the current standard of care, which includes a resource guide with various options available to the cancer survivor. RESULTS In the EX group, all physical fitness measures significantly improved compared with baseline (P < .001), while remaining unchanged for the CG (P > .05). Patients in the CG had the highest total mean health care utilization across all measures (CG: $8,598 US dollars, compared with EX: $6,356 US dollars) for emergency visits, outpatient visits, and office-base visits that were not a part of their treatment plan. At baseline, the mean Eastern Cooperative Oncology Group (ECOG) scores did not significantly differ (P > .05); however, at follow-up, a larger proportion of the EX group had ECOG scores of 0 or 1, compared with the CG (P < .05). Finally, patient-reported outcomes were significantly higher in the exercise group, compared with the CG at the 12-week follow-up (P < .001). CONCLUSION A supervised, individualized 12-week exercise intervention led to significant improvements in fitness parameters and ECOG scores, as well as a decrease in unplanned health care utilization among early-stage breast cancer survivors.
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Affiliation(s)
- Karen Y. Wonders
- Department of Kinesiology and Health, Wright State University, Dayton, OH
- Maple Tree Cancer Alliance, Dayton, OH
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12
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Stine JG, Schreibman IR, Faust AJ, Dahmus J, Stern B, Soriano C, Rivas G, Hummer B, Kimball SR, Geyer NR, Chinchilli VM, Schmitz K, Sciamanna C. Reply. Hepatology 2022; 76:E18-E19. [PMID: 35266179 PMCID: PMC9436407 DOI: 10.1002/hep.32390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/31/2022] [Indexed: 12/08/2022]
Affiliation(s)
- Jonathan G. Stine
- Division of Gastroenterology and Hepatology, Department of
Medicine, The Pennsylvania State University–Milton S. Hershey Medical Center,
Hershey, Pennsylvania, USA,Department of Public Health Sciences, The Pennsylvania
State University–College of Medicine, Hershey, Pennsylvania, USA,Liver Center, The Pennsylvania State
University–Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA,Cancer Institute, The Pennsylvania State
University–Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Ian R. Schreibman
- Division of Gastroenterology and Hepatology, Department of
Medicine, The Pennsylvania State University–Milton S. Hershey Medical Center,
Hershey, Pennsylvania, USA,Liver Center, The Pennsylvania State
University–Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Alison J. Faust
- Division of Gastroenterology and Hepatology, Department of
Medicine, The Pennsylvania State University–Milton S. Hershey Medical Center,
Hershey, Pennsylvania, USA,Liver Center, The Pennsylvania State
University–Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Jessica Dahmus
- Division of Gastroenterology and Hepatology, Department of
Medicine, The Pennsylvania State University–Milton S. Hershey Medical Center,
Hershey, Pennsylvania, USA
| | - Benjamin Stern
- Division of Gastroenterology and Hepatology, Department of
Medicine, The Pennsylvania State University–Milton S. Hershey Medical Center,
Hershey, Pennsylvania, USA
| | - Christopher Soriano
- Division of Gastroenterology and Hepatology, Department of
Medicine, The Pennsylvania State University–Milton S. Hershey Medical Center,
Hershey, Pennsylvania, USA
| | - Gloriany Rivas
- Division of Gastroenterology and Hepatology, Department of
Medicine, The Pennsylvania State University–Milton S. Hershey Medical Center,
Hershey, Pennsylvania, USA
| | - Breianna Hummer
- Division of Gastroenterology and Hepatology, Department of
Medicine, The Pennsylvania State University–Milton S. Hershey Medical Center,
Hershey, Pennsylvania, USA
| | - Scot R. Kimball
- Department of Physiology, The Pennsylvania State
University–College of Medicine, Hershey, Pennsylvania, USA
| | - Nathaniel R. Geyer
- Department of Public Health Sciences, The Pennsylvania
State University–College of Medicine, Hershey, Pennsylvania, USA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, The Pennsylvania
State University–College of Medicine, Hershey, Pennsylvania, USA
| | - Kathryn Schmitz
- Department of Public Health Sciences, The Pennsylvania
State University–College of Medicine, Hershey, Pennsylvania, USA,Cancer Institute, The Pennsylvania State
University–Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA,Department of Kinesiology, The Pennsylvania State
University–College of Medicine, Hershey, Pennsylvania, USA,Department of Physical Medicine & Rehabilitation, The
Pennsylvania State University–Milton S. Hershey Medical Center, Hershey,
Pennsylvania, USA
| | - Christopher Sciamanna
- Department of Public Health Sciences, The Pennsylvania
State University–College of Medicine, Hershey, Pennsylvania, USA,Cancer Institute, The Pennsylvania State
University–Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA,Department of Medicine, The Pennsylvania State
University–Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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13
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Stine JG, Schreibman IR, Faust AJ, Dahmus J, Stern B, Soriano C, Rivas G, Hummer B, Kimball SR, Geyer NR, Chinchilli VM, Loomba R, Schmitz K, Sciamanna C, Strine C, Wentzel R, Marlin S, Sica C, Vesek J, Eyster E, Sinoway L, Bentz K, Handley N, Hershey Fell B, Mottilla S, Christ C, George S, Novchich T, Beyer M, Clarke K, Myers T, Glading‐Steinruck M, Krok K, Ma T, Riley T, Thompson E, Tressler H, Broach J, Doan T, Patrick S, Reed S, Hamilton C, Slavoski K, Tregea D. NASHFit: A randomized controlled trial of an exercise training program to reduce clotting risk in patients with NASH. Hepatology 2022; 76:172-185. [PMID: 34890063 PMCID: PMC9184303 DOI: 10.1002/hep.32274] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/04/2021] [Accepted: 12/01/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS NASH is a common disease associated with increased rates of thromboembolism (TE). Although exercise training can lessen thrombotic risk in patients with vascular disease, whether similar findings are observed in patients with NASH is open for study. APPROACH AND RESULTS We conducted a 20-week randomized controlled clinical trial involving patients with biopsy-confirmed NASH. Patients were randomly assigned (2:1 ratio) to receive either an exercise training program or standard clinical care. The primary endpoint was change in plasminogen activator inhibitor 1 (PAI-1) level, an established thrombotic biomarker. Twenty-eight patients were randomly assigned (18 exercise training and 10 standard clinical care). PAI-1 level was significantly decreased by exercise training when compared to standard clinical care (-40 ± 100 vs. +70 ± 63 ng/ml; p = 0.02). Exercise training decreased MRI proton density fat fraction (MRI-PDFF; -4.7 ± 5.6 vs. 1.2 ± 2.8% absolute liver fat; p = 0.01); 40% of exercise subjects had a ≥30% relative reduction in MRI-PDFF (histological response threshold) compared to 13% for standard of care (p < 0.01). Exercise training improved fitness (VO2 peak, +3.0 ± 5.6 vs. -1.8 ± 5.1 ml/kg/min; p = 0.05) in comparison to standard clinical care. CONCLUSIONS This clinical trial showed that, independent of weight loss or dietary change, exercise training resulted in a significantly greater decrease in thrombotic risk than standard clinical care in patients with NASH, in parallel with MRI-PDFF reduction and improvement in fitness. Future studies are required to determine whether exercise training can directly impact patient outcomes and lower rates of TE.
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Affiliation(s)
- Jonathan G. Stine
- Division of Gastroenterology and Hepatology, Department of
Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center,
Hershey PA,Department of Public Health Sciences, The Pennsylvania
State University- College of Medicine, Hershey PA,Liver Center, The Pennsylvania State University- Milton S.
Hershey Medical Center, Hershey PA,Cancer Institute, The Pennsylvania State University-
Milton S. Hershey Medical Center, Hershey PA
| | - Ian R. Schreibman
- Division of Gastroenterology and Hepatology, Department of
Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center,
Hershey PA,Liver Center, The Pennsylvania State University- Milton S.
Hershey Medical Center, Hershey PA
| | - Alison J. Faust
- Division of Gastroenterology and Hepatology, Department of
Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center,
Hershey PA
| | - Jessica Dahmus
- Division of Gastroenterology and Hepatology, Department of
Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center,
Hershey PA
| | - Benjamin Stern
- Division of Gastroenterology and Hepatology, Department of
Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center,
Hershey PA
| | - Christopher Soriano
- Division of Gastroenterology and Hepatology, Department of
Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center,
Hershey PA
| | - Gloriany Rivas
- Division of Gastroenterology and Hepatology, Department of
Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center,
Hershey PA
| | - Breianna Hummer
- Division of Gastroenterology and Hepatology, Department of
Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center,
Hershey PA
| | - Scot R. Kimball
- Department of Physiology, The Pennsylvania State
University- College of Medicine, Hershey PA
| | - Nate R. Geyer
- Department of Public Health Sciences, The Pennsylvania
State University- College of Medicine, Hershey PA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, The Pennsylvania
State University- College of Medicine, Hershey PA
| | - Rohit Loomba
- Division of Gastroenterology and Hepatology, Department of
Medicine, University of California San Diego, San Diego CA,NAFLD Research Center, University of California San Diego,
San Diego CA
| | - Kathryn Schmitz
- Department of Public Health Sciences, The Pennsylvania
State University- College of Medicine, Hershey PA,Cancer Institute, The Pennsylvania State University-
Milton S. Hershey Medical Center, Hershey PA,Department of Kinesiology, The Pennsylvania State
University- College of Medicine, Hershey PA,Department of Physical Medicine & Rehabilitation,
The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey
PA
| | - Christopher Sciamanna
- Department of Public Health Sciences, The Pennsylvania
State University- College of Medicine, Hershey PA,Cancer Institute, The Pennsylvania State University-
Milton S. Hershey Medical Center, Hershey PA,Department of Medicine, The Pennsylvania State University-
Milton S. Hershey Medical Center, -Hershey PA
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14
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Irwin ML, Lowry D, Neuhouser ML, Henry C, Sears D, Schmitz K, Nebeling L, Ligibel JA. Transdisciplinary research in energetics and cancer (TREC) training program for early career investigators. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.11031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11031 Background: Given the rising prevalence of obesity, poor diet and physical inactivity, known in combination as “energy balance” or “energetics”, as well as their associations with cancer incidence and mortality, innovative research, clinical care and training of scientists are needed to lower the prevalence of these risk factors and in turn, lower cancer incidence and mortality rates. Methods: With NCI support (R25CA203650) from 2016-2021, we developed and offered an annual one-week, in-residence Transdisciplinary Research in Energetics and Cancer (TREC) Training workshop, followed by a yearlong mentoring program, that focused on energy balance and cancer research across the cancer control continuum. Results: We recruited, educated, trained and mentored 123 early career investigators (TREC Fellows) from 64 different institutions and from diverse academic backgrounds (i.e., 20% basic, 33% clinical and 47% population sciences) in transdisciplinary research in energetics and cancer. Fellows accepted to the TREC Training Program worked with more than 20 expert international TREC Faculty on developing grant applications and original research toward key gaps in energy balance and cancer research. TREC Fellows have published over 270 manuscripts in peer-reviewed journals, with at least 62 published manuscripts including the TREC Fellow as first or senior author and including a TREC Faculty and/or Fellow as co-author. Since completing the Program, TREC Fellows have received at least 31 extramural grants, as principal investigator. Building upon the strengths of the previous five years, we were awarded a competitive renewal to continue the TREC Training Program through 2026. TREC Training program goals are: (1) to continue to offer a TREC Training Program for ̃100 academically diverse early career investigators including a 5-day in-residence workshop focused on the Fellows research, networking, mentoring and professional development; (2) to evaluate the TREC Training Program and track TREC Fellows career development; and (3) to disseminate the TREC Training sessions, webinars and newsletter to the broader community of investigators. Conclusions: To our knowledge, no other in-residence training program exists that focuses on energetics and cancer research. Our vision is to continue the TREC mission of training scientists and clinicians to develop a cadre of well-trained, diverse researchers. The overall impact of this transdisciplinary training course will be defined by the degree to which TREC Fellows produce innovative research approaches and discoveries, thereby accelerating the dissemination and implementation of evidence-based approaches into everyday practice and patient care and improving the health of the population at risk for cancer as well as cancer survivors.
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Affiliation(s)
| | - Diana Lowry
- Fred Hutch Cancer Research Center, Seattle, WA
| | | | - Curtis Henry
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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15
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Truica CI, Schmitz K, Doerksen S, Calo W, Stout NL, Wang M, Lengerich E, Moss J, Vanness DJ. Nurse AMIE: Addressing symptoms in rural patients with advanced cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps12148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS12148 Background: Prior research has shown that monitoring symptoms in advanced cancer patients may provide a survival benefit. Monitoring is a labor-intensive process that requires nursing staff response and visiting a medical office. This may be more challenging in rural areas, given staffing challenges and distances traveled for care. Lower density of supportive care services has been documented in rural as compared to urban settings in Pennsylvania and West Virginia. We have developed a computer tablet-based supportive care program, called Nurse AMIE, and are investigating its use in symptom management among cancer survivors. Our hypothesis is that a tablet-based supportive care program can improve overall survival of advanced cancer patients in rural Pennsylvania and West Virginia. Methods: This randomized controlled trial will recruit 344 patients residing in a rural county or zip code (RUCC 4-9 or RUCA 4-10) in Pennsylvania or West Virginia, who receive treatment for stage III-IV cancer, are 18 years or older, ECOG 0-3, are fluent in written and spoken English, have sufficient vision/hearing to interact with a computer tablet and staff, and have a clinician-defined life expectancy of 6 months or more. Exclusion criteria: patients on active treatment or behavioral or supportive care trials, or with medical or psychiatric conditions that would impair ability to test study hypotheses. Patients will be randomized on a 1:1 basis to receive either Nurse AMIE or a binder with written supportive care materials. Intervention participants will be asked to log into Nurse AMIE daily, where they will interact with a nurse avatar and answer symptom questions (focusing on sleep, fatigue, pain, and distress). They will receive an empathic response to symptoms and be offered evidence based, guideline concordant self-care interventions to address symptoms (including exercise, nutrition, guided meditation, cognitive behavioral therapy videos, and soothing music). Once weekly, patients will answer 21 questions from the Pro-CTCAE survey. All symptom data will be loaded into a dashboard reviewed daily by study staff. Pain or distress scores of 7+ (out of 10) will be communicated to the care team through the EMR. The trial is powered to detect a 19% difference in overall survival at 2 years follow-up (based on Denis et al JAMA 2019). Secondary outcomes include incidence of chemotherapy toxicities, patient reported outcomes, and cost effectiveness. Enrollment is anticipated to start in March 2022. A community advisory board of 12 cancer patients and stakeholders meet on a quarterly basis to provide feedback on study activities (e.g., usability testing, adaptations, overall implementation) and ensure the project responds to the needs and preferences of rural cancer patients in Pennsylvania and West Virginia. NIH R01-CA254659. Clinical trial information: NCT05221606.
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Affiliation(s)
| | | | | | | | | | - Ming Wang
- Penn State Milton S Hershey Medical Center, Hershey, PA
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16
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Riechelmann F, Hackl W, Schmitz K, Henninger B, Keiler A. Primäre synoviale Chondromatose. Arthroskopie 2022. [DOI: 10.1007/s00142-022-00536-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Zusammenfassung
Hintergrund
Die primäre synoviale Chondromatose (SC) ist eine seltene Erkrankung der Synovialmembran unklarer Ätiologie. Der aktuelle Wissensstand zu dieser Erkrankung soll in einer kurzen Übersicht dargestellt werden.
Methoden
Übersichtsarbeiten und rezente Fallberichte zur SC wurden systematisch ausgewertet und mit Daten eigener Fälle in Kontext gesetzt.
Ergebnisse
Auf Grund neuer genomischer Daten wird die SC als benigne Neoplasie eingestuft. In 60 % der Fälle liegen Mutationen im Fibronektin-1-Gen (FN1) und/oder im Gen für den Activin-A-Typ-II-Rezeptor (ACVR2A) vor. Diagnoseweisend ist die Magnetresonanztomographie (MRT) und die meist arthroskopische Biopsie der Synovia. An einem Fallbeispiel soll gezeigt werden, dass die Knorpelaggregate der SC radiologisch nicht immer schattengebend sein müssen. Differenzialdiagnostisch kommen Monarthritiden anderer Ursachen, andere Gelenk- und Muskelerkrankungen mit Mineralisierung sowie weitere von der Synovialmembran ausgehende Erkrankungen in Betracht. Die Entartungsrate liegt bei 2–4 %. Therapeutisch hat sich in den letzten Jahren das arthroskopische Vorgehen durchgesetzt, das an die Ausdehnung der Erkrankung adaptiert wird.
Schlussfolgerung
Genomische Untersuchungen sowie Fallserien und Fallberichte aus jüngerer Zeit werfen ein neues Licht auf die SC. Therapeutisch wird in jüngeren Arbeiten überwiegend arthroskopisch vorgegangen.
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17
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Potiaumpai M, Schmitz K, Mineishi S, Naik S. Pre-Transplant Strength Training Exercise: The Improve-BMT Trial. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00722-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Yang Y, Cuffee YL, Aumiller BB, Schmitz K, Almeida DM, Chinchilli VM. Serial Mediation Roles of Perceived Stress and Depressive Symptoms in the Association Between Sleep Quality and Life Satisfaction Among Middle-Aged American Adults. Front Psychol 2022; 13:822564. [PMID: 35265017 PMCID: PMC8899090 DOI: 10.3389/fpsyg.2022.822564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/26/2022] [Indexed: 01/26/2023] Open
Abstract
In this study, we used data from the second wave of Midlife in the United States (MIDUS) Study, MIDUS Biomarkers and MIDUS 3. We applied the serial mediation model to explore the serial mediating effects of perceived stress and depressive symptoms on the relationship between sleep quality and life satisfaction. A total of 945 participants were included in our study. The total indirect effect of sleep quality on life satisfaction through perceived stress, depressive symptoms and the combination of perceived stress and depressive symptoms accounted for within the overall model was 45.5%. At the intervention level, programs designed to improve the level of life satisfaction among adults should focus on perceived stress and depressive symptoms. The prevention of perceived stress and depression contributes to improving life satisfaction and wellbeing. The serial mediation results should be confirmed by further longitudinal study.
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Affiliation(s)
- Yanxu Yang
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States,*Correspondence: Yanxu Yang
| | - Yendelela L. Cuffee
- College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Betsy B. Aumiller
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Kathryn Schmitz
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
| | - David M. Almeida
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, United States
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
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19
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Smith AL, Chen J, Wyman JF, Newman DK, Berry A, Schmitz K, Stapleton AE, Klusaritz H, Lin G, Stambakio H, Sutcliffe S. Survey of lower urinary tract symptoms in United States women using the new lower urinary tract dysfunction research Network-Symptom Index 29 (LURN-SI-29) and a national research registry. Neurourol Urodyn 2022; 41:650-661. [PMID: 35032354 DOI: 10.1002/nau.24870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/17/2021] [Accepted: 12/25/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE An online bladder health survey was administered to national registry volunteers to: (1) determine the feasibility of using ResearchMatch for studying lower urinary tract symptoms (LUTS); (2) pilot the new, comprehensive Lower Urinary Tract Dysfunction Research Network Symptom Index-29 (LURN-SI-29) and determine its ability to detect known associations with LUTS; and (3) explore novel areas of bladder health in community-based women. METHODS A cross-sectional web-based survey was administered to a random sample of ResearchMatch adult female, transgender and non-binary volunteers. Participant demographics, health characteristics, the LURN-SI-29, and LUTS-related experiences were collected. RESULTS A total of 1725 ReseachMatch volunteers with a mean age of 44.0 years completed the study and were eligible for the analysis. Participants were primarily white, cisgendered, highly educated, nulliparous, and premenopausal. The median LURN-SI-29 score was 17 (interquartile range: 11-26). More than half the sample reported urinary urgency (71.0%), nocturia (65.7%), and stress incontinence (52.3%) a "few times" or more in the last 7 days. Approximately half reported sensation of incomplete bladder emptying (49.6%) with one-third reporting urgency incontinence (37.6%); notably, 52.6% of respondents reported being at least "somewhat" bothered by LUTS. LURN-SI-29 scores increased with age, body mass index, decrements in self-reported health, medical comorbidity, parity, menopausal status, and urinary symptom bother, providing evidence of convergent validity. LURN-SI-29 scores varied by race and education, with the lowest scores in Asian and highly educated women. CONCLUSION Overall, the prevalence and spectrum of LUTS in an online research registry of women volunteers were high and comparable to other population-based samples. The new LURN-SI-29 demonstrated its ability to detect expected associations with demographic and health characteristics in a nonclinical population.
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Affiliation(s)
- Ariana L Smith
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jingwen Chen
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jean F Wyman
- Division of Nursing Research, University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | - Diane K Newman
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Philadelphia, Pennsylvania, USA
| | - Amanda Berry
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kathryn Schmitz
- Division of Public Health Sciences, Penn State University State College, State College, Pennsylvania, USA
| | - Ann E Stapleton
- Division of Infectious Disease, University of Washington Seattle, Seattle, Washington, USA
| | - Heather Klusaritz
- Department of Family Medicine and Community Health, University of Pennsylvania Philadelphia, Pennsylvania, USA
| | - George Lin
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hanna Stambakio
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Philadelphia, Pennsylvania, USA
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
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20
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Zaorsky NG, Garrett S, Spratt DE, Nguyen PL, Sciamanna C, Schmitz K. Exercise: A Treatment That Should Be Prescribed With Radiation Therapy. Int J Radiat Oncol Biol Phys 2022; 112:96-98. [PMID: 34561128 DOI: 10.1016/j.ijrobp.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Sara Garrett
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Chris Sciamanna
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; Department of Medicine Division of General Internal Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Kathryn Schmitz
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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21
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Bluethmann S, Flores E, Grotte M, Heitezenrater J, Truica C, Schmitz K. Adapting an Evidence-based Physical Activity Program for The REJOIN Trial for Older Breast Cancer Survivors. Innov Aging 2021. [PMCID: PMC8681518 DOI: 10.1093/geroni/igab046.2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: Physical activity (PA) is a recommended part of breast cancer survivorship. PA promotes survival and mitigates symptoms in older breast cancer survivors (BCS), especially in reducing joint pain associated with adjuvant hormonal treatment. The purpose of this report is to describe adaptations to Fit & Strong!, an evidence-based curriculum, to meet the needs of older BCS. Methods: First, we reviewed all educational materials with scientific experts, including specialists in breast and exercise oncology. Next, we conducted semi-structured phone interviews with 3 BCS for an in-depth review of educational materials for the trial. All interviews were recorded and transcribed. Constant comparative analysis was used to identify themes and specify required technical changes. Subsequently, we recruited 3 new BCS to pre-test adapted materials and exercise sessions, complete a follow-up interview to refine our final product and rate acceptability with older BCS. Results: Overall, BCS found the materials and experience very acceptable (mean score of 9.5/10). Content changes included simplifying exercise instructions, prioritizing trial-specific content and updating photographs to be more age-appropriate. Due to COVID, the pre-test activity was conducted by Zoom and participants were given additional time and coaching to participate using this technology. BCS said they would prefer to exercise in person but reported the remote experience as very satisfactory. Conclusion: Our multi-step adaptation process provided an acceptable intervention to meet the needs of older BCS. Lessons learned will be applied to the forthcoming clinical trial, which will also be conducted remotely to maximize safety and access.
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Affiliation(s)
| | - Eileen Flores
- Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Meghan Grotte
- Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Jared Heitezenrater
- Penn State College of Medecine, Penn State College of Medicine/ Hershey, Pennsylvania, United States
| | - Cristina Truica
- Penn State College of Medicine, Penn State Cancer Institute, Pennsylvania, United States
| | - Kathryn Schmitz
- Penn State College of Medicine, Hershey, Pennsylvania, United States
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22
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Hill A, Ellger S, Schmitz K, Ogbeide T, Jöhnk D, Rombach K, Stoppe C. Investigating nutrition and functional outcome severely ill icu patients – the "INFO"-study. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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23
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Stine JG, Soriano C, Schreibman I, Rivas G, Hummer B, Yoo E, Schmitz K, Sciamanna C. Breaking Down Barriers to Physical Activity in Patients with Nonalcoholic Fatty Liver Disease. Dig Dis Sci 2021; 66:3604-3611. [PMID: 33098023 DOI: 10.1007/s10620-020-06673-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lifestyle changes, including physical activity, are the cornerstones of the treatment of nonalcoholic fatty liver disease (NAFLD). For unclear reasons, most NAFLD patients do not achieve the recommended amount of weekly activity. AIMS Our aim was to measure perceived barriers to physical activity and enablers to exercise intervention. METHODS Consecutive subjects aged 18-70 with NAFLD were prospectively enrolled. An exercise motivation questionnaire was administered to assess current behaviors and perceived barriers. RESULTS Eighty-seven subjects (60% female) were enrolled with mean age 52 years and mean body mass index (BMI) 34.5 kg/m2. Metabolic comorbidities were common: 49% had hyperlipidemia, 42% hypertension, and 40% diabetes. The majority (75%) did not achieve ≥ 150 min/week of physical activity. Ninety-one percent agreed that activity was important in improving NAFLD; 88% desired to be more active. Lack of exercise resources and education from treating provider (47%), physical discomfort during exercise (44%), and time constraints (32%) were the most common barriers. Rates of fitness tracker (34%), gym (33%), exercise program (33%), and personal trainer (17%) use were low. CONCLUSIONS While nearly all subjects with NAFLD identify physical activity to be important and desire to be more active, only a few meet activity recommendations. This discordance is due to a perceived lack of resources and education, physical discomfort, and time constraints. Better understanding of these barriers and behaviors are important to improve morbidity and mortality in NAFLD. Future behavioral research removing the identified barriers is of great importance to global public health and should be prioritized.
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Affiliation(s)
- Jonathan G Stine
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA. .,Department of Public Health Sciences, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA. .,Liver Center, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA. .,Cancer Institute, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA. .,Penn State Cancer Institute, Hershey, USA.
| | - Christopher Soriano
- Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ian Schreibman
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.,Liver Center, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Gloriany Rivas
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Breianna Hummer
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Esther Yoo
- Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Kathryn Schmitz
- Department of Public Health Sciences, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA.,Cancer Institute, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA.,Department of Kinesiology, The Pennsylvania State University- College of Medicine, Hershey, PA, USA.,Department of Physical Medicine & Rehabilitation, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Christopher Sciamanna
- Department of Public Health Sciences, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA.,Cancer Institute, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA.,Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
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Irwin ML, Lowry D, Neuhouser ML, Ligibel J, Schmitz K, Patterson RE, Colditz G, Li F, Nebeling L. Transdisciplinary Research in Energetics and Cancer early career investigator training program: first year results. Transl Behav Med 2021; 11:549-562. [PMID: 32065834 DOI: 10.1093/tbm/ibaa009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Energy imbalance increases cancer burden by increasing cancer risk and mortality. Training early career investigators on conducting impactful energy balance and cancer research is needed. We developed a Transdisciplinary Research in Energetics and Cancer (TREC) Training Program for early career investigators. This analysis examined program satisfaction, knowledge gained, publications, and awards among Year 1 participants (i.e., fellows). The program consists of an in-person course, followed by 1 year of mentorship. Faculty and fellows completed precourse and postcourse surveys. Following the mentorship period, we surveyed fellows for TREC-related research productivity, including publications and grant funding attributed to the program. Twenty fellows were accepted into the program: 3 basic, 7 clinical, and 10 population scientists. Sixteen fellows were junior faculty and four were postdoctoral fellows. The course included ~50 lectures, small group sessions, and faculty-fellow sessions. 96.7% of attendees rated the course in the highest categories of "good/very good." Knowledge significantly improved in 37 of 39 research competencies (94.8%). In the 18 months following the course, fellows published 25 manuscripts, with 3 published in journals with impact factor ≥10. Nineteen grants were funded to TREC fellows (i.e., 7 National Institutes of Health awards, 2 American Cancer Society [ACS] awards, and 10 foundation/pilot awards), and 7 fellows received career promotions. The program's impact will be defined by the degree to which TREC fellows produce discoveries that could improve the health of populations at risk for and/or surviving cancer. Upon the conclusion of our fifth year in 2021, we will publicly disseminate the program material.
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Affiliation(s)
- Melinda L Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.,Yale Cancer Center, New Haven, CT, USA
| | - Diana Lowry
- Cancer Prevention Program/Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marian L Neuhouser
- Cancer Prevention Program/Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Kathryn Schmitz
- Division of Health Services and Behavioral Research, Pennsylvania State University, Hershey, PA, USA
| | - Ruth E Patterson
- Department of Family and Preventive Medicine, Division of Epidemiology, University of California, La Jolla, CA, USA
| | - Graham Colditz
- Division of Public Health Sciences, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Fangyong Li
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.,Yale Cancer Center, New Haven, CT, USA
| | - Linda Nebeling
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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25
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Kanski B, Schleicher E, Doerksen S, Truica C, Cream L, Kass R, Farnan M, Suess R, Gordon B, Hayes M, Zucker D, Schmitz K. Acceptability And Feasibility Of A Tablet Based Supportive Care Platform For Metastatic Breast Cancer Patients. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000764848.13762.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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26
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Lin D, Potiaumpai M, Schmitz K, Sturgeon K. Increased Duration of Exercise Decreases Rate of Nonresponse to Exercise but May Not Decrease Risk for Cancer Mortality. Med Sci Sports Exerc 2021; 53:928-935. [PMID: 33044435 PMCID: PMC8026778 DOI: 10.1249/mss.0000000000002539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Previous studies have observed an inverse relationship between exercise and breast cancer risk. However, there is interindividual variability in response to exercise training interventions. We investigated whether increasing the dose of aerobic exercise (150 or 300 min·wk-1), while keeping intensity of exercise constant (70%-80% HRmax), decreases the number of exercise nonresponders and further decreases associated risk for cancer mortality in our study population of women genetically predisposed for breast cancer. METHODS Healthy premenopausal women at elevated risk of breast cancer were randomized into control (<75 min·wk-1, n = 47), low-dose exercise (150 min·wk-1, n = 39), and high-dose exercise groups (300 min·wk-1, n = 39) for approximately 6 months. We assessed 1) clinical effectiveness (CE), defined as an improvement in predicted V˙O2max of ≥1 mL·kg-1·min-1, and twice the typical error (2× TE) of V˙O2max as thresholds to classify exercise "nonresponders"; 2) CE and 2× TE relative to exercise adherence levels; and 3) related changes in V˙O2max to predicted cancer mortality risk. RESULTS After our 6-month intervention, we observed that 23.5% of women in the low-dose group and 5.6% of women in the high-dose group were clinical nonresponders (P = 0.04). Clinical nonresponder status was independent of adherence level. Associated reduction in risk for cancer mortality was observed among 87.2% of women in the low-dose group and 94.9% in the high-dose group (P = 0.43). CONCLUSION Increasing volume (not intensity) of exercise via time spent exercising significantly decreases the number of "nonresponders." True nonresponders were observed as some women did not improve their fitness capacity despite high exercise adherence levels. Lastly, it appears 150 min·wk-1 is sufficient to decrease the predicted risk of cancer mortality.
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Affiliation(s)
- Dan Lin
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA
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27
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Bluethmann S, Truica C, Olsen N, Sciamanna C, Klepin H, Chinchilli V, Schmitz K. Overview of REJOIN: A Clinical Trial to Use Exercise to Relieve Joint Pain in Older Breast Cancer Survivors. Innov Aging 2020. [PMCID: PMC7741719 DOI: 10.1093/geroni/igaa057.2239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aromatase Inhibitors (AIs) are recommended for survival in hormone-sensitive breast cancer survivors, yet are underutilized, especially in older survivors. Joint pain is a prevalent AI-related symptom that is associated with low adherence. The aims for this randomized clinical trial (n=76) are to: 1) adapt a self-management (exercise + education) intervention for older survivors planning to take AIs; 2) Test the effect of a pilot intervention on arthralgia; and 3) Test its effect on AI medication adherence behaviors. We will adapt a program for seniors that includes bi-weekly 60-minute sessions of supervised exercise plus 30 minutes of education. The 16-week program includes: 8-weeks in person plus 8-weeks at home with phone counseling. We will conduct geriatric plus baseline assessment of exercise, joint pain, and AI adherence (repeated 4, 6 and 12 months). More research with geriatric survivors is required to address treatment needs and to promote survival. Part of a symposium sponsored by the Cancer and Aging Interest Group.
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Affiliation(s)
| | - Cristina Truica
- Penn State Cancer Institute, Hershey, Pennsylvania, United States
| | - Nancy Olsen
- Penn State College of Medicine, Hershey, Pennsylvania, United States
| | | | - Heidi Klepin
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Vernon Chinchilli
- Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Kathryn Schmitz
- Penn State College of Medicine, Hershey, Pennsylvania, United States
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28
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Russo S, Walker JL, Carlson JW, Carter J, Ward LC, Covens A, Tanner EJ, Armer JM, Ridner S, Hayes S, Taghian AG, Brunelle C, Lopez-Acevedo M, Davidson BA, Schaverien MV, Ghamande SA, Bernas M, Cheville AL, Yost KJ, Schmitz K, Coyle B, Zucker J, Enserro D, Pugh S, Paskett ED, Ford L, McCaskill-Stevens W. Standardization of lower extremity quantitative lymphedema measurements and associated patient-reported outcomes in gynecologic cancers. Gynecol Oncol 2020; 160:625-632. [PMID: 33158510 DOI: 10.1016/j.ygyno.2020.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/20/2020] [Indexed: 01/07/2023]
Abstract
Practice changing standardization of lower extremity lymphedema quantitative measurements with integrated patient reported outcomes will likely refine and redefine the optimal risk-reduction strategies to diminish the devastating limb-related dysfunction and morbidity associated with treatment of gynecologic cancers. The National Cancer Institute (NCI), Division of Cancer Prevention brought together a diverse group of cancer treatment, therapy and patient reported outcomes experts to discuss the current state-of-the-science in lymphedema evaluation with the potential goal of incorporating new strategies for optimal evaluation of lymphedema in future developing gynecologic clinical trials.
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Affiliation(s)
- Sandra Russo
- National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Rockville, MD 20892-9785, USA.
| | - Joan L Walker
- Stephen Cancer Center, OUHSC, Oklahoma City, OK 73104, USA.
| | - Jay W Carlson
- Cancer Research for Ozarks, 1235 E. Cherokee, Springfield, MO 65804, USA.
| | - Jeanne Carter
- Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA.
| | - Leigh C Ward
- University of Queensland, St Lucia, Brisbane, QLD 4072, Australia.
| | - Allan Covens
- University of Toronto and Sunnybrook Health Science Centre, Toronto, ON M4N 3M5, Canada.
| | - Edward J Tanner
- Northwestern Medicine, Feinberg School of Medicine, Prentice Women's Hospital, 250 E Superior, Chicago, IL 60611, USA.
| | - Jane M Armer
- Sinclair School of Nursing, University of Missouri Health, DC 116.05, Ellis Fischel Cancer Center, 115 Business Loop 70 West, Columbia, MO 65203, USA.
| | - Sheila Ridner
- Vanderbilt University School of Nursing, 461 21st Ave South, Nashville, TN 37240, USA.
| | - Sandi Hayes
- Queensland University of Technology, School of Public Health and Biomedical Innovation, Queensland, Australia.
| | - Alphonse G Taghian
- Harvard Medical School/Massachusetts General Hospital, Radiation Oncology, Boston, MA 02114, USA.
| | - Cheryl Brunelle
- Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA 02114, USA.
| | - Micael Lopez-Acevedo
- The George Washington University Hospital, School of Medicine and Health Sciences, 2150 Pennsylvania Ave, NW, Washington, DC 20037, USA.
| | - Brittany A Davidson
- Duke University School of Medicine, Duke Cancer Center, 20 Duke Medical Center, Durham, NC 27710, USA.
| | - Mark V Schaverien
- The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
| | - Sharad A Ghamande
- Augusta University, Augusta Oncology, 3696 Wheeler Road, Augusta, GA 30909, USA.
| | - Michael Bernas
- TCU and UNTHSC School of Medicine, Forth Worth, TX 76207, USA.
| | | | | | - Kathryn Schmitz
- Penn State Cancer Institute, 400 University Drive, Hershey, PA 17033, USA.
| | - Barbara Coyle
- Patient Advocate, Lymphedema Advocacy Group, Minneapolis, MN, USA
| | - Jeannette Zucker
- National Lymphedema Network, 411 Lafayette Street, 6th Floor, New York, NY 10003, USA.
| | - Danielle Enserro
- NRG Oncology Statistics and Data Management Center, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | - Stephanie Pugh
- NRG Oncology Statistics and Data Management Center, 1600 JFK Blvd, Suite 1020, Philadelphia, PA 1903, USA.
| | - Electra D Paskett
- The Ohio State University, 1590 N High Street, Suite 525, Columbus, OH 43210, USA.
| | - Leslie Ford
- National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Rockville, MD 20892-9785, USA.
| | - Worta McCaskill-Stevens
- National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Rockville, MD 20892-9785, USA.
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Stine JG, Xu D, Schmitz K, Sciamanna C, Kimball SR. Exercise Attenuates Ribosomal Protein Six Phosphorylation in Fatty Liver Disease. Dig Dis Sci 2020; 65:3238-3243. [PMID: 32239376 PMCID: PMC7529701 DOI: 10.1007/s10620-020-06226-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/18/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Nonalcoholic fatty liver disease (NAFLD) is the leading cause of liver disease worldwide. Nonalcoholic steatohepatitis (NASH), is a more severe type of NAFLD. Exercise improves NASH, by reversing steatosis, and may arrest fibrosis. However, the mechanisms underlying these interactions are unknown. AMP-activated protein kinase (AMPK) is a fuel-sensing enzyme that is activated by energy stress. Mammalian target of rapamycin in complex 1 (mTORC1) is a nutrient sensor that regulates protein synthesis. In NASH, AMPK activity is low and mTORC1 is high. In healthy persons, exercise activates AMPK and suppresses mTORC1. We examined the effects of exercise on hepatic ribosomal protein S6 phosphorylation, a downstream target of AMPK and mTORC1 in patients with NASH. METHODS Three subjects with biopsy-proven NASH underwent a structured, 20-week aerobic exercise intervention, five-days a week for 30-min at a moderate intensity (40-55% of VO2max). Immunofluorescence staining for rpS6 phosphorylation in hepatic tissue was quantified by ImageJ software. RESULTS Following 20-weeks of aerobic exercise, rpS6 levels were significantly attenuated (3.9 ± 1.9 pre-exercise vs. 1.4 +/0.4 post-exercise, p = 0.04). CONCLUSIONS These findings suggest exercise modulates the AMPK/mTORC1 pathway in patients with NASH and may guide the design of future studies into the mechanism of how exercise improves NASH and possibly reverses fibrosis.
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Affiliation(s)
- Jonathan G Stine
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
- Department of Public Health Sciences, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA.
- Liver Center, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA.
- Cancer Institute, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA.
| | - Dandan Xu
- Department of Cellular and Molecular Physiology, The Pennsylvania State University- College of Medicine, Hershey, PA, USA
| | - Kathryn Schmitz
- Department of Public Health Sciences, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
- Cancer Institute, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Kinesiology, The Pennsylvania State University- College of Medicine, Hershey, PA, USA
- Department of Physical Medicine and Rehabilitation, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Christopher Sciamanna
- Department of Public Health Sciences, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
- Cancer Institute, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Scot R Kimball
- Department of Cellular and Molecular Physiology, The Pennsylvania State University- College of Medicine, Hershey, PA, USA
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Schäfer D, Wagner J, Schmitz K, Benz J, Harth S, Oreb M, Weuster-Botz D. Two‐step bioprocess for
L
‐galactonate production from sugar beet pulp. CHEM-ING-TECH 2020. [DOI: 10.1002/cite.202055108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- D. Schäfer
- Technical University of Munich Biochemical Engineering Boltzmannstr. 15 85748 Garching Germany
| | - J. Wagner
- Technical University of Munich Biochemical Engineering Boltzmannstr. 15 85748 Garching Germany
| | - K. Schmitz
- Technical University of Munich Wood Bioprocesses Hans-Carl-von-Carlowitz-Platz 2 85354 Freising Germany
| | - J. P. Benz
- Technical University of Munich Wood Bioprocesses Hans-Carl-von-Carlowitz-Platz 2 85354 Freising Germany
| | - S. Harth
- Goethe University Frankfurt Molecular Biosciences Max-von-Laue-Str. 9 60438 Frankfurt am Main Germany
| | - M. Oreb
- Goethe University Frankfurt Molecular Biosciences Max-von-Laue-Str. 9 60438 Frankfurt am Main Germany
| | - D. Weuster-Botz
- Technical University of Munich Biochemical Engineering Boltzmannstr. 15 85748 Garching Germany
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31
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Stine JG, Schreibman I, Navabi S, Kang M, Dahmus J, Soriano C, Rivas G, Hummer B, Beyer M, Tressler H, Kimball SR, Patterson AD, Schmitz K, Sciamanna C. Nonalcoholic steatohepatitis Fitness Intervention in Thrombosis (NASHFit): Study protocol for a randomized controlled trial of a supervised aerobic exercise program to reduce elevated clotting risk in patients with NASH. Contemp Clin Trials Commun 2020; 18:100560. [PMID: 32309672 PMCID: PMC7154986 DOI: 10.1016/j.conctc.2020.100560] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/17/2020] [Accepted: 03/28/2020] [Indexed: 02/07/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease worldwide affecting upwards of one third the global population. For reasons not fully understood, individuals with NAFLD and its more severe variant, nonalcoholic steatohepatitis (NASH), are at increased risk for venous thromboembolism which significantly increases morbidity and mortality. Lifestyle changes centering around exercise training are the mainstay of treatment for NAFLD/NASH. While exercise training can lessen venous thromboembolic risk in healthy persons and those with cardiovascular disease, whether or not this benefit is seen in patients with NAFLD/NASH remains unknown. In order to better understand how exercise training impacts thrombosis risk in NAFLD, we present the design of a thirty-two week randomized controlled clinical trial of 42 sedentary subjects age 18-69 with biopsy proven NASH. The main aim is to determine the impact of an aerobic exercise training program on the abnormal hemostatic system unique to NAFLD/NASH. The main outcome is change in plasminogen activator inhibitor one level, an established marker for venous thromboembolism. Secondary outcomes include body composition, cardiorespiratory fitness, control of comorbid metabolic conditions (e.g., obesity, hypertension, hyperlipidemia, diabetes), dietary composition, health related quality of life, liver enzymes and histology, NAFLD/NASH disease activity (e.g., biomarkers, clinical decision aids), microbiome, other markers of hemostasis, and PNPLA3 gene expression. The study represents the first clinical trial of an exercise training program to reduce elevated clotting risk in subjects with NAFLD/NASH.
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Affiliation(s)
- Jonathan G. Stine
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
- Liver Center, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
- Cancer Institute, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ian Schreibman
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
- Liver Center, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Seyedehsan Navabi
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Mitchell Kang
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jessica Dahmus
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Christopher Soriano
- Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Gloriany Rivas
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Breianna Hummer
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Megan Beyer
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Heather Tressler
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Scot R. Kimball
- Department of Physiology, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Andrew D. Patterson
- Department of Biochemistry and Molecular Biology, The Pennsylvania State University, University Park, PA, USA
| | - Kathryn Schmitz
- Department of Public Health Sciences, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
- Cancer Institute, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Kinesiology, The Pennsylvania State University- College of Medicine, Hershey, PA, USA
- Department of Physical Medicine & Rehabilitation, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Christopher Sciamanna
- Department of Public Health Sciences, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
- Cancer Institute, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
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Mama SK, Bhuiyan N, Lengerich E, Schmitz K. DETERMINANTS OF LEISURE-TIME PHYSICAL ACTIVITY IN OLDER, RURAL CANCER SURVIVORS IN CENTRAL PENNSYLVANIA. Innov Aging 2019. [PMCID: PMC6840450 DOI: 10.1093/geroni/igz038.1424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study explored social and environmental determinants of leisure-time physical activity (LTPA) in cancer survivors (CS) residing in Central Pennsylvania, a largely rural region. Rural CS completed questionnaires assessing LTPA, social support (SS) for LTPA, home and neighborhood environments for LTPA. Logistic regression models were used to assess associations with being active/inactive. Participants (n=219) were categorized as mature survivors (<75 years, 80.7%) or elderly survivors (>=75 years, 19.3%). Only 28.2% of elderly survivors reported meeting LTPA guidelines compared to 45.6% of mature survivors. Survivors reporting SS for LTPA were 10% more likely to active than those who did not have SS (OR=1.1, CI 1-1.1). Mature survivors that reported environmental support (home: OR=1.2: CI 1-1.3; neighborhood: OR=1.8, CI: 1-3.2) were more likely to be active than those without strong environmental support. Creating more supportive environments to foster LTPA in elderly survivors in rural areas is a key priority for future research.
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Affiliation(s)
- Scherezade K Mama
- The Pennsylvania State University, University Park, Pennsylvania, United States
| | - Nishat Bhuiyan
- The Pennsylvania State University, University Park, Pennsylvania, United States
| | - Eugene Lengerich
- Pennsylvania State University, Hershey, Pennsylvania, United States
| | - Kathryn Schmitz
- The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States
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Irwin ML, Lowry DK, Neuhouser ML, Ligibel J, Schmitz K, Patterson RE, Colditz G, Li F, Nebeling L. Abstract LB-164: Transdisciplinary research in energetics and cancer (TREC) early career investigator training program: First year results. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-lb-164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Obesity, poor diet and physical inactivity increase the burden of cancer by increasing risk of incident cancer, mortality, and long term adverse treatment effects. It is critical that scientists receive training in conducting rigorous and impactful energy balance and cancer research. To address this need, we developed an annual one-week, in residence NCI-R25-funded Transdisciplinary Research in Energetics and Cancer (TREC) Training Course for early career investigators in basic, clinical and population sciences. This analysis examined the impact of the TREC Training Program on course satisfaction, knowledge gained, publications and awards among TREC Year 1 program participants (i.e., TREC Fellows).
Methods: The TREC program consists of two components: an intensive, in-person, one-week Course, followed by a one-year TREC mentorship program. TREC Faculty are comprised of a TD team of ~20 international expert faculty members. TREC Faculty and Fellows completed surveys before and immediately after the course. The Wilcoxon Signed Rank Test was used to determine course-related changes in knowledge and skills. At the end of the one-year mentorship period, a survey was sent inquiring about TREC-related research productivity and collaborations. Number of publications and grant-funding between June 2017 and December 2018 was compiled and summarized for the 20 TREC Fellows participating in the inaugural TREC course.
Results: Information about the program was shared with ~30 organizations, resulting in 77 applications for the inaugural course. Twenty TREC Fellows completed the program, including three basic, seven clinical, and 10 population scientists. Sixteen of the TREC fellows were junior faculty and four were postdoctoral fellows. The 5-day course included over 50 lectures, small-group breakouts and Faculty-Fellow sessions. Attendees rated the course as very high, with an average 96.7% of responses scoring in the top two categories of “good” or “very good”. Knowledge related to conducting energy balance and cancer research significantly improved in 37 out of 39 competencies (94.8%). Between the end of the TREC Year 1 program in June 2017 and December 2018, TREC Year 1 Fellows published 20 manuscripts, with 15 co-authored with other TREC Fellows and/or Faculty. Fifteen % of manuscripts were published in journals with an impact factor > 10. A total of 19 grant applications were funded to TREC Fellows (i.e., five NIH awards, three ACS awards, three foundation awards, and eight internal pilot awards). Seven TREC Fellows were appointed or promoted in academic positions.
Conclusion: The overall impact of the TREC Program will be defined by the degree to which TREC Fellows produce innovative research approaches and discoveries that could improve the health of populations at risk for cancer as well as cancer survivors. Upon completion of the 5th year of the TREC Training Program in 2021, we will disseminate the TREC Training Program material for adoption by the broader research and clinical community.
Citation Format: Melinda L. Irwin, Diana K. Lowry, Marian L. Neuhouser, Jennifer Ligibel, Kathryn Schmitz, Ruth E. Patterson, Graham Colditz, Fangyong Li, Linda Nebeling. Transdisciplinary research in energetics and cancer (TREC) early career investigator training program: First year results [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr LB-164.
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Affiliation(s)
| | | | | | | | | | | | | | - Fangyong Li
- 1Yale School of Public Health, New Haven, CT
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Taylor KG, Schleicher EA, Potiaumpai M, Moyer J, Burse N, Schmitz K. Feasibility And Adherence For Exercise During All Chemotherapy: EnACT. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561228.65892.4e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Schleicher E, Potiaumpai M, Taylor K, Moyer J, Burse N, Schmitz K. Exercise During Chemotherapy And Its Effects On Symptom Management: Enact: Exercise In All Chemotherapy. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561230.04011.a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Potiaumpai M, Schleicher E, Taylor KG, Moyer J, Burse N, Schmitz K. Exercise during Chemotherapy Improves Physical Function: Findings from EnACT: Exercise in All Chemotherapy. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561232.88762.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Chu* C, Schmitz K, Khanijow K, Stambakio H, Newman D, Andy U, Arya L. PD06-12 FEASIBILITY AND OUTCOMES IN A PILOT RANDOMIZED CONTROLLED TRIAL OF A HOME-BASED INTEGRATED PHYSICAL EXERCISE AND BLADDER TRAINING PROGRAM VERSUS USUAL CARE FOR COMMUNITY-DWELLING OLDER WOMEN WITH URINARY INCONTINENCE. J Urol 2019. [DOI: 10.1097/01.ju.0000555233.29108.0b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Basen-Engquist K, Alfano C, Maitin-Shepard M, Thomson C, Stein K, Syrjala K, Fallon E, Pinto B, Schmitz K, Zucker D, Doyle C, Demark-Wahnefried W. Moving Research Into Practice: Physical Activity, Nutrition, and Weight Management for Cancer Patients and Survivors. NAM Perspect 2018. [DOI: 10.31478/201810g] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mathis KM, Sturgeon KM, Winkels RM, Wiskemann J, Williams NI, Schmitz K. Exercise and chemotherapy-induced amenorrhea. Med Hypotheses 2018; 116:49-53. [DOI: 10.1016/j.mehy.2018.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/27/2018] [Accepted: 04/24/2018] [Indexed: 11/26/2022]
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Sturgeon KM, Foo W, Heroux M, Schmitz K. Change in Inflammatory Biomarkers and Adipose Tissue in BRCA1/2+ Breast Cancer Survivors Following a Yearlong Lifestyle Modification Program. Cancer Prev Res (Phila) 2018; 11:545-550. [PMID: 29925515 DOI: 10.1158/1940-6207.capr-18-0098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/16/2018] [Accepted: 06/14/2018] [Indexed: 11/16/2022]
Abstract
Breast cancer survivors who carry a genetic mutation for one of the BRCA genes often undergo surgically induced menopause a decade or more before the usual age of natural menopause. These women are at elevated risk for multiple negative health outcomes, including metabolic diseases, heart disease, and cancer recurrence. Effects of a 12-month commercially available web-based lifestyle program (Precision Nutrition) were tested on body composition and markers of inflammation in a randomized controlled trial. Participants (N = 35) were BRCA1/2+, breast cancer survivors, and had completed surgically induced menopause at age <45 years. Dual-energy X-ray absorptiometry was used to quantify body composition. Fasting blood samples were used to assay insulin, IL1β, IL6, IL8, and TNFα. At baseline, we observed relationships between insulin, TNFα, and IL6, and between biomarkers and adiposity. Insulin and subcutaneous adipose tissue levels significantly decreased following the intervention compared with the change in the control group. Compared with baseline, TNFα and total adipose tissue levels decreased significantly in the intervention group. The percent change in insulin levels was moderately correlated with the percent change in subcutaneous adipose tissue (r = 0.33). Change in adiposity was not related to change in TNFα or IL6. Women in the intervention group decreased levels of subcutaneous, but not visceral, adipose tissue. The change in subcutaneous adipose tissue was the main driver of change in insulin levels for the women in the intervention group. However, the change in body composition achieved by the Precision Nutrition program was not sufficient to alter biomarker levels of inflammation. Cancer Prev Res; 11(9); 545-50. ©2018 AACR.
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Affiliation(s)
- Kathleen M Sturgeon
- Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - Wayne Foo
- Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | | | - Kathryn Schmitz
- Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA.
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Lenssen R, Schmitz K, Griesel C, Heidenreich A, Schulz JB, Trautwein C, Marx N, Fitzner C, Jaehde U, Eisert A. Comprehensive pharmaceutical care to prevent drug-related readmissions of dependent-living elderly patients: a randomized controlled trial. BMC Geriatr 2018; 18:135. [PMID: 29898670 PMCID: PMC6000946 DOI: 10.1186/s12877-018-0814-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 05/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elderly patients are vulnerable to adverse drug reactions (ADRs). Drug-related readmissions (DRRs) can be a major consequence of ADR. Therefore, this study aimed to investigate the effects of a ward-based, comprehensive pharmaceutical care service on the occurrence of DRRs as the endpoint in dependent-living elderly patients. METHODS A randomized, controlled trial was performed at a German University Hospital. Patients fulfilling the following criteria were eligible: admission to a cooperating ward, existing drug therapy at admission, 65 years of age and older, home-care or nursing home residents in ambulatory care, and a minimum hospital stay of three days. Patients received either standard care (control group) or pharmaceutical care (intervention group). Follow-up consultations were conducted for each patient at 1, 8, 26, and 52 weeks after discharge. The time to DRR was defined as the primary outcome measure and was analysed using the log-rank test. The Cox-proportional hazard model was used for risk factor analysis. RESULTS Sixty patients (n = 31 intervention group, n = 29 control group) participated in the study. For patients in the intervention group, the median time to DRR was prolonged; however, the level of statistical significance was not reached (log-rank test P = 0.068; HR = 3.28, P = 0.086). When the risk factors 'age' or 'length of stay on the ward' were added to the Cox proportional hazard model, patients in the control group exhibited a significantly higher risk of experiencing a DRR than patients of the intervention group (HR = 4.62; P = 0.028 including age and HR = 5.76; P = 0.033 including length of stay on the ward). CONCLUSIONS Our findings demonstrate the successful implementation of ward-based, comprehensive pharmaceutical care for dependent-living elderly. Despite a low participation rate, which led to an underpowered study, the results provide a preliminary efficacy signal and effect size estimates to power a definitive trial. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01578525 , prospectively registered April 13, 2012.
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Affiliation(s)
- R Lenssen
- Hospital Pharmacy, University Hospital RWTH Aachen, Steinbergweg 20, 52074, Aachen, Germany.,Institute of Pharmacy, Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121, Bonn, Germany.,Present address: Hospital Pharmacy, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - K Schmitz
- Hospital Pharmacy, University Hospital RWTH Aachen, Steinbergweg 20, 52074, Aachen, Germany.,Institute of Pharmacy, Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121, Bonn, Germany
| | - C Griesel
- Hospital Pharmacy, University Hospital RWTH Aachen, Steinbergweg 20, 52074, Aachen, Germany
| | - A Heidenreich
- Department of Urology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.,Present address: Department of Urology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - J B Schulz
- Department of Neurology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - C Trautwein
- Department of Internal Medicine III, Gastroenterology, Metabolic Disorders and Internal Intensive Medicine, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - N Marx
- Department of Internal Medicine I, Cardiology, Pneumology, Angiology and Internal Intensive Medicine, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - C Fitzner
- Department of Medical Statistics, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - U Jaehde
- Institute of Pharmacy, Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121, Bonn, Germany
| | - A Eisert
- Hospital Pharmacy, University Hospital RWTH Aachen, Steinbergweg 20, 52074, Aachen, Germany.
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Schleicher E, Cream L, Kass R, Farnan M, Zhang X, Mathis K, Moyer J, Schmitz K. Nurse Amie (Addressing Metastatic Individuals Everyday). Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000538776.16249.d4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Burse N, Sturgeon K, Bryan C, Foo W, Mathis K, Moyer J, Winkels R, Wiskemann J, Schmitz K. Exercise In All Chemotherapy (EnACT) Study. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000538779.01001.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Calo WA, Bluethmann S, Foo W, Lengerich E, Mama S, Segel J, Winkels R, Wiskemann J, Schmitz K. Exploring Racial/Ethnic Differences in Physical Activity and Behavioral Risk Factors among Cancer Survivors in Central Pennsylvania. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536320.65565.a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Foo W, Schmitz K. Physical Activity Patterns Among Older Central Pennsylvania Cancer Survivors. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536073.33189.5b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Schmitz K, Brunkhorst R, de Bruin N, Mayer CA, Häussler A, Ferreiros N, Schiffmann S, Parnham MJ, Tunaru S, Chun J, Offermanns S, Foerch C, Scholich K, Vogt J, Wicker S, Lötsch J, Geisslinger G, Tegeder I. Dysregulation of lysophosphatidic acids in multiple sclerosis and autoimmune encephalomyelitis. Acta Neuropathol Commun 2017; 5:42. [PMID: 28578681 PMCID: PMC5457661 DOI: 10.1186/s40478-017-0446-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/21/2017] [Indexed: 01/18/2023] Open
Abstract
Abstract Bioactive lipids contribute to the pathophysiology of multiple sclerosis. Here, we show that lysophosphatidic acids (LPAs) are dysregulated in multiple sclerosis (MS) and are functionally relevant in this disease. LPAs and autotaxin, the major enzyme producing extracellular LPAs, were analyzed in serum and cerebrospinal fluid in a cross-sectional population of MS patients and were compared with respective data from mice in the experimental autoimmune encephalomyelitis (EAE) model, spontaneous EAE in TCR1640 mice, and EAE in Lpar2-/- mice. Serum LPAs were reduced in MS and EAE whereas spinal cord LPAs in TCR1640 mice increased during the ‘symptom-free’ intervals, i.e. on resolution of inflammation during recovery hence possibly pointing to positive effects of brain LPAs during remyelination as suggested in previous studies. Peripheral LPAs mildly re-raised during relapses but further dropped in refractory relapses. The peripheral loss led to a redistribution of immune cells from the spleen to the spinal cord, suggesting defects of lymphocyte homing. In support, LPAR2 positive T-cells were reduced in EAE and the disease was intensified in Lpar2 deficient mice. Further, treatment with an LPAR2 agonist reduced clinical signs of relapsing-remitting EAE suggesting that the LPAR2 agonist partially compensated the endogenous loss of LPAs and implicating LPA signaling as a novel treatment approach. Graphical abstract Graphical summary of lysophosphatidic signaling in multiple sclerosis![]() Electronic supplementary material The online version of this article (doi:10.1186/s40478-017-0446-4) contains supplementary material, which is available to authorized users.
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Haggerty A, Zhang X, Wilson E, Wong V, Schmitz K, Ko E, Mastroyannis S. Weight changes after the diagnosis of endometrial cancer. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cory L, Zhang X, Schmitz K, Ko E, Haggerty A. An area for physician intervention: Trends in lifestyle behaviors and cardiovascular risk factors among endometrial cancer patients over a five-year follow-up period. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE/OBJECTIVES To establish the feasibility and acceptability of completing a higher dose of the planned physical activity volume among women with ovarian cancer, including those undergoing active treatment.
. DESIGN A pre-/post-test exercise intervention. All participants were asked to complete 225 minutes per week of physical activity for 26 weeks. Multiple supports were provided, including exercise DVDs, self-reported logs, and an objective physical activity tracker (Fitbit®).
. SETTING Home-based exercise intervention with in-person training and telephone follow-ups.
. SAMPLE 10 women with ovarian cancer who were treated within Penn Medicine in Philadelphia, Pennsylvania.
. METHODS Home-based, in-person exercise counseling was provided by an exercise trainer weekly for the first six weeks and then monthly for a total of 26 weeks. Weekly follow-up telephone calls were used to assess exercise adherence and barriers to completing exercise, review symptom changes, and provide behavioral support.
. MAIN RESEARCH VARIABLES Feasibility and acceptability.
. FINDINGS Eight participants completed the study and achieved at least 80% of the prescribed exercise dose. Five participants were undergoing chemotherapy simultaneously. Participants experienced no adverse events during the 26-week intervention. Compared to baseline, average steps increased by 1,593 per day and moderate-intensity physical activity increased by 15 minutes per day.
. CONCLUSIONS A 225-minutes-per-week exercise program is feasible and acceptable in a population of patients with ovarian cancer. Participants significantly improved their physical activity during the 26-week intervention.
. IMPLICATIONS FOR NURSING The findings suggest that nursing professionals could recommend that women with ovarian cancer exercise 225 minutes per week regardless of cancer and/or treatment trajectory. For those experiencing aches and pains, behavioral supports and suggestions of a lower exercise dose are needed to maintain physical activity.
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Segal S, John G, Sammel M, Andy UU, Chu C, Arya LA, Brown J, Schmitz K. Urinary incontinence and other pelvic floor disorders after radiation therapy in endometrial cancer survivors. Maturitas 2017; 105:83-88. [PMID: 28396018 DOI: 10.1016/j.maturitas.2017.03.313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate radiation therapy as a risk factor for urinary or fecal incontinence, pelvic organ prolapse, and sexual dysfunction in endometrial cancer survivors. STUDY DESIGN We performed a retrospective cohort study of endometrial cancer survivors. Data were collected using a mailed survey and the medical record. Validated questionnaires were used to generate rates of urinary incontinence and other pelvic floor disorders. The incidence rates of pelvic floor disorders were compared across groups with different exposures to radiation. RESULTS Of the 149 endometrial cancer survivors, 41% received radiation therapy. Fifty-one percent of women reported urine leakage. The rates of urinary incontinence in women exposed and not exposed to vaginal brachytherapy (VBT) or whole-pelvis radiation were 48% and 58%, respectively (p=0.47). The incidence of fecal incontinence did not differ between groups, but the score for overall sexual function was significantly higher in women who did not undergo radiation therapy. On multivariable analysis, significant risk factors for urinary incontinence were age (AOR 1.06 95% CI 1.02, 1.10) and BMI (AOR 1.07 95% CI 1.02, 1.11), but treatment with radiation was not significantly associated with urinary incontinence, or fecal incontinence (p>0.05). Age, BMI, and radiation exposure were independent predictors of decreased sexual function score (p<0.01). CONCLUSION Local or regional radiation is not associated with urinary or fecal incontinence, but may contribute to sexual dysfunction in endometrial cancer survivors.
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Affiliation(s)
- Saya Segal
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, and Division of Urology, Department of Surgery, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ, United States.
| | - Gabriella John
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Mary Sammel
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Uduak Umoh Andy
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania; Philadelphia, PA, United States
| | - Christina Chu
- Division of Gynecologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Lily A Arya
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania; Philadelphia, PA, United States
| | - Justin Brown
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Kathryn Schmitz
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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