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Smith GVH, Myers SA, Fujita RA, Yu C, Campbell KL. Virtually Supervised Exercise Programs for People With Cancer: A Scoping Review. Cancer Nurs 2024:00002820-990000000-00236. [PMID: 38598778 DOI: 10.1097/ncc.0000000000001353] [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: 04/12/2024]
Abstract
BACKGROUND Exercise has been shown to improve physical function and quality of life for individuals with cancer. However, low rates of exercise adoption and commonly reported barriers to accessing exercise programming have demonstrated a need for virtual exercise programming in lieu of traditional in-person formats. OBJECTIVE The aim of this study was to summarize the existing research on supervised exercise interventions delivered virtually for individuals living with and beyond cancer. METHODS We conducted a scoping review of randomized controlled trials, pilot studies, or feasibility studies investigating virtually supervised exercise interventions for adults either during or after treatment of cancer. The search included EMBASE, MEDLINE, CINAHL, SPORTDiscus, Cochrane Library, and conference abstracts. RESULTS Fifteen studies were included. The interventions were delivered mostly over Zoom in a group format, with various combinations of aerobic and resistance exercises. Attendance ranged from 78% to 100%, attrition ranged from 0% to 29%, and satisfaction ranged from 94% to 100%. No major adverse events were reported, and only 3 studies reported minor adverse events. Significant improvements were seen in upper and lower body strength, endurance, pain, fatigue, and emotional well-being. CONCLUSION Supervised exercise interventions delivered virtually are feasible and may improve physical function for individuals with cancer. The supervision included in these virtual programs promoted similar safety as seen with in-person programming. More randomized controlled trials with large cohorts are needed to validate these findings. IMPLICATIONS FOR PRACTICE Individuals living with and beyond cancer can be encouraged to join virtually supervised exercise programs because they are safe, well enjoyed, and may improve physical function and quality of life.
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Affiliation(s)
- Gillian V H Smith
- Author Affiliations: Department of Physical Therapy, University of British Columbia (Mss Smith, Myers, and Yu; Mr Fujita; and Dr Campbell), Vancouver, Canada; and University of São Paulo (Mr Fujita), Brazil
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Sattar S, Haase KR, Lee K, Campbell KL. Exercise interventions for frail older adults with cancer. Curr Opin Support Palliat Care 2024; 18:22-26. [PMID: 38126248 DOI: 10.1097/spc.0000000000000685] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW Frailty is prevalent in older adults with cancer and can lead to complications during cancer treatment and poor health outcomes. Exercise has been shown to be a promising strategy to mitigate frailty and slow the accumulation of functional impairment in the general geriatric population. In this review, we present a discussion on the state of the science of exercise interventions for frail older adults with cancer. This review is timely and relevant given the aging of the population and corresponding increase in proportion of older adults living with cancer. RECENT FINDINGS Existing research related to exercise interventions for frail older adults with cancer appear to show some promise in feasibility and efficacy in both surgical and systemic treatment settings. SUMMARY More research on this topic and testing rigorously structured exercise interventions for older adults with cancer may help inform cancer-specific guidelines and create a foundation of evidence to enable implementation of exercise interventions. These interventions can support cancer care to attenuate frailty-related outcomes while extending its benefit to overall health of this population.
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Affiliation(s)
- Schroder Sattar
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Kristen R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia
- BC Cancer Research Institute, Cancer Control
| | - Kayoung Lee
- Faculty of Applied Science, School of Nursing, University of British Columbia
| | - Kristin L Campbell
- BC Cancer Research Institute, Cancer Control
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Ip N, Zhang K, Karimuddin AA, Brown CJ, Campbell KL, Puyat JH, Sutherland JM, Conklin AI. Preparing for colorectal surgery: a feasibility study of a novel web-based multimodal prehabilitation programme in Western Canada. Colorectal Dis 2024; 26:534-544. [PMID: 38229235 DOI: 10.1111/codi.16851] [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: 07/25/2023] [Revised: 10/04/2023] [Accepted: 11/20/2023] [Indexed: 01/18/2024]
Abstract
AIM Prehabilitation for colorectal cancer has focused on exercise-based interventions that are typically designed by clinicians; however, no research has yet been patient-oriented. The aim of this feasibility study was to test a web-based multimodal prehabilitation intervention (known as PREP prehab) consisting of four components (physical activity, diet, smoking cessation, psychological support) co-designed with five patient partners. METHOD A longitudinal, two-armed (website without or with coaching support) feasibility study of 33 patients scheduled for colorectal surgery 2 weeks or more from consent (January-September 2021) in the province of British Columbia, Canada. Descriptive statistics analysed a health-related quality of life questionnaire (EQ5D-5L) at baseline (n = 25) and 3 months postsurgery (n = 21), and a follow-up patient satisfaction survey to determine the acceptability, practicality, demand for and potential efficacy in improving overall health. RESULTS Patients had a mean age of 52 years (SD 14 years), 52% were female and they had a mean body mass index of 25 kg m-2 (SD 3.8 kg m-2). Only six patients received a Subjective Global Assessment for being at risk for malnutrition, with three classified as 'severely/moderately' malnourished. The majority (86%) of patients intended to use the prehabilitation website, and nearly three-quarters (71%) visited the website while waiting for surgery. The majority (76%) reported that information, tools and resources provided appropriate support, and 76% indicated they would recommend the PREP prehab programme. About three-quarters (76%) reported setting goals for lifestyle modification: 86% set healthy eating goals, 81% aimed to stay active and 57% sought to reduce stress once a week or more. No patients contacted the team to obtain health coaching, despite broad interest (71%) in receiving active support and 14% reporting they received 'active support'. CONCLUSION This web-based multimodal prehabilitation programme was acceptable, practical and well-received by all colorectal surgery patients who viewed the patient-oriented multimodal website. The feasibility of providing active health coaching support requires further investigation.
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Affiliation(s)
- Nathanael Ip
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kexin Zhang
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ahmer A Karimuddin
- Colorectal Surgery, St Paul's Hospital, Providence Health Care, and General Surgery Residency Training Program at the University of British Columbia, Vancouver, British Columbia, Canada
- Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Carl J Brown
- Colorectal Surgery, St Paul's Hospital, Providence Health Care, and General Surgery Residency Training Program at the University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph H Puyat
- Centre for Advancing Health Outcomes, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Jason M Sutherland
- Centre for Advancing Health Outcomes, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Annalijn I Conklin
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
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Caan BJ, Brown JC, Lee C, Binder AM, Weltzien E, Ross MC, Quesenberry CP, Campbell KL, Cespedes Feliciano EM, Castillo A, Quinney S, Yang S, Meyerhardt JA, Schmitz KH. Effect of home-based resistance training on chemotherapy relative dose intensity and tolerability in colon cancer: The FORCE randomized control trial. Cancer 2024. [PMID: 38265970 DOI: 10.1002/cncr.35204] [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] [Received: 08/23/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Many patients with colon cancer cannot fully adhere to postoperative chemotherapy due to dose-limiting toxicities, resulting in lower relative dose intensity (RDI) and potentially compromising overall survival. This study examined whether home-based resistance training (RT) during adjuvant chemotherapy improves RDI and patient-reported toxicities versus usual care (UC) in colon cancer patients. METHODS Multicenter, randomized control trial (RCT) conducted at community and academic practices. Enrollment of patients receiving postoperative chemotherapy for colon cancer occurred between February 23, 2018, and September 29, 2021; final follow-up was March 21, 2022. Participants were randomized to RT (n = 90) or UC (n = 91) for the duration of chemotherapy. Participants in the RT group engaged in twice weekly home-based progressive RT. At the end of the study, UC was given an online exercise program. RESULTS Among 181 randomized patients (mean age, 55.2 [SD, 12.8] years, 95 [52.5%] were men), there were no differences in the mean RDI among those in RT (79% [SD, 19%]) and those in UC (82% [SD, 19%]); (mean difference -0.04 [95% confidence interval (CI), -0.09 to 0.02]). Assignment to RT did not significantly reduce the number of moderate/severe symptoms per week across follow-up (relative rate: 0.94 [95% CI, 0.72-1.22]). Additionally, time since randomization did not significantly modify the effect of RT on the overall number of symptoms (p = .06). CONCLUSIONS Among patients with colon cancer, these results do not support home-based RT as an adjunct to chemotherapy specifically to improve planned treatment intensity.
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Affiliation(s)
- Bette J Caan
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Justin C Brown
- Cancer Metabolism Program, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Alexandra M Binder
- Cancer Epidemiology, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
- Department of Epidemiology, University of California, Los Angeles, California, USA
| | - Erin Weltzien
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Michelle C Ross
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Charles P Quesenberry
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Kristin L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Adrienne Castillo
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Sara Quinney
- Indiana University School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Shengping Yang
- Cancer Metabolism Program, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | | | - Kathryn H Schmitz
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Campbell KL, Brown JC, Lee C, Weltzien E, Li J, Sternfeld B, Campbell N, Vaughan M, Fedric R, Meyerhardt JA, Caan BJ, Schmitz KH. Advances in Adherence Reporting of Resistance Training in a Clinical Trial during Adjuvant Chemotherapy for Colon Cancer. Med Sci Sports Exerc 2024:00005768-990000000-00458. [PMID: 38233992 DOI: 10.1249/mss.0000000000003395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
PURPOSE Detailed reporting of individually tailored exercise prescriptions (ExRx) used in clinical trials is essential to describe feasibility, tolerability, and efficacy of the intervention and to inform translation to clinical care. This paper outlines the methodology used to develop a resistance training (RT) ExRx for people with colon cancer receiving chemotherapy and reports adherence to the randomized controlled trial testing the impact of RT on relative dose intensity of chemotherapy and patient-reported toxicities. METHODS Participants randomized to the exercise arm (n = 90) were included. To promote muscle hypertrophy, the ExRx was twice-weekly, moderate to heavy loads (65-85% 1-RM), high sets (3-5), and intermediate repetitions (6-10) of five large multi-joint movements with adjustable dumbbells. Attendance (achieved frequency) and adherence (achieved volume) were calculated. Group-based trajectory modeling was used to identify clusters of individuals with similar adherence patterns and compared baseline characteristics across adherence groups. RESULTS The median attendance was 69.1%. Adherence was 60.6%, but higher for those receiving 3 versus 6 months of chemotherapy (80.4 vs. 47.4%; p < 0.05). Participants engaged in a median of 1.4 days of RT each week, lifting 62% of the 1-RM load, for 3.0 sets and 7.5 repetitions per set. Three distinct adherence groups were identified: 13% "non-starter", 37% "tapered off", and 50% "consistent exercisers". Females were more likely to be in the "non-starter" and "tapered off" groups. CONCLUSIONS This paper outlines suggested methods for reporting ExRx of RT in oncology clinical trials and provides insight into the tolerance of ExRx of RT during chemotherapy treatment for colon cancer. These findings aim to foster constructive dialogue, and offer a premise for designing future research to elucidate the benefits of exercise during chemotherapy.
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Affiliation(s)
| | | | | | | | - Jia Li
- Kaiser Permanente Northern California, Oakland, CA
| | | | | | | | - Regan Fedric
- Kaiser Permanente Northern California, Oakland, CA
| | | | - Bette J Caan
- Kaiser Permanente Northern California, Oakland, CA
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Lopez CJ, Jones JM, Campbell KL, Bender JL, Strudwick G, Langelier DM, Reiman T, Greenland J, Neil-Sztramko SE. A pre-implementation examination of barriers and facilitators of an electronic prospective surveillance model for cancer rehabilitation: a qualitative study. BMC Health Serv Res 2024; 24:17. [PMID: 38178095 PMCID: PMC10768357 DOI: 10.1186/s12913-023-10445-3] [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: 07/04/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND An electronic Prospective Surveillance Model (ePSM) uses patient-reported outcomes to monitor symptoms along the cancer pathway for timely identification and treatment. Randomized controlled trials show that ePSMs can effectively manage treatment-related adverse effects. However, an understanding of optimal approaches for implementing these systems into routine cancer care is limited. This study aimed to identify barriers and facilitators prior to the implementation of an ePSM to inform the selection of implementation strategies. METHODS A qualitative study using virtual focus groups and individual interviews was conducted with cancer survivors, oncology healthcare providers, and clinic leadership across four cancer centres in Canada. The Consolidated Framework for Implementation Research (CFIR) guided the interviews and analysis of barriers and facilitators based on five domains (intervention characteristics, individual characteristics, inner setting, outer setting, and process). RESULTS We conducted 13 focus groups and nine individual interviews with 13 patient participants and 56 clinic staff. Of the 39 CFIR constructs, 18 were identified as relevant determinants to the implementation. The adaptability, relative advantage, and complexity of an ePSM emerged as key intervention-level factors that could influence implementation. Knowledge of the system was important at the individual level. Within the inner setting, major determinants were the potential fit of an ePSM with clinical workflows (compatibility) and the resources that could be dedicated to the implementation effort (readiness for implementation). In the outer setting, meeting the needs of patients and the availability of rehabilitation supports were key determinants. Engaging various stakeholders was critical at the process level. CONCLUSIONS Improving the implementation of ePSMs in routine cancer care has the potential to facilitate early identification and management of treatment-related adverse effects, thereby improving quality of life. This study provides insight into important factors that may influence the implementation of an ePSM, which can be used to select appropriate implementation strategies to address these factors.
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Affiliation(s)
- Christian J Lopez
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Jennifer M Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Jackie L Bender
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Gillian Strudwick
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - David M Langelier
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Tony Reiman
- Department of Oncology, Saint John Regional Hospital, Saint John, Canada
- Department of Medicine, Dalhousie University, Halifax, Canada
| | - Jonathan Greenland
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Canada
- Dr. H. Bliss Murphy Cancer Centre, Eastern Health, St. John's, Canada
| | - Sarah E Neil-Sztramko
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
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Avery J, Campbell KL, Mosher P, Al-Awamer A, Goddard K, Edwards A, Burnett L, Hannon B, Gupta A, Howard AF. Advanced Cancer in Young Adults (YAs): Living in a Liminal Space. Qual Health Res 2024; 34:72-85. [PMID: 37844970 PMCID: PMC10714712 DOI: 10.1177/10497323231204182] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Young adults (YAs), defined as individuals between the ages of 18 and 39 years, experience unique challenges when diagnosed with advanced cancer. Using the social constructivist grounded theory approach, we aimed to develop a theoretical understanding of how YAs live day to day with their diagnosis. A sample of 25 YAs (aged 22-39 years) with advanced cancer from across Canada participated in semi-structured interviews. Findings illustrate that the YAs described day-to-day life as an oscillating experience swinging between two opposing disease outcomes: (1) hoping for a cure and (2) facing the possibility of premature death. Oscillating between these potential outcomes was characterized as living in a liminal space wherein participants were unsure how to live from one day to the next. The participants oscillated at various rates, with different factors influencing the rate of oscillation, including inconsistent and poor messaging from their oncologists or treatment team, progression or regression of their cancer, and changes in their physical functioning and mental health. These findings provide a theoretical framework for designing interventions to help YAs adapt to their circumstance.
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Affiliation(s)
- Jonathan Avery
- Anew Research Collaborative: Reshaping Young Adult Cancer Care, Royal Roads University, Victoria, BC, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Kristin L. Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Pamela Mosher
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ahmed Al-Awamer
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | | | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Abha Gupta
- Division of Medical Oncology, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - A. Fuchsia Howard
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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Schneider C, Ryffel C, Stütz L, Rabaglio M, Suter TM, Campbell KL, Eser P, Wilhelm M. Supervised exercise training in patients with cancer during anthracycline-based chemotherapy to mitigate cardiotoxicity: a randomized-controlled-trial. Front Cardiovasc Med 2023; 10:1283153. [PMID: 38111886 PMCID: PMC10725952 DOI: 10.3389/fcvm.2023.1283153] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/20/2023] [Indexed: 12/20/2023] Open
Abstract
Background Exercise training (ET) has been shown to mitigate cardiotoxicity of anthracycline-based chemotherapies (AC) in animal models. Data from randomized controlled trials in patients with cancer are sparse. Methods Patients with breast cancer or lymphoma receiving AC were recruited from four cancer centres and randomly assigned to 3 months supervised ET. Primary outcome was change in left ventricular global longitudinal strain (GLS) from baseline (before AC) to post AC (AC-end) compared between the EXduringAC group, who participated in an exercise intervention during AC including the provision of an activity tracker, and the control group EXpostAC, who received an activity tracker only. Secondary outcome parameters were changes in high sensitivity Troponin T (hsTnT), NT-pro-brain natriuretic peptide (NT-proBNP), peak oxygen consumption (peak VO2) and objectively measured physical activity (PA) during this same time-period. All assessments were repeated at a 12-week follow-up from AC-end, when also the EXpostAC group had completed the ET, that started after AC. In exploratory analyses, robust linear models were performed to assess the association of PA with changes in echocardiographic parameters and biomarkers of LV function. Results Fifty-seven patients (median age 47 years; 95% women) were randomized to EXduringAC (n = 28) and EXpostAC (n = 29) group. At AC-end, GLS deteriorated in both study groups (albeit insignificantly) with 7.4% and 1.0% in EXduringAC (n = 18) and EXpostAC (n = 18), respectively, and hsTnT and NT-proBNP significantly increased in both groups, without difference between groups for any parameter. Change in peak VO2 (-1.0 and -1.1 ml/kg/min) at AC-end was also similar between groups as was duration of moderate-to-vigorous PA (MVPA) with a median of 33 [26, 47] min/day and 32 [21, 59] min/day in the EXduringAC and EXpostAC group, respectively. In the robust linear model including the pooled patient population, MVPA was significantly associated with a more negative GLS and lesser increase in hsTnT at AC-end. Conclusion In this small scale RCT, supervised ET during AC was not superior to wearing a PA tracker to mitigate cardiotoxicity. The dose-response relationship between PA and cardioprotective effects during AC found in our and previous data supports the notion that PA should be recommended to patients undergoing AC. Clinical Trial Registration ClinicalTrials.gov, identifier NCT03850171.
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Affiliation(s)
- Caroline Schneider
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Christoph Ryffel
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Laura Stütz
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Manuela Rabaglio
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Thomas M. Suter
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Kristin L. Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Prisca Eser
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Matthias Wilhelm
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
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Cheng E, Caan BJ, Cawthon PM, Evans WJ, Hellerstein MK, Shankaran M, Campbell KL, Binder AM, Sternfeld B, Meyerhardt JA, Schmitz KH, Cespedes Feliciano EM. D3-creatine dilution, computed tomography and dual-energy X-ray absorptiometry for assessing myopenia and physical function in colon cancer: A cross-sectional study. J Cachexia Sarcopenia Muscle 2023; 14:2768-2778. [PMID: 37899757 PMCID: PMC10751410 DOI: 10.1002/jcsm.13353] [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: 10/20/2022] [Revised: 08/23/2023] [Accepted: 09/11/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Low skeletal muscle mass (myopenia) is common in cancer populations and is associated with functional decline and mortality, but prior oncology studies did not assess total body skeletal muscle mass. Instead, they measured surrogates such as cross-sectional area (CSA) of skeletal muscle at L3 from computed tomography (CT) or appendicular lean mass (ALM) from dual-energy X-ray absorptiometry (DXA). D3-creatine (D3Cr) dilution is a non-invasive method to assess total body skeletal muscle mass, which has been examined in a variety of populations but not in cancer. To compare the associations of D3Cr muscle mass, CT CSA, and DXA ALM with myopenia and physical function, we conducted a cross-sectional study among 119 patients with colon cancer (2018-2022). METHODS For each technique (D3Cr, CT and DXA), myopenia was defined as the lowest sex-specific quartile of its measurement. Physical function was measured by the short physical performance battery and grip strength. We calculated Pearson correlations (r) among three techniques, computed Cohen's kappa coefficients (κ) to assess the agreement of myopenia, and estimated Pearson correlations (r) of three techniques with physical function. All analyses were sex-specific. RESULTS Sixty-one (51.3%) participants were male, the mean (standard deviation) age was 56.6 (12.9) years, and most (68.9%) had high physical function (short physical performance battery: ≥11 points). Correlations and myopenia agreement among three techniques were greater in men than women; for example, regarding D3Cr muscle mass versus CT CSA, r was 0.73 (P < 0.001) for men versus 0.45 (P < 0.001) for women, and κ was 0.82 (95% CI: 0.65, 0.99) for men versus 0.24 (95% CI: -0.08, 0.52) for women. Among men, higher D3Cr muscle mass was significantly correlated with faster gait speed (r = 0.43, P < 0.01) and stronger grip strength (r = 0.32, P < 0.05); similar correlations were observed for CT CSA and DXA ALM. However, among women, no measure of muscle or lean mass was significantly associated with physical function. CONCLUSIONS This is the first study using D3-creatine dilution method to assess muscle mass in a cancer population. Regardless of the techniques used for muscle or lean mass assessment, we observed stronger correlations, greater myopenia agreement, and more significant associations with physical function in men with colon cancer than women. D3Cr, CT and DXA are not interchangeable methods for assessing myopenia and physical function, especially in women with colon cancer. Future studies should consider relative advantages of these techniques and examine the D3-creatine dilution method in other cancer types.
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Affiliation(s)
- En Cheng
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Bette J. Caan
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Peggy M. Cawthon
- San Francisco Coordinating CenterCalifornia Pacific Medical Center Research InstituteSan FranciscoCaliforniaUSA
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - William J. Evans
- Department of Nutritional Sciences and ToxicologyUniversity of CaliforniaBerkeleyCaliforniaUSA
- Division of GeriatricsDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Marc K. Hellerstein
- Department of Nutritional Sciences and ToxicologyUniversity of CaliforniaBerkeleyCaliforniaUSA
| | - Mahalakshmi Shankaran
- Department of Nutritional Sciences and ToxicologyUniversity of CaliforniaBerkeleyCaliforniaUSA
| | - Kristin L. Campbell
- Department of Physical Therapy, Faculty of MedicineUniversity of British ColumbiaVancouverCanada
| | - Alexandra M. Binder
- Population Sciences in the Pacific ProgramUniversity of Hawaii Cancer CenterHonoluluHawaiiUSA
- Department of EpidemiologyUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Barbara Sternfeld
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | | | - Kathryn H. Schmitz
- Division of Hematology and OncologyUniversity of PittsburghPittsburghPennsylvaniaUSA
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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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Brick R, Voss L, Arbid S, Joshi Y, Ammendolia Tomé G, El Hassanieh D, Sleight AG, Klein C, Sabir A, Wechsler S, Campbell G, Campbell KL, Lam A, Lyons KD, Padgett L, Jones JM. Reporting Rigor of Cancer Rehabilitation Interventions: Application of the CReDECI-2 Guidelines. Am J Phys Med Rehabil 2023; 102:1029-1033. [PMID: 37594223 PMCID: PMC10592237 DOI: 10.1097/phm.0000000000002324] [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: 08/19/2023]
Abstract
ABSTRACT Clear reporting of cancer rehabilitation interventions is critical for interpreting and translating research into clinical practice. This study sought to examine the completeness of intervention reporting of cancer rehabilitation interventions addressing disability and to identify which elements are most frequently missing. This was a secondary analysis of randomized controlled trials included in two systematic reviews examining effectiveness of cancer rehabilitation interventions that address cancer-related disability, including functional outcomes. Eligible trials were reviewed for intervention reporting rigor using the Criteria for Reporting the Development and Evaluation of Complex Interventions in Healthcare 2 checklist. Intervention descriptions for cancer rehabilitation interventions were generally incomplete. Approximately 85% ( n = 157) of trials described ≤50% of Criteria for Reporting the Development and Evaluation of Complex Interventions in Healthcare 2 checklist items. Commonly underreported items included description of the intervention's underlying theoretical basis, fidelity, description of process evaluation or external conditions influencing intervention delivery, and costs or required resources for intervention delivery. The findings reveal that cancer rehabilitation intervention descriptions lacked necessary detail in this body of literature. Poor descriptions limit the translation of research to clinical practice. To ensure higher-quality study design and reporting, future intervention research should incorporate an intervention reporting checklist to ensure more complete descriptions for research and practice.
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Affiliation(s)
- Rachelle Brick
- From the Division of Cancer Control and Population Sciences, Behavioral Research Program, Basic Biobehavioral and Psychological Sciences Research Branch, National Cancer Institute, Bethesda, Maryland (RB); University of Toronto, Faculty of Kinesiology and Physical Education, Toronto, Canada (LV); University Health Network, Princess Margaret Cancer Centre, Cancer Rehabilitation and Survivorship Program, Toronto, Canada (SA, YJ, GAT, DEH, AL, JMJ); Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California (AGS); Mrs T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California (CK); West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia (AS); Department of Occupational Therapy, Institute of Health Professions, Boston, Massachusetts (SW, KDL); Duquesne University, School of Nursing, Pittsburg, Pennsylvania; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (GC); Department of Physical Therapy, University of British Columbia, Vancouver, Canada (KLC); and Veterans Affairs, Office of Research and Development, Health Systems Research, Washington, District of Columbia (LP)
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12
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Cheng E, Caan BJ, Cawthon PM, Evans WJ, Hellerstein MK, Shankaran M, Nyangau E, Campbell KL, Lee C, Binder AM, Meyerhardt JA, Schmitz KH, Cespedes Feliciano EM. Body Composition, Relative Dose Intensity, and Adverse Events among Patients with Colon Cancer. Cancer Epidemiol Biomarkers Prev 2023; 32:1373-1381. [PMID: 37450841 PMCID: PMC10592319 DOI: 10.1158/1055-9965.epi-23-0227] [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: 03/10/2023] [Revised: 05/10/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Despite evidence that low muscle increases the risk of chemotoxicity, most chemotherapies are dosed on body surface area without considering body composition. Among 178 patients with colon cancer, we assessed muscle and adipose tissue with multiple techniques and examined their associations with relative dose intensity (RDI) and adverse events. METHODS We estimated (i) cross-sectional skeletal muscle area (SMA) and total adipose tissue (TAT) area at L3 from computed tomography (CT); (ii) appendicular lean mass (ALM) and total body fat (TBF) mass from dual-energy X-ray absorptiometry (DXA); and (iii) total body skeletal muscle mass using D3-creatine (D3Cr) dilution. We standardized each measurement by its sex-specific standard deviation (SD). The primary outcome was reduced RDI (RDI <85%). The secondary outcome was the number of moderate and severe adverse events during each cycle of chemotherapy. We estimated the associations of muscle and adipose tissue measurements (per SD increase) with reduced RDI using logistic regression and adverse events using generalized estimating equations for repeated measures. RESULTS Higher CT SMA and DXA ALM were significantly associated with a lower risk of reduced RDI [odds ratios: 0.56 (0.38-0.81) for CT SMA; 0.56 (0.37-0.84) for DXA ALM]. No measurements of muscle or adipose tissue were associated with adverse events. CONCLUSIONS More muscle was associated with improved chemotherapy completion among patients with colon cancer, whereas muscle and adipose tissue were not associated with adverse events. IMPACT Considering body composition may help personalize dosing for colon cancer chemotherapy by identifying patients at risk for poor chemotherapy outcomes.
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Affiliation(s)
- En Cheng
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Bette J. Caan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Peggy M. Cawthon
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - William J. Evans
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA, USA
- Division of Geriatrics, Duke University Medical Center, Durham, NC, USA
| | - Marc K. Hellerstein
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA, USA
| | - Mahalakshmi Shankaran
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA, USA
| | - Edna Nyangau
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA, USA
| | - Kristin L. Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Alexandra M. Binder
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA
- Department of Epidemiology, University of California, Los Angeles, CA, USA
| | | | - Kathryn H. Schmitz
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA
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13
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Dolgoy ND, Al Onazi MM, Parkinson JF, Gudmundsson H, Radke LL, Dennett L, Campbell KL, Harris SR, Keast D, McNeely ML. The Appraisal of Clinical Practice Guidelines for Breast Cancer-Related Lymphedema. Lymphat Res Biol 2023; 21:469-478. [PMID: 37037029 DOI: 10.1089/lrb.2022.0090] [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] [Indexed: 04/12/2023] Open
Abstract
Background: Approaches to screening, assessment, and treatment of breast cancer-related lymphedema (BCRL) vary widely. We evaluated overall quality of clinical practice guidelines (CPGs) for managing BCRL using the Appraisal of Guidelines for REsearch and Evaluation II (AGREE II) tool, and relevance of consensus recommendations for the Canadian health context. Methods and Results: We searched electronic databases, gray literature, national lymphedema frameworks, and expert opinions, to identify lymphedema CPGs, printed/published from January 2013 to October 2021. Using AGREE II, six health care professionals reviewed CPGs for consensus. Domain-specific AGREE II quality consensus scores were required (≥70% for Rigor of Development; ≥ 60% for Stakeholder Involvement and Editorial Independence; and ≥50% for Clarity of Presentation, Applicability, Scope, and Purpose). Results and overall recommendations from the CPGs were summarized and synthesized. Nine CPGs met inclusion criteria for review. Wide variability of evidence-based recommendations, and limited clinical considerations were found. Scope and Purpose, and Clarity of Presentation were adequate in six of nine CPGs; Stakeholder Involvement in seven of nine CPGs; and Editorial Independence in three of nine CPGs. Across all CPGs, Applicability was minimally reported. Only the Queensland Health CPG met quality consensus scores for Rigor and Development; however, the focus was limited to compression therapy. Conclusions: No CPG reviewed could be adopted for the Canadian health context. The proposed Canadian BCRL CPG will focus on stakeholder engagement, methodology, and implementation/evaluation. Using AGREE II allowed for assessment of quality of methods used to develop identified CPGs from other countries before consideration of adoption in a Canadian Context.
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Affiliation(s)
- Naomi D Dolgoy
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Mona M Al Onazi
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Joanna F Parkinson
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | - Lori L Radke
- Rehabilitation Oncology, Holy Cross Site, Cancer Care Alberta, Alberta Health Services, Calgary, Canada
| | - Liz Dennett
- Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Susan R Harris
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Patient Representative, Vancouver, Canada
| | - David Keast
- Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute, St. Joseph's Health Care, London, Canada
| | - Margaret L McNeely
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
- Cancer Care Alberta, Edmonton, Canada
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14
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Andrushko JW, Rinat S, Greeley B, Larssen BC, Jones CB, Rubino C, Denyer R, Ferris JK, Campbell KL, Neva JL, Boyd LA. Improved processing speed and decreased functional connectivity in individuals with chronic stroke after paired exercise and motor training. Sci Rep 2023; 13:13652. [PMID: 37608062 PMCID: PMC10444837 DOI: 10.1038/s41598-023-40605-8] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/14/2023] [Indexed: 08/24/2023] Open
Abstract
After stroke, impaired motor performance is linked to an increased demand for cognitive resources. Aerobic exercise improves cognitive function in neurologically intact populations and may be effective in altering cognitive function post-stroke. We sought to determine if high-intensity aerobic exercise paired with motor training in individuals with chronic stroke alters cognitive-motor function and functional connectivity between the dorsolateral prefrontal cortex (DLPFC), a key region for cognitive-motor processes, and the sensorimotor network. Twenty-five participants with chronic stroke were randomly assigned to exercise (n = 14; 66 ± 11 years; 4 females), or control (n = 11; 68 ± 8 years; 2 females) groups. Both groups performed 5-days of paretic upper limb motor training after either high-intensity aerobic exercise (3 intervals of 3 min each, total exercise duration of 23-min) or watching a documentary (control). Resting-state fMRI, and trail making test part A (TMT-A) and B were recorded pre- and post-intervention. Both groups showed implicit motor sequence learning (p < 0.001); there was no added benefit of exercise for implicit motor sequence learning (p = 0.738). The exercise group experienced greater overall cognitive-motor improvements measured with the TMT-A. Regardless of group, the changes in task score, and dwell time during TMT-A were correlated with a decrease in DLPFC-sensorimotor network functional connectivity (task score: p = 0.025; dwell time: p = 0.043), which is thought to reflect a reduction in the cognitive demand and increased automaticity. Aerobic exercise may improve cognitive-motor processing speed post-stroke.
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Affiliation(s)
- Justin W Andrushko
- Brain Behaviour Laboratory, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Shie Rinat
- Brain Behaviour Laboratory, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Brian Greeley
- Brain Behaviour Laboratory, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Beverley C Larssen
- Brain Behaviour Laboratory, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Christina B Jones
- Brain Behaviour Laboratory, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Cristina Rubino
- Brain Behaviour Laboratory, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Ronan Denyer
- Brain Behaviour Laboratory, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- Graduate Program in Neuroscience, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Jennifer K Ferris
- Brain Behaviour Laboratory, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Jason L Neva
- Faculty of Medicine, School of Kinesiology and Physical Activity Sciences, University of Montreal, Montreal, QC, H3T 1J4, Canada
- Research Center of the Montreal Geriatrics Institute (CRIUGM), Montreal, QC, Canada
| | - Lara A Boyd
- Brain Behaviour Laboratory, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada.
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada.
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15
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Sattar S, Papadopoulos E, Smith GVH, Haase KR, Kobekyaa F, Tejero I, Bradley C, Nadler MB, Campbell KL, Santa Mina D, Alibhai SMH. State of research, feasibility, safety, acceptability, and outcomes examined on remotely delivered exercises using technology for older adult with cancer: a scoping review. J Cancer Surviv 2023:10.1007/s11764-023-01427-9. [PMID: 37418170 DOI: 10.1007/s11764-023-01427-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Technology-based exercise is gaining attention as a promising strategy for increasing physical activity (PA) in older adults with cancer (OACA). However, a comprehensive understanding of the interventions, their feasibility, outcomes, and safety is limited. This scoping review (1) assessed the prevalence and type of technology-based remotely delivered exercise interventions for OACA and (2) explored the feasibility, safety, acceptability, and outcomes in these interventions. METHODS Studies with participant mean/median age ≥ 65 reporting at least one outcome measure were included. Databases searched included the following: PubMed, CINAHL, Embase, Cochrane Library Online, SPORTDiscus, and PsycINFO. Multiple independent reviewers completed screening and data abstractions of articles in English, French, and Spanish. RESULTS The search yielded 2339 citations after removing duplicates. Following title and abstract screening, 96 full texts were review, and 15 were included. Study designs were heterogeneous, and sample sizes were diverse (range 14-478). The most common technologies used were website/web portal (n = 6), videos (n = 5), exergaming (n = 2), accelerometer/pedometer with video and/or website (n = 4), and live-videoconferencing (n = 2). Over half (9/15) of the studies examined feasibility using various definitions; feasibility outcomes were reached in all. Common outcomes examined include lower body function and quality of life. Adverse events were uncommon and minor were reported. Qualitative studies identified cost- and time-savings, healthcare professional support, and technology features that encourage engagement as facilitators. CONCLUSION Remote exercise interventions using technology appear to be feasible and acceptable in OACA. IMPLICATIONS FOR CANCER SURVIVORS Some remote exercise interventions may be a viable way to increase PA for OACA.
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Affiliation(s)
- S Sattar
- College of Nursing, University of Saskatchewan, 108-4400 4th Ave, Regina, SK, S4T 0H6, Canada.
| | - E Papadopoulos
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2C4, Canada
- Department of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, 3/F, Toronto, ON, M5S 3H2, Canada
| | - G V H Smith
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - K R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia, T201-2211, Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - F Kobekyaa
- Faculty of Applied Science, School of Nursing, University of British Columbia, T201-2211, Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - I Tejero
- Department of Geriatric Medicine, Parc de Salut Mar, Pg. Marítim de la Barceloneta, 25, 29, 08003, Barcelona, Spain
| | - C Bradley
- Library, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - M B Nadler
- Department of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, 3/F, Toronto, ON, M5S 3H2, Canada
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2C4, Canada
| | - K L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - D Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada
| | - S M H Alibhai
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2C4, Canada
- Department of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, 3/F, Toronto, ON, M5S 3H2, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Ste. 425, Toronto, ON, M5T 3M6, Canada
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Lopez CJ, Teggart K, Ahmed M, Borhani A, Kong J, Fazelzad R, Langelier DM, Campbell KL, Reiman T, Greenland J, Jones JM, Neil-Sztramko SE. Implementation of electronic prospective surveillance models in cancer care: a scoping review. Implement Sci 2023; 18:11. [PMID: 37101231 PMCID: PMC10134630 DOI: 10.1186/s13012-023-01265-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/19/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Electronic prospective surveillance models (ePSMs) for cancer rehabilitation include routine monitoring of the development of treatment toxicities and impairments via electronic patient-reported outcomes. Implementing ePSMs to address the knowledge-to-practice gap between the high incidence of impairments and low uptake of rehabilitation services is a top priority in cancer care. METHODS We conducted a scoping review to understand the state of the evidence concerning the implementation of ePSMs in oncology. Seven electronic databases were searched from inception to February 2021. All articles were screened and extracted by two independent reviewers. Data regarding the implementation strategies, outcomes, and determinants were extracted. The Expert Recommendations for Implementing Change taxonomy and the implementation outcomes taxonomy guided the synthesis of the implementation strategies and outcomes, respectively. The Consolidated Framework for Implementation Research guided the synthesis of determinants based on five domains (intervention characteristics, individual characteristics, inner setting, outer setting, and process). RESULTS Of the 5122 records identified, 46 interventions met inclusion criteria. The common implementation strategies employed were "conduct educational meetings," "distribute educational materials," "change record systems," and "intervene with patients to enhance uptake and adherence." Feasibility and acceptability were the prominent outcomes used to assess implementation. The complexity, relative advantage, design quality, and packaging were major implementation determinants at the intervention level. Knowledge was key at the individual level. At the inner setting level, major determinants were the implementation climate and readiness for implementation. At the outer setting level, meeting the needs of patients was the primary determinant. Engaging various stakeholders was key at the process level. CONCLUSIONS This review provides a comprehensive summary of what is known concerning the implementation of ePSMs. The results can inform future implementation and evaluation of ePSMs, including planning for key determinants, selecting implementation strategies, and considering outcomes alongside local contextual factors to guide the implementation process.
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Affiliation(s)
- Christian J Lopez
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Kylie Teggart
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mohammed Ahmed
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Anita Borhani
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Jeffrey Kong
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Rouhi Fazelzad
- Library and Information Services, University Health Network, Toronto, Canada
| | - David M Langelier
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Tony Reiman
- Department of Oncology, Saint John Regional Hospital, Saint John, Canada
| | - Jonathan Greenland
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Canada
| | - Jennifer M Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Sarah E Neil-Sztramko
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
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Potiaumpai M, Schleicher EA, Wang M, Campbell KL, Sturgeon K, Schmitz KH. Exercise during chemotherapy: Friend or foe? Cancer Med 2023; 12:10715-10724. [PMID: 37076972 DOI: 10.1002/cam4.5831] [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] [Received: 11/06/2022] [Revised: 02/21/2023] [Accepted: 03/12/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND A higher chemotherapy completion rate is associated with better outcomes including treatment efficacy and overall survival. Exercise may have the potential to improve relative dose intensity (RDI) by reducing the frequency and severity of chemotherapy-related toxicities. We examined the association between exercise adherence and RDI and possible clinical- and health-related fitness predictors of RDI. METHODS Chemotherapy records were extracted from the electronic medical record for patients enrolled in the ENACT trial (n = 105). Chemotherapy completion was assessed using average RDI. A threshold of 85% was established for "high" versus "low" RDI. Logistic regression analyses were used to estimate the associations between the clinical- and health-related fitness predictors of RDI. RESULTS Patients with breast cancer (BC) had a significantly higher average RDI (89.8% ± 17.6%) compared with gastrointestinal cancer (GI) (76.8% ± 20.9%, p = 0.004) and pancreatic cancer (PC) (65.2% ± 20.1%, p < 0.001). Only 25% of BC patents required a dose reduction compared to 56.3% of GI and 86.4% of PC patients. Cancer site was significantly associated with RDI. Compared with BC, patients with GI (β = -0.12, p = 0.03) and PC (β = -0.22, p = 0.006) achieved significantly lower RDI. Every 2.72 unit increase in overall exercise adherence led to a significant 7% decrease in RDI (p = 0.001) in GI patients. Metastatic GI patients had a 15% RDI increase for every 2.72 unit increase in exercise adherence (p = 0.04). CONCLUSION Exercise is a supportive therapy that has potential to enhance chemotherapy tolerance and completion. The relationship between exercise adherence and RDI is influenced by factor such as cancer site and treatment type. Special attention must be paid to how exercise is prescribed to ensure that exercise adherence does not negatively affect RDI. Cancer site, exercise dosage, and multimodal interventions to address toxicities are key areas identified for future research.
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Affiliation(s)
- Melanie Potiaumpai
- Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Erica A Schleicher
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ming Wang
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kristin L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathleen Sturgeon
- Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Kathryn H Schmitz
- Department of Medicine, University of Pittsburgh, Pennsylvania, Pittsburgh, USA
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Sekely A, Bernstein LJ, Campbell KL, Mason WP, Laperriere N, Kalidindi N, Or R, Ramos R, Climans SA, Pond GR, Ann Millar B, Shultz D, Tsang DS, Zadeh G, Edelstein K. Neurocognitive impairment, neurobehavioral symptoms, fatigue, sleep disturbance, and depressive symptoms in patients with newly diagnosed glioblastoma. Neurooncol Pract 2023; 10:89-96. [PMID: 36659968 PMCID: PMC9837779 DOI: 10.1093/nop/npac068] [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: 01/22/2023] Open
Abstract
Background In addition to poor survival rates, individuals with glioblastoma (GBM) are at risk of neurocognitive impairment due to multiple factors. This study aimed to characterize neurocognitive impairment, neurobehavioral symptoms, fatigue, sleep disturbance, and depressive symptoms in newly diagnosed GBM patients; and to examine whether neurobehavioral symptoms, fatigue, sleep, and depressive symptoms influence neurocognitive performance. Methods This study was part of a prospective, inception cohort, single-arm exercise intervention in which GBM patients underwent a neuropsychological assessment shortly after diagnosis (median 4 weeks; ie, baseline) and 3, 6, 12, and 18 months later, or until tumor progression. Here, we present baseline data. Forty-five GBM patients (mean age = 55 years) completed objective neurocognitive tests, and self-report measures of neurobehavioral symptoms, fatigue, sleep disturbance, and depressive symptoms. Results Compared to normative samples, GBM patients scored significantly lower on all neurocognitive tests, with 34 (76%) patients exhibiting neurocognitive impairment. Specifically, 53% exhibited impairment in memory retention, 51% in executive function, 42% in immediate recall, 41% in verbal fluency, and 24% in attention. There were high rates of clinically elevated sleep disturbance (70%), fatigue (57%), depressive symptoms (16%), and neurobehavioral symptoms (27%). A multivariate regression analysis revealed that depressive symptoms are significantly associated with neurocognitive impairment. Conclusions GBM patients are vulnerable to adverse outcomes including neurocognitive impairment, neurobehavioral symptoms, fatigue, sleep disturbance, and depressive symptoms shortly after diagnosis, prior to completing chemoradiation. Those with increased depressive symptoms are more likely to demonstrate neurocognitive impairment, highlighting the need for early identification and treatment of depression in this population.
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Affiliation(s)
- Angela Sekely
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Lori J Bernstein
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Warren P Mason
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Normand Laperriere
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Navya Kalidindi
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Rosemarylin Or
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ronald Ramos
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Seth A Climans
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Gregory R Pond
- Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Barbara Ann Millar
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - David Shultz
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Kim Edelstein
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Davis EE, Campbell KL. Event boundaries structure the contents of long-term memory in younger and older adults. Memory 2023; 31:47-60. [PMID: 36107809 DOI: 10.1080/09658211.2022.2122998] [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] [Indexed: 10/14/2022]
Abstract
Event boundaries impose structure on how events are stored in long-term memory. Research with young adults has shown that associations within events are stronger than those that cross event boundaries. Recently, this effect was observed in both young and old adults using movie stimuli (Davis, Chemnitz, et al., 2021). Here, we test whether this effect extends to written narratives. Young and old participants read a series of narratives that were interspersed with temporal shifts in the storyline meant to elicit the perception of an event boundary. Later, participants were cued with sentences and were asked to recall the sentence that immediately followed. We expected participants would have worse memory when a cue and correct answer flanked a boundary than when it did not. In Experiment 1, we found that despite older adults' lower performance overall, both age groups had lower accuracy for cues that flanked a boundary, compared to cues that elicited a response from within the same event. Experiment 2 replicated the results from Experiment 1. Our results support past work that did not find age differences in event perception and demonstrate that older and younger adults may store events similarly in long-term memory.
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Affiliation(s)
- E E Davis
- Psychology Department, Brock University, St. Catharines, Canada
| | - K L Campbell
- Psychology Department, Brock University, St. Catharines, Canada
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20
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Campbell KL, Winters-Stone KM, Schmitz KH. We All Seem to Agree: Exercise Is Medicine in Medical Oncology. J Clin Oncol 2023; 41:147-148. [PMID: 36075002 DOI: 10.1200/jco.22.01448] [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: 12/27/2022] Open
Affiliation(s)
- Kristin L Campbell
- Kristin L. Campbell, PhD, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Kerri M. Winters-Stone, PhD, Knight Cancer Institute, Oregon Health Sciences University, Portland, OR; and Kathryn H. Schmitz, PhD, MPH, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Kerri M Winters-Stone
- Kristin L. Campbell, PhD, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Kerri M. Winters-Stone, PhD, Knight Cancer Institute, Oregon Health Sciences University, Portland, OR; and Kathryn H. Schmitz, PhD, MPH, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Kathryn H Schmitz
- Kristin L. Campbell, PhD, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Kerri M. Winters-Stone, PhD, Knight Cancer Institute, Oregon Health Sciences University, Portland, OR; and Kathryn H. Schmitz, PhD, MPH, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
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21
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Myers SA, Mackenzie KA, LeVasseur N, Faulkner G, Campbell KL. Can Breast Cancer Survivors Achieve Exercise Intensity Goals In A Virtual Supervised Exercise Program? Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000876040.86680.b0] [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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22
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23
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Schneider C, González-Jaramillo N, Marcin T, Campbell KL, Suter T, Bano A, Wilhelm M, Eser P. Time-Dependent Effect of Anthracycline-Based Chemotherapy on Central Arterial Stiffness: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:873898. [PMID: 35865379 PMCID: PMC9295862 DOI: 10.3389/fcvm.2022.873898] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Aims Anthracycline-based chemotherapy (ANTH-BC) has been proposed to increase arterial stiffness, however, the time-dependency of these effects remain unclear. This systematic review and meta-analysis aimed to investigate the time-dependent effect of ANTH-BC on markers of central aortic stiffness, namely aortic distensibility (AD) and pulse-wave-velocity (PWV) in cancer patients. Methods An extensive literature search without language restrictions was performed to identify all studies presenting longitudinal data on the effect of ANTH-BC on either AD and/or central PWV in cancer patients of all ages. An inverse-variance weighted random-effect model was performed with differences from before to after chemotherapy, as well as for short vs. mid-term effects. Results Of 2,130 articles identified, 9 observational studies with a total of 535 patients (mean age 52 ± 11; 73% women) were included, of which four studies measured AD and seven PWV. Short-term (2–4 months), there was a clinically meaningful increase in arterial stiffness, namely an increase in PWV of 2.05 m/s (95% CI 0.68–3.43) and a decrease in AD (albeit non-significant) of −1.49 mmHg-1 (−3.25 to 0.27) but a smaller effect was observed mid-term (6–12 months) for PWV of 0.88 m/s (−0.25 to 2.02) and AD of −0.37 mmHg-1 (−1.13 to 0.39). There was considerable heterogeneity among the studies. Conclusions Results from this analysis suggest that in the short-term, ANTH-BC increases arterial stiffness, but that these changes may partly be reversible after therapy termination. Future studies need to elucidate the long-term consequences of ANTH-BC on arterial stiffness, by performing repeated follow-up measurements after ANTH-BC termination. Systematic Review Registration [www.crd.york.ac.uk/prospero/], identifier [CRD42019141837].
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Affiliation(s)
- Caroline Schneider
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Nathalia González-Jaramillo
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Thimo Marcin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Thomas Suter
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arjola Bano
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- *Correspondence: Prisca Eser,
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24
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Hart NH, Poprawski DM, Ashbury F, Fitch MI, Chan RJ, Newton RU, Campbell KL. Exercise for people with bone metastases: MASCC endorsed clinical recommendations developed by the International Bone Metastases Exercise Working Group. Support Care Cancer 2022; 30:7061-7065. [PMID: 35710641 DOI: 10.1007/s00520-022-07212-1] [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: 10/18/2022]
Affiliation(s)
- Nicolas H Hart
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia. .,Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia. .,Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia. .,Institute for Health Research, The University of Notre Dame Australia, Perth, WA, Australia.
| | - Dagmara M Poprawski
- Department of Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Fred Ashbury
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Oncology, University of Calgary, Calgary, Canada
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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25
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Myers SA, Finch ER, Ness KK, Campbell KL. Physical performance limitations and participation restrictions among cancer survivors: A population-based study from NHANES data 2015-2018. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12096] [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
12096 Background: Anti-cancer therapies have improved survival outcomes in cancer survivors; however, therapy-related toxicities may impact organ structure and function and interfere with physical performance and participation in life roles. This analysis aimed to estimate the prevalence of physical performance limitations (PL) and participation restrictions (PR) among recent (< 5 years since diagnosis), and long-term (≥ 5 years) cancer survivors. Methods: Data from the 2015-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed using multivariable logistic regression, accounting for age, sex, race, and income, and incorporating survey sampling methodology. Odds ratios compared proportions of PL and PR among 663 (weighted population estimate 14,319,219) recent and 341 (weighted population estimate 7,261,088) long-term survivors, and 10,284 (weighted population estimate 215,042,155) persons with no reported cancer history. Two-sided two sample z-tests were used to compare proportions to a previous publication of data from 1999-2002 NHANES data. Results: Physical performance limitations were 1.5-1.7 times (63% vs 29%) and PR 1.5-1.6 times (38% vs 18%) more prevalent in cancer survivors than in those with no cancer history. Long-term cancer diagnosis was associated with increased prevalence of PL and PR, particularly in survivors aged 20-39 years. Proportions increased by 7% for PL and by 10% for PR compared to 1999-2002 values (p-values <0.001). Conclusions: Over 60% of cancer survivors reported PL and nearly 40% reported PR. Despite an interim increase in evidence of the benefits of exercise to manage therapy-related toxicities, these values are a significant increase when compared to 1999-2002 NHANES data. Targeted education for providers and exercise interventions aimed to improve physical function and performance in early cancer survivors should be considered to address the physical sequelae from anti-cancer therapies. [Table: see text]
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26
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Wang R, Yao C, Hung SH, Meyers L, Sutherland JM, Karimuddin A, Campbell KL, Conklin AI. Preparing for colorectal surgery: a qualitative study of experiences and preferences of patients in Western Canada. BMC Health Serv Res 2022; 22:730. [PMID: 35650598 PMCID: PMC9161453 DOI: 10.1186/s12913-022-08130-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 10/28/2021] [Accepted: 05/16/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives The burden and costs of abdominal surgery for chronic conditions are on the rise, but could be reduced through self-management support. However, structured support to prepare for colorectal surgery is not routinely offered to patients in Canada. This study aimed to describe experiences and explore preferences for multimodal prehabilitation among colorectal surgery patients. Methods A qualitative descriptive study using three focus groups (FG) was held with 19 patients who had a surgical date for abdominal surgery (April 2017-April 2018) and lived close (≤ 50 km radius) to a tertiary hospital in Western Canada (including a Surgical Lead for the British Columbia Enhanced Recovery After Surgery (ERAS) Collaborative). FGs were audio-taped and verbatim transcribed with coding and pile-and-sort methods performed by two independent reviewers, confirmed by a third reviewer, in NVivo v9 software; followed by thematic analysis and narrative synthesis. Results Four themes emerged: support, informed decision-making, personalization of care, and mental/emotional health, which patients felt was particularly important but rarely addressed. Patient preferences for prehabilitation programming emphasised regular support from a single professional source, simple health messages, convenient access, and flexibility. Conclusions There is an unmet need for structured preoperative support to better prepare patients for colorectal surgery. Future multimodal prehabilitation should be flexible and presented with non-medical information so patients can make informed decisions about their preoperative care and surgical outcomes. Healthcare providers have an important role in encouraging healthy lifestyle changes before colorectal surgery, though clearer communication and accurate advice on self-care, particularly mental health, are needed for improving patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08130-y. • Optimising preoperative care for abdominal surgery patients could improve outcomes. • Patient experiences of preparing for colorectal surgery could inform future interventions, but patient-oriented research to improve quality of care is scarce. • There is an unmet need for preoperative support in colorectal surgery. • Future multimodal prehabilitation should incorporate patient preferences.
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Affiliation(s)
- Rebecca Wang
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Christopher Yao
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, Canada.,Department of Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Stanley H Hung
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Logan Meyers
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Jason M Sutherland
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, Canada.,School of Population and Public Health, Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Ahmer Karimuddin
- Colorectal Surgery, St. Paul's Hospital, Providence Health Care, and General Surgery Residency Training Program at the University of British Columbia, Vancouver, Canada
| | - Kristin L Campbell
- Department of Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Annalijn I Conklin
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada. .,Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, Canada.
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27
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Schneider C, Reimann S, Schmid J, Bernhard J, Campbell KL, Wilhelm M, Eser P. Facilitators and barriers to centre- and home-based exercise training in breast cancer patients - a swiss tertiary centre experience. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.216] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss Cancer Research
Background
Exercise is an effective therapy for cancer patients to reduce fatigue and to improve health-related quality of life and physical function. Yet, cancer patients often do not meet physical activity guidelines.
Purpose
To understand why recommendations are not met, we aimed at identifying facilitators and barriers to supervised, centre-based exercise within a cardio-oncologic rehabilitation (CORE) programme and to unsupervised, home-based exercise as well as strategies used to manage these barriers.
Methods
Breast cancer patients who had completed a CORE programme at a Swiss tertiary centre were recruited. Semi-structured interviews were conducted with subsequent thematic analysis.
Results
Of 37 eligible breast cancer patients, 19 patients (mean age 48.9±9.7 years) participated to our invitation. Facilitators for centre-based exercise were social support, committedness and provision of structured exercise. Barriers towards centre-based exercise included physical and environmental barriers, while psychological barriers were reported predominantly for home-based exercise. Strategies to manage barriers included the adaptation of training circumstances, behaviour change strategies and strategies to deal with side effects.
Conclusions
Our results support the importance of providing CORE programmes and suggest that a special focus should be directed at the transition from supervised to self-organized exercise in order to enhance long-term exercise participation.
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Affiliation(s)
- C Schneider
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S Reimann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - J Schmid
- University of Bern, Institute of Sport Science, Bern, Switzerland
| | - J Bernhard
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - KL Campbell
- University of British Columbia, Faculty of Medicine, Vancouver, Canada
| | - M Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - P Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Campbell KL, Cormie P, Weller S, Alibhai SMH, Bolam KA, Campbell A, Cheville AL, Dalzell MA, Hart NH, Higano CS, Lane K, Mansfield S, McNeely ML, Newton RU, Quist M, Rauw J, Rosenberger F, Santa Mina D, Schmitz KH, Winters-Stone KM, Wiskemann J, Goulart J. Exercise Recommendation for People With Bone Metastases: Expert Consensus for Health Care Providers and Exercise Professionals. JCO Oncol Pract 2022; 18:e697-e709. [PMID: 34990293 PMCID: PMC9810134 DOI: 10.1200/op.21.00454] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Exercise has been underutilized in people with advanced or incurable cancer despite the potential to improve physical function and reduce psychosocial morbidity, especially for people with bone metastases because of concerns over skeletal complications. The International Bone Metastases Exercise Working Group (IBMEWG) was formed to develop best practice recommendations for exercise programming for people with bone metastases on the basis of published research, clinical experience, and expert opinion. METHODS The IBMEWG undertook sequential steps to inform the recommendations: (1) modified Delphi survey, (2) systematic review, (3) cross-sectional survey to physicians and nurse practitioners, (4) in-person meeting of IBMEWG to review evidence from steps 1-3 to develop draft recommendations, and (5) stakeholder engagement. RESULTS Recommendations emerged from the contributing evidence and IBMEWG discussion for pre-exercise screening, exercise testing, exercise prescription, and monitoring of exercise response. Identification of individuals who are potentially at higher risk of exercise-related skeletal complication is a complex interplay of these factors: (1) lesion-related, (2) cancer and cancer treatment-related, and (3) the person-related. Exercise assessment and prescription requires consideration of the location and presentation of bone lesion(s) and should be delivered by qualified exercise professionals with oncology education and exercise prescription experience. Emphasis on postural alignment, controlled movement, and proper technique is essential. CONCLUSION Ultimately, the perceived risk of skeletal complications should be weighed against potential health benefits on the basis of consultation between the person, health care team, and exercise professionals. These recommendations provide an initial framework to improve the integration of exercise programming into clinical care for people with bone metastases.
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Affiliation(s)
- Kristin L. Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada,Kristin L. Campbell, PT, PhD, 212, 2177 Wesbrook Mall, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada V6T 1Z3; e-mail:
| | - Prue Cormie
- Australian Catholic University, Melbourne, Australia,Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - Sarah Weller
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada,BC Cancer, Vancouver, British Columbia, Canada
| | | | | | | | | | - Mary-Ann Dalzell
- Oncology Division of the Canadian Physiotherapy Association, Montreal, Quebec, Canada
| | - Nicolas H. Hart
- Edith Cowan University, Joondalup, Australia,Queensland University of Technology, Brisbane, Australia
| | | | - Kirstin Lane
- University of Victoria, Victoria, British Columbia, Canada
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Al Onazi MM, Campbell KL, Thompson RB, Ghosh S, Mackey JR, Muir A, McNeely ML. Decongestive progressive resistance exercise with an adjustable compression wrap for breast cancer-related lymphoedema (DREAM): protocol for a randomised controlled trial. BMJ Open 2022; 12:e053165. [PMID: 35379618 PMCID: PMC8981291 DOI: 10.1136/bmjopen-2021-053165] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Breast cancer-related lymphoedema (BCRL) is a chronic swelling in the arm on the side of the breast cancer surgery, affecting one in five women. Recent studies in BCRL have demonstrated that resistance exercise can improve symptoms and quality of life without worsening lymphoedema. No studies have explored whether combining the principles of progressive resistance exercise training with therapeutic strategies of compression therapy and the decongestive lymphatic exercise sequence are beneficial in reducing arm lymphoedema volume. The aim of this three-arm, provincial randomised controlled trial is to determine the efficacy of a 12-week decongestive progressive resistance exercise (DRE) programme in combination with the one of two types of compression garments compared with standard care. METHODS AND ANALYSIS Sixty women with BCRL will be recruited and randomly assigned to one of the following three groups: (1) Standard care, (2) DRE with use of a daytime compression garment during exercise and (3) DRE with use of an adjustable compression wrap during exercise. The primary outcome is the percentage reduction in arm lymphoedema volume. Secondary outcomes include bioimpedance analysis, muscular strength, shoulder range of motion, physical activity level and health-related quality of life. Exploratory outcomes include evaluating changes in arm tissue composition using MRI and examining outcomes between the two DRE experimental groups. The primary analysis will compare changes between the groups from baseline to week 12 reflecting the end of the randomised control trial period. ETHICS AND DISSEMINATION The trial has received ethics approval from the Health Research Ethics Board of Alberta: Cancer Committee. The study results will be disseminated through scientific peer-reviewed publications, and presented at national and international conferences, and other media portals. The programme protocol will be shared with healthcare professionals and patient groups through clinical workshops and webinars. TRIAL REGISTRATION NUMBER NCT05022823. PROTOCOL VERSION 12 November 2021. ISSUE DATE 26 April 2021.
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Affiliation(s)
- Mona M Al Onazi
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Sunita Ghosh
- Department of Mathematics and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - John R Mackey
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Anne Muir
- Cancer Rehabilitation Clinic, University of Alberta, Edmonton, Alberta, Canada
| | - Margaret L McNeely
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
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30
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McNeely ML, Harris SR, Dolgoy ND, Al Onazi MM, Parkinson JF, Radke L, Kostaras X, Dennett L, Ryan JA, Dalzell MA, Kennedy A, Capozzi L, Towers A, Campbell KL, Binkley J, King K, Keast D. Update to the Canadian clinical practice guideline for best-practice management of breast cancer-related lymphedema: study protocol. CMAJ Open 2022; 10:E338-E347. [PMID: 35414596 PMCID: PMC9007443 DOI: 10.9778/cmajo.20210038] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND One of the more frequent complications following treatment for breast cancer, lymphedema is a substantial swelling of the arm, breast and chest wall that occurs on the side where lymph nodes were removed. The aim of this work is to update recommendations on the prevention, diagnosis and management of lymphedema related to breast cancer. METHODS We present the protocol for an update of the 2001 clinical practice guideline on lymphedema from the Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. We will use a patient-oriented research approach with a focus on self-management and the positive health model to inform the updated guideline development. The methods proposed will be undertaken with consideration of the standards outlined in the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. The literature will be appraised by evaluating existing guidelines from other countries, the evidence from systematic reviews and meta-analyses and direct evidence from clinical studies. We will manage competing interests according to Guidelines International Network principles. Recommendations will be presented using an actionable statement format and will be linked to the level of evidence along with any relevant considerations used in formulation. A draft of the guideline will be produced by the steering committee then sent out to international experts and stakeholder groups for feedback. INTERPRETATION The primary benefit of this clinical guideline will be to improve the quality of care of women with breast cancer-related lymphedema. Findings will be disseminated at national and international conferences and through webinars and educational videos hosted on the websites of the supporting organizations.
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Affiliation(s)
- Margaret Lynn McNeely
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont.
| | - Susan R Harris
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Naomi D Dolgoy
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Mona M Al Onazi
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Joanna F Parkinson
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Lori Radke
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Xanthoula Kostaras
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Liz Dennett
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Jean Ann Ryan
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Mary-Ann Dalzell
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Anna Kennedy
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Lauren Capozzi
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Anna Towers
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Kristin L Campbell
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Jill Binkley
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Karen King
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - David Keast
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
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Winters-Stone KM, Boisvert C, Li F, Lyons KS, Beer TM, Mitri Z, Meyers G, Eckstrom E, Campbell KL. Delivering exercise medicine to cancer survivors: has COVID-19 shifted the landscape for how and who can be reached with supervised group exercise? Support Care Cancer 2022; 30:1903-1906. [PMID: 34741653 PMCID: PMC8571667 DOI: 10.1007/s00520-021-06669-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/01/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE Due to stay-at-home orders during COVID-19, we transitioned supervised, group, in-person resistance training interventions in two clinical trials in cancer survivors to live, online delivery using video-conferencing technology. We describe the feasibility, preliminary efficacy, and safety of live online group training and compare to in-person training. METHODS Adherence (% sessions attended), retention (% participants completing intervention), and safety (# adverse events) data of resistance training groups from two randomized controlled trials in cancer survivors that participated before or during the COVID-19 pandemic were collated. Participants were post-treatment breast cancer survivors and their spouses (n = 62) and prostate cancer survivors (n = 32) (age range: 38-82 years). During COVID-19, delivery of supervised, group resistance exercise sessions was delivered live online via video-conference. Preliminary evidence for training efficacy was assessed by chair stand performance over the 6-month intervention. RESULTS Feasibility of online resistance training was better than in-person for both studies (adherence: 86% vs 82% and 91% vs. 81% and retention 95% vs. 80% and 92% vs. 84% for online and in-person classes). Improvements in chair stand time were similar in prostate cancer and spouse groups that trained online vs. in-person, except for breast cancer survivors who improved more with in-person training (7% vs. 14% for online vs. in-person). Safety was similar between formats (12 vs. 11 adverse events for online vs. in-person). CONCLUSION Supervised, in-person group resistance training can be feasibly adapted for live, online delivery and could help broaden approaches to exercise delivery in cancer survivors, including older adults. TRIAL REGISTRATION The studies described in this commentary were registered on ClinicalTrials.gov on August 3, 2018 (NCT03630354) and on October 30, 2018 (NCT03741335).
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Affiliation(s)
- Kerri M Winters-Stone
- Knight Cancer Institute, Oregon Health & Science University, KCRB-CPC, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA.
| | - Cassie Boisvert
- Knight Cancer Institute, Oregon Health & Science University, KCRB-CPC, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA
| | - Fuzhong Li
- Oregon Research Institute, Eugene, OR, USA
| | - Karen S Lyons
- Connell School of Nursing, Boston College, Boston, MA, USA
| | - Tomasz M Beer
- Knight Cancer Institute, Oregon Health & Science University, KCRB-CPC, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA
| | - Zahi Mitri
- Knight Cancer Institute, Oregon Health & Science University, KCRB-CPC, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA
| | - Gabrielle Meyers
- Knight Cancer Institute, Oregon Health & Science University, KCRB-CPC, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA
| | - Elizabeth Eckstrom
- Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
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Bland KA, Neil-Sztramko SE, Zadravec K, Medysky ME, Kong J, Winters-Stone KM, Campbell KL. Correction to: Attention to principles of exercise training: an updated systematic review of randomized controlled trials in cancers other than breast and prostate. BMC Cancer 2022; 22:182. [PMID: 35177033 PMCID: PMC8855544 DOI: 10.1186/s12885-021-09022-w] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Kelcey A Bland
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Sarah E Neil-Sztramko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kendra Zadravec
- Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary E Medysky
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Jeffrey Kong
- Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | | | - Kristin L Campbell
- Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada. .,Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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Myers SA, Weller S, Schwartz S, Van Patten C, LeVasseur N, Faulkner G, Campbell KL. Feasibility of a Supervised Virtual Exercise Program for Women on Hormone Therapy for Breast Cancer. Transl J ACSM 2022. [DOI: 10.1249/tjx.0000000000000213] [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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Neva JL, Greeley B, Chau B, Ferris JK, Jones CB, Denyer R, Hayward KS, Campbell KL, Boyd LA. Acute High-Intensity Interval Exercise Modulates Corticospinal Excitability in Older Adults. Med Sci Sports Exerc 2021; 54:673-682. [PMID: 34939609 DOI: 10.1249/mss.0000000000002839] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Acute exercise can modulate the excitability of the non-exercised upper-limb representation in the primary motor cortex (M1). Measures of M1 excitability using transcranial magnetic stimulation (TMS) are modulated following various forms of acute exercise in young adults, including high intensity interval training (HIIT). However, the impact of HIIT on M1 excitability in older adults is currently unknown. Therefore, the purpose of the current study was to investigate the effects of lower-limb cycling HIIT on bilateral upper-limb M1 excitability in older adults. METHODS We assessed the impact of acute lower-limb HIIT or rest on bilateral corticospinal excitability, intracortical inhibition and facilitation, and interhemispheric inhibition of the non-exercised upper-limb muscle in healthy older adults (aged 66 ± 8). We used single and paired-pulse TMS to assess motor evoked potentials (MEPs), short-interval intracortical inhibition (SICI), intracortical facilitation (ICF) and the ipsilateral silent period (iSP). Two groups of healthy older adults completed either HIIT exercise or seated rest for 23 min, with TMS measures performed pre (T0), immediately post (T1) and 30 min post (T2) HIIT/rest. RESULTS MEPs were significantly increased after HIIT exercise at T2 compared to T0 in the dominant upper-limb. Contrary to our hypothesis we did not find any significant change in SICI, ICF or iSP following HIIT. CONCLUSIONS Our findings demonstrate that corticospinal excitability of the non-exercised upper-limb is increased following HIIT in healthy older adults. Our results indicate that acute HIIT exercise impacts corticospinal excitability in older adults, without affecting intracortical or interhemispheric circuitry. These findings have implications for the development of exercise strategies to potentiate neuroplasticity in healthy older and clinical populations.
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Affiliation(s)
- Jason L Neva
- University of Montreal, School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Montreal, QC, Canada Research Center of the Montreal Geriatrics Institute (CRIUGM), Montreal, QC, Canada University of British Columbia, Department of Physical Therapy, Faculty of Medicine, Vancouver, BC, Canada University of British Columbia, Rehabilitation Research Program, Vancouver, BC, Canada University of British Columbia, Graduate Program in Neuroscience, Vancouver, BC, Canada University of Melbourne, Department of Physiotherapy, Department of Medicine, & Florey Institute of Neuroscience and Mental Health, Melbourne, Australia The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
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Dennett AM, Tang CY, Chiu A, Osadnik C, Granger CL, Taylor NF, Campbell KL, Barton C. Development and evaluation of the Cancer Exercise Toolkit: a website for exercise professionals using a co-design approach (Preprint). JMIR Cancer 2021; 8:e34903. [PMID: 35451966 PMCID: PMC9073617 DOI: 10.2196/34903] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/17/2022] [Accepted: 03/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Access to exercise therapy for cancer survivors is poor. Professional development to support exercise professionals in delivering these interventions is needed. Few online resources exist for exercise professionals to address this issue. Objective To develop and evaluate a freely available online toolkit to support exercise professionals working with cancer survivors. Methods A 2-phase, experience-based co-design approach was used to develop and evaluate the online toolkit. The two phases were as follows: 1) needs identification and co-design of resources and platform and 2) pilot evaluation. Four co-design workshops were conducted, transcribed, and thematically analyzed to identify key elements for the toolkit. For the pilot evaluation, a customized survey (the Determinants of Implementation Behavior Questionnaire) was distributed to exercise professionals at baseline and 3 months after launch of the online toolkit to determine its usability, utility, and effectiveness in improving their knowledge, confidence, and behavior. Results were reported as the median and interquartile range and changes were calculated using non-parametric tests. Website analytics described site usage after the initial evaluation. Results Twenty-five exercise professionals participated in co-designing 8 key elements of the online Cancer Exercise Toolkit: the homepage and pages for getting started, screening and safety, assessment, exercise prescription, education, locations, and resources. For the pilot evaluation, 277/320 respondents (87% of whom were physiotherapists) from 26 countries completed the survey at baseline, with 58 exercise professionals completing follow-up surveys at 3 months. Exercise professionals’ knowledge, skills, and confidence in delivering exercise therapy to cancer survivors increased 3 months after baseline (items 1, 6, and 8: median score 5, IQR 3 to 6) to follow-up (items 1 and 6: median score 6, IQR 5 to 6; item 8: median score 5, IQR 5 to 7; P<.001) on a 1 to 7 Likert scale. Most participants (35/44, 80%) agreed or strongly agreed they would recommend the toolkit to colleagues. In the 6 months following the pilot evaluation, the toolkit received an average of 866 views per month. Conclusions The co-designed online Cancer Exercise Toolkit was a useful resource for exercise professionals that may increase their knowledge, skills, and confidence in providing exercise therapy to cancer survivors.
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Affiliation(s)
- Amy M Dennett
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Clarice Y Tang
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
| | - April Chiu
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Christian Osadnik
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Parkville, Australia
- Department of Physiotherapy, The Royal Melbourne Hospital, Parkville, Australia
| | - Nicholas F Taylor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Kristin L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christian Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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McNeely ML, Dolgoy ND, Rafn BS, Ghosh S, Ospina PA, Al Onazi MM, Radke L, Shular M, Kuusk U, Webster M, Campbell KL, Mackey JR. Nighttime compression supports improved self-management of breast cancer-related lymphedema: A multicenter randomized controlled trial. Cancer 2021; 128:587-596. [PMID: 34614195 DOI: 10.1002/cncr.33943] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/05/2021] [Revised: 06/11/2021] [Accepted: 06/28/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lymphedema is a prevalent long-term effect of breast cancer treatment associated with reduced quality of life. This study examined the efficacy of nighttime compression as a self-management strategy for women with chronic breast cancer-related lymphedema. METHODS Th authors conducted a parallel 3-arm, multicenter, randomized trial. Women were recruited from 3 centers in Canada and randomized to group 1 (daytime compression garment alone [standard care]), group 2 (daytime compression garment plus nighttime compression bandaging), or group 3 (daytime compression garment plus the use of a nighttime compression system garment). The primary outcome was the change in excess arm volume from the baseline to 12 weeks. Participants from all groups used a nighttime compression system garment from weeks 13 to 24. RESULTS One hundred twenty women were enrolled, 118 completed the randomized trial, and 114 completed the 24-week follow-up. The rates of adherence to nighttime compression were 95% ± 15% and 96% ± 11% in the compression bandaging and nighttime compression system groups, respectively. After the intervention, the addition of nighttime compression was found to be superior to standard care for both absolute milliliter reductions (P = .006) and percentage reductions (P = .002) in excess arm lymphedema volume. Significant within-group changes were seen for quality of life across all groups; however, no between-group differences were found (P > .05). CONCLUSIONS The trial demonstrated a significant improvement in arm lymphedema volume from the addition of nighttime compression whether through the application of compression bandaging or through the use of a nighttime compression system garment. LAY SUMMARY Lymphedema is swelling that occurs in the arm on the side of the surgery for breast cancer. Lymphedema occurs in approximately 21% of women. Lymphedema tends to worsen over time and can result in recurrent infections in the arm, functional impairment, and pain. Currently, treatment consists of intensive treatments to reduce the swelling followed by regular use of a compression sleeve during the day. This study examined and found a benefit from the addition of nighttime compression (whether through self-applied compression bandaging or through the use of a nighttime compression system garment) to the use of a daytime compression sleeve.
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Affiliation(s)
- Margaret L McNeely
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.,Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Naomi D Dolgoy
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Bolette Skjodt Rafn
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sunita Ghosh
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Paula A Ospina
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Mona M Al Onazi
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Lori Radke
- Tom Baker Cancer Centre, Alberta Health Service, Calgary, Alberta, Canada
| | - Mara Shular
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Urve Kuusk
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marc Webster
- Tom Baker Cancer Centre, Alberta Health Service, Calgary, Alberta, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - John R Mackey
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
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Weller S, Hart NH, Bolam KA, Mansfield S, Santa Mina D, Winters-Stone KM, Campbell A, Rosenberger F, Wiskemann J, Quist M, Cormie P, Goulart J, Campbell KL. Exercise for individuals with bone metastases: A systematic review. Crit Rev Oncol Hematol 2021; 166:103433. [PMID: 34358650 DOI: 10.1016/j.critrevonc.2021.103433] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 11/08/2020] [Revised: 03/26/2021] [Accepted: 07/28/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Exercise has the potential to improve physical function and quality of life in individuals with bone metastases but is often avoided due to safety concerns. This systematic review summarizes the safety, feasibility and efficacy of exercise in controlled trials that include individuals with bone metastases. METHODS MEDLINE, Embase, Pubmed, CINAHL, PEDro and CENTRAL databases were searched up to July 16, 2020. RESULTS A total of 17 trials were included incorporating aerobic exercise, resistance exercise or soccer interventions. Few (n = 4, 0.5%) serious adverse events were attributed to exercise participation, with none related to bone metastases. Mixed efficacy results were found, with exercise eliciting positive changes or no change. The majority of trials included an element of supervised exercise instruction (n = 16, 94%) and were delivered by qualified exercise professionals (n = 13, 76%). CONCLUSIONS Exercise appears safe and feasible for individuals with bone metastases when it includes an element of supervised exercise instruction.
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Affiliation(s)
- Sarah Weller
- Provincial Programs, BC Cancer, 750 West Broadway, Vancouver, BC, V5Z 1H5, Canada. https://twitter.com/_sarahweller
| | - Nicolas H Hart
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, 191 Ipswich Rd, Woolloongabba, QLD, 4102, Australia; Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia; Institute for Health Research, University of Notre Dame Australia, 23 High Street, Freemantle, WA, 6160, Australia. https://twitter.com/DrNicolasHart
| | - Kate A Bolam
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Fack 23400, SE-141 83 Huddinge, Stockholm, Sweden. https://twitter.com/katebolam
| | - Sami Mansfield
- Cancer Wellness for Life, 8022 Reeder Street, Lenexa, KS, 66214, USA. https://twitter.com/bewellwithsami
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, 27 King's College Cir, Toronto, Ontario, ON M5S, Canada. https://twitter.com/DR_SantaMina
| | - Kerri M Winters-Stone
- Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA. https://twitter.com/winters_stone
| | - Anna Campbell
- Department of Sport, Exercise and Health & Science, School of Applied Sciences, Edinburgh Napier University, Sighthill Court, Edinburgh, EH11 4BN, UK. https://twitter.com/CanRehab
| | - Friederike Rosenberger
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany
| | - Joachim Wiskemann
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany. https://twitter.com/exoncolgermany
| | - Morten Quist
- The University Hospitals Centre for Health Research, Rigshospitalet, Blegdamsvej 9, 2100, København, Denmark. https://twitter.com/QuistMorten
| | - Prue Cormie
- Mary MacKillop Institute for Health Research, Australian Catholic University, 5/215 Spring Street, Melbourne, VIC, 3000, Australia. https://twitter.com/PrueCormie
| | - Jennifer Goulart
- Department of Radiation Oncology, BC Cancer, 2410 Lee Avenue, Victoria, BC, V8R 6V5, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, 212-2177 Wesbrook Mall, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada.
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Schulte HK, Schwartz S, Weller S, LeVasseur N, Van Patten C, Campbell KL. Feasibility And Participant Satisfaction Of A 6-week Virtual Exercise Program For Breast Cancer Survivors Receiving Endocrine Therapy Treatments. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000764736.17160.9c] [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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Zadravec K, Weller S, Meyers L, Lane K, Kong J, Campbell KL. Factors Influencing Engagement Rate Of A Daily Twitter Campaign To Disseminate Exercise Oncology Literature. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000764896.53759.1d] [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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Myers SA, Schwartz S, Weller S, LeVasseur N, Van Patten C, Campbell KL. Preliminary Efficacy Of A Virtual Exercise Program For Breast Cancer Survivors Receiving Endocrine Therapy Treatment. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000764780.81264.b2] [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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Adams SC, Smith-Turchyn J, Santa Mina D, Neil-Sztramko S, Cormie P, Culos-Reed SN, Campbell KL, Pugh G, Langelier D, Schmitz KH, Phipps DJ, Nadler M, Sabiston CM. The Exercise Oncology Knowledge Mobilization Initiative: An International Modified Delphi Study. Front Oncol 2021; 11:713199. [PMID: 34350125 PMCID: PMC8327176 DOI: 10.3389/fonc.2021.713199] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/22/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Exercise is vital to health and well-being after a cancer diagnosis yet is poorly integrated in cancer care. Knowledge mobilization (KM) is essential to enhance exercise opportunities. We aimed to (1) develop and refine a list of highly important exercise oncology research and KM themes and (2) establish the relative importance of the themes for supporting the implementation of exercise as a standard of care for people living with and beyond cancer. METHODS Informed by the Co-Produced Pathway to Impact KM framework, a modified Delphi study approach was used to develop, rate, and rank exercise oncology research and KM themes through an international stakeholder workshop and a three-round iterative online survey. Open-ended stakeholder feedback from cancer survivors, healthcare practitioners (HCPs), qualified exercise professionals (QEPs), policy makers, and researchers was used to update themes between survey rounds. Themes were ranked from highest to lowest importance and agreement was examined across all stakeholders and within stakeholder groups. RESULTS A total of 269 exercise oncology stakeholders from 13 countries participated in the study. Twelve final exercise oncology research and KM themes were produced. The final top ranked research themes were related to: (1) QEP integration into primary cancer care teams, (2) Exercise oncology education for HCPs, and (3) Accessibility of cancer exercise programs & support services. There was statistically significant agreement between stakeholders (p<0.001) and within stakeholder groups (p's≤0.02) on the general rankings of themes (i.e., some themes generally ranked higher and lower compared to others). Low Kendall's W statistics indicated variability related to the specific ranked order of the themes between stakeholders and within stakeholder groups. Moreover, there were key differences in the rankings for specific themes between policy makers and other stakeholder groups that highlight potentially important discordance in the research and KM priorities for policy makers that warrants further study. CONCLUSION These findings can be used to guide initiatives and align stakeholders on priorities to support exercise implementation as a standard of cancer care. Additional research is needed to better understand the differences in the proposed research and KM priorities across stakeholders.
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Affiliation(s)
- Scott C. Adams
- Department of Cardiology, Toronto General Hospital Research Institute, Toronto, ON, Canada
- Ted Rogers Cardiotoxicity Prevention Program, Peter Munk Cardiac Centre, Toronto, ON, Canada
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
| | | | - Daniel Santa Mina
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Sarah Neil-Sztramko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ON, Canada
| | - Prue Cormie
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - S. Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kristin L. Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Gemma Pugh
- National Child Cancer Network, Auckland, New Zealand
| | - David Langelier
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Cancer Rehabilitation and Survivorship, Princess Margaret Hospital, Toronto, ON, Canada
| | | | - David J. Phipps
- Division of Vice-President Research & Innovation, York University, Toronto, ON, Canada
| | - Michelle Nadler
- Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Catherine M. Sabiston
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
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Avery J, Schulte HK, Campbell KL, Bates A, McCune L, Howard AF. "What We Want Is More Access…": Experiences of Supportive Cancer Care and Strategies for Advancement in a Canadian Provincial Cancer Care Organization. ACTA ACUST UNITED AC 2021; 28:2227-2238. [PMID: 34203638 PMCID: PMC8293065 DOI: 10.3390/curroncol28030205] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/08/2021] [Indexed: 02/07/2023]
Abstract
Objectives: Despite calls for better supportive care, patients and families still commonly bear significant responsibility for managing the physical and mental health and social challenges of being diagnosed with and treated for cancer. As such, there is increased advocacy for integrated supportive care to ease the burden of this responsibility. The purpose of this study was to understand patient and caregiver experiences with supportive care to advance its delivery at a large provincial cancer care organization in Canada. Method: We used a qualitative descriptive approach to analyze focus groups with patients and caregivers from seven sites across the large provincial cancer care organization. Results: Focus group participants (n = 69) included cancer patients (n = 57) and caregivers (n = 12). Participants highlighted positive and negative aspects of their experience and strategies for improvement. These are depicted in three themes: (1) improving patient and provider awareness of services; (2) increasing access; (3) enhancing coordination and integration. Participants’ specific suggestions included centralizing relevant information about services, implementing a coach or navigator to help advocate for access, and delivering care virtually. Conclusions: Participants highlighted barriers to access and made suggestions for improving supportive care that they believed would reduce the burden associated with trying to manage their cancer journey.
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Affiliation(s)
- Jonathan Avery
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
| | - Hannah K. Schulte
- Rehabilitation Sciences Graduate Program, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
| | - Kristin L. Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
| | - Alan Bates
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 2A1, Canada;
- BC Cancer, Vancouver, BC V5Z 1G1, Canada;
| | | | - Amanda Fuchsia Howard
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
- Correspondence:
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Adams J, Rauw J, Weller S, Campbell KL, Pollock P, Goulart J. Physical activity recommendations for cancer survivors living with bony metastases: views of oncologic healthcare providers. J Cancer Surviv 2021; 15:414-417. [PMID: 33604871 DOI: 10.1007/s11764-021-00999-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/03/2020] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The potential of physical activity to improve function and quality of life of an individual with advanced cancer is now established. The purpose of this survey of oncologic healthcare providers (OHPs) is to understand their attitude towards physical activity for individuals living with bony metastases and to assess requirements to confidently provide physical activity recommendations. METHODS A web-based survey administered through Qualtrics™ included questions on participant demographics and attitude questions ranked on a Likert scale. Eligibility was a physician or nurse practitioner currently providing care in the cancer care system of a public healthcare system in Canada. 338 participants were identified and invited to participate in this survey. RESULTS The response rate was 34.6%. The majority of OHPs believed physical activity is important (89%) and safe (82%) in individuals living with bony metastases. OHPs agreed that these individuals looked to them for physical activity recommendations (74%) and that these recommendations would be followed (58%). Yet, 86% of OHPs felt they required more information before they could recommend physical activity to individuals living with bony metastases, and less than half (43%) of OHPs felt confident enough to prescribe physical activity. CONCLUSIONS OHPs agree that physical activity for individuals living with bony metastatic cancer is beneficial and safe. However, OHPs are not confident in their ability to recommend physical activity to this population. IMPLICATIONS FOR CANCER SURVIVORS There is a need to create physical activity guidelines for individuals living with bony metastases and improve access to rehabilitation services.
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Affiliation(s)
- J Adams
- BC Cancer, 2410 Lee Avenue, Victoria, BC, V8R 6V5, Canada
| | - J Rauw
- BC Cancer, 2410 Lee Avenue, Victoria, BC, V8R 6V5, Canada
| | - S Weller
- BC Cancer Vancouver, 600 W 10th Ave, Vancouver, BC, V5Z 4E6, Canada
| | - K L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Cancer Control, BC Cancer Research Centre, Vancouver, BC, Canada
| | - P Pollock
- BC Cancer, 2410 Lee Avenue, Victoria, BC, V8R 6V5, Canada
| | - J Goulart
- BC Cancer, 2410 Lee Avenue, Victoria, BC, V8R 6V5, Canada.
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Kirkham AA, Gelmon KA, Van Patten CL, Bland KA, Wollmann H, McKenzie DC, Landry T, Campbell KL. Impact of Exercise on Chemotherapy Tolerance and Survival in Early-Stage Breast Cancer: A Nonrandomized Controlled Trial. J Natl Compr Canc Netw 2020; 18:1670-1677. [PMID: 33285521 DOI: 10.6004/jnccn.2020.7603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/03/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Available preliminary evidence is conflicting on whether exercise can positively influence antineoplastic treatment tolerance and in turn improve survival. PATIENTS AND METHODS This study compared chemotherapy treatment tolerance and survival among women receiving adjuvant chemotherapy for early-stage breast cancer who participated in a single-arm trial of supervised aerobic and resistance exercise programming versus a historical cohort that did not receive structured exercise programming. RESULTS The exercise group (EX; n=73) and control group (CTR; n=85) participants were matched on age and treatment and balanced on medical history, cancer diagnosis, and body mass index. Attendance in the EX group was 64% ± 27% of 3 offered sessions per week. For all chemotherapy agents combined, the relative risk (RR) of a chemotherapy dose reduction (RR, 0.78; 95% CI, 0.54-1.11) or delay (RR, 1.05; 95% CI, 0.62-1.80) did not differ between groups. However, the EX group had reduced relative and absolute risks of a dose reduction in doxorubicin by 60% and 18%, respectively. For all agents combined, there were no differences between groups in risk of anemia, neutropenia, or weight gain. In the EX group, dose reductions due to neutropenia (P=.027), other infections (P=.049), and fatigue (P=.037) were less common, whereas mucositis was more common (P=.023), compared with the CTR group. The EX group had reduced relative and absolute risks of weight gain on the docetaxel + cyclophosphamide regimen by 38% and 30%, respectively. After a median follow-up of 70 months (range, 54-84 months), there was no difference between the EX and CTR groups in disease-free survival events (n=8 [11%] vs n=9 [11%], respectively; log-rank test, P=.78) or overall survival events (n=5 [7%] vs n=6 [7%], respectively; log-rank test, P=.974). CONCLUSIONS Overall, exercise programming during adjuvant chemotherapy does not appear to impact treatment tolerance or survival in women receiving common modern regimens of adjuvant chemotherapy for early-stage breast cancer. However, exercise may provide selective benefits, depending on the treatment regimen received.
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Affiliation(s)
- Amy A Kirkham
- 1University of Alberta, Edmonton, Alberta, Canada.,2Now: University of Toronto, Toronto, Canada
| | - Karen A Gelmon
- 3British Columbia Cancer, Vancouver, British Columbia, Canada
| | | | - Kelcey A Bland
- 4Australian Catholic University, Mary Mackillop Institute for Health Research, Melbourne, Victoria, Australia; and
| | - Holly Wollmann
- 5University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald C McKenzie
- 5University of British Columbia, Vancouver, British Columbia, Canada
| | - Taryne Landry
- 5University of British Columbia, Vancouver, British Columbia, Canada
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Caan BJ, Meyerhardt JA, Brown JC, Campbell KL, Cespedes Feliciano EM, Lee C, Ross MC, Quinney S, Quesenberry C, Sternfeld B, Schmitz KH. Recruitment strategies and design considerations in a trial of resistance training to prevent dose-limiting toxicities in colon cancer patients undergoing chemotherapy. Contemp Clin Trials 2020; 101:106242. [PMID: 33301991 DOI: 10.1016/j.cct.2020.106242] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 08/27/2020] [Revised: 11/25/2020] [Accepted: 12/04/2020] [Indexed: 12/29/2022]
Abstract
Low muscle is associated with an increased risk of chemotherapy-related dose limiting toxicities (DLT) in cancer patients. Resistance training (RT) improves muscle mass; however, the effects of RT on preventing DLTs and dose reductions in colon cancer patients has not been investigated. FOcus on Reducing dose-limiting toxicities in Colon cancer with resistance Exercise (FORCE) is a multicenter, randomized clinical trial examining the effects of RT on relative dose intensity (RDI; primary outcome) and moderate and severe chemotoxicities (primary outcome) in non-metastatic colon cancer patients receiving adjuvant chemotherapy. Patients (N = 180) will be recruited from Kaiser Permanente Northern California, Dana-Farber Cancer Institute, and Penn State Cancer Institute. This paper describes recruitment strategies and design considerations. Patients will be randomized in equal numbers to RT intervention or control. Patients have baseline and post completion of chemotherapy visits where information on anthropometry, physical function, body composition, quality of life, physical activity and dietary behaviors, and inflammatory blood markers will be collected. Patient-reported outcomes of chemotherapy side effects will be collected around the time of chemotherapy throughout the duration of the trial. Intervention participants will be prescribed a progressive RT program consisting of 4-6 visits with a certified exercise trainer, delivered either in-person or remotely by video conference, and will be asked to engage twice weekly in-home training sessions. Control patients at the end of the study receive a consult with a FORCE exercise trainer, an online exercise RT training program and a set of resistance bands. Results of this trial will provide information on the benefit of resistance exercise as a treatment to increase RDI.
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Affiliation(s)
- Bette J Caan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA 02215, USA.
| | - Justin C Brown
- Cancer Metabolism Research Program, Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, Louisiana 70808, USA.
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, 212 Friedman Building, 2177 Westbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada.
| | | | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Michelle C Ross
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Sara Quinney
- Disease and Therapeutic Response Modeling Program, Indiana University School of Medicine, 950 W Walnut Street, Indianapolis, Indiana 46202, USA.
| | - Charles Quesenberry
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Barbara Sternfeld
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Kathryn H Schmitz
- Penn State Cancer Institute, The Pennsylvania State University, 500 University Drive, Hershey, PA 17033, USA.
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Balneaves LG, Truant TLO, Van Patten C, Kirkham AA, Waters E, Campbell KL. Patient and Medical Oncologists' Perspectives on Prescribed Lifestyle Intervention-Experiences of Women with Breast Cancer and Providers. J Clin Med 2020; 9:jcm9092815. [PMID: 32878120 PMCID: PMC7564717 DOI: 10.3390/jcm9092815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/18/2020] [Accepted: 08/27/2020] [Indexed: 01/16/2023] Open
Abstract
This study explored the perspectives and experiences of breast cancer patients and medical oncologists with regards to participation in a lifestyle intervention at a tertiary cancer treatment center. A thematic approach was used to understand the context within which a lifestyle intervention was recommended and experienced, to inform future lifestyle programming and promote uptake. Twelve women with breast cancer receiving adjuvant chemotherapy and eight medical oncologists completed interviews. Findings suggest receiving a prescription for a lifestyle intervention from a trusted health professional was influential to women with breast cancer. The intervention offered physical, psychological, emotional, social, and informational benefits to the women and oncologists perceived both physiological and relational benefit to prescribing the intervention. Challenges focused on program access and tailored interventions. Lifestyle prescriptions are perceived by women with breast cancer to have numerous benefits and may promote lifestyle interventions and build rapport between oncologists and women. Oncology healthcare professionals play a pivotal role in motivating women’s participation in lifestyle interventions during breast cancer treatment. Maintenance programs that transition patients into community settings and provide on-going information and follow-up are needed.
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Affiliation(s)
- Lynda G. Balneaves
- College of Nursing, University of Manitoba, Winnipeg, MB R3T 2N2, Canada;
| | | | | | - Amy A. Kirkham
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2W6, Canada;
| | - Erin Waters
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
| | - Kristin L. Campbell
- BC Cancer, Vancouver, BC V5Z 1G1, Canada; (T.L.O.T.); (C.V.P.)
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212, 2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada
- Correspondence: ; Tel.: +1-604-827-4704; Fax: +1-604-822-1870
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Kirkham AA, Virani SA, Bland KA, McKenzie DC, Gelmon KA, Warburton DER, Campbell KL. Exercise training affects hemodynamics not cardiac function during anthracycline-based chemotherapy. Breast Cancer Res Treat 2020; 184:75-85. [PMID: 32816189 DOI: 10.1007/s10549-020-05824-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/20/2020] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Preclinical data demonstrate the potential for exercise training to protect against anthracycline-related cardiotoxicity, but this remains to be shown in humans. PURPOSE To assess whether exercise training during anthracycline-based chemotherapy for treatment of breast cancer affects resting cardiac function and hemodynamics. METHODS In this prospective, non-randomized controlled study, 26 women who participated in aerobic and resistance training 3×/wk during chemotherapy were compared to 11 women receiving usual care. Two-dimensional echocardiography was performed before and 7-14 days after completion of anthracycline-based chemotherapy. Pre- and post-anthracycline cardiac function and hemodynamic variables were compared within each group with paired t-tests; the change was compared between groups using ANCOVA with adjustment for baseline values. RESULTS Left ventricular longitudinal strain, volumes, ejection fraction, E/A ratio, and mass did not change in either group. Hemoglobin, hematocrit, and mean arterial pressure decreased significantly from baseline in both groups (all p < 0.05) with no differences between groups. Cardiac output increased in the usual care group only (+ 0.27 ± 0.24 L/min/m2, p < 0.01), which differed significantly from the exercise group (p = 0.03). Systemic vascular resistance (SVR) decreased in both groups (usual care: - 444, p < 0.01; exercise: - 265, dynes/s/cm5, p = 0.01). However, the reduction in SVR was significantly attenuated in the exercise group (p = 0.03) perhaps due to a compensatory decrease in estimated vessel lumen radius. CONCLUSION Exercise training during anthracycline chemotherapy treatment had no effect on resting cardiac function but appeared to modify hemodynamic responses. Specifically, exercise training attenuated the drop in SVR in response to chemotherapy-related reductions in hematocrit potentially by increasing vessel lumen radius.
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Affiliation(s)
- Amy A Kirkham
- University of Alberta, 1098 Research Transition Facility, 8308 114 Street NW, Edmonton, AB, T6G 2V2, Canada
| | - Sean A Virani
- University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, V6T 1Z3, Canada
| | - Kelcey A Bland
- Australian Catholic University, 115 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Donald C McKenzie
- University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, V6T 1Z3, Canada
| | - Karen A Gelmon
- University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, V6T 1Z3, Canada
- British Columbia Cancer Agency, 600 W 10th Ave, Vancouver, V5Z 4E6, Canada
| | - Darren E R Warburton
- University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, V6T 1Z3, Canada
| | - Kristin L Campbell
- University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, V6T 1Z3, Canada.
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Bland KA, Bigaran A, Campbell KL, Trevaskis M, Zopf EM. Exercising in Isolation? The Role of Telehealth in Exercise Oncology During the COVID-19 Pandemic and Beyond. Phys Ther 2020; 100:1713-1716. [PMID: 32737965 PMCID: PMC7454921 DOI: 10.1093/ptj/pzaa141] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Kelcey A Bland
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Victoria, Australia
| | - Ashley Bigaran
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University and Department of Sports Cardiology, Baker Institute, Victoria, Australia. Ms Bigaran is an accredited exercise physiologist
| | - Kristin L Campbell
- Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Mark Trevaskis
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University. Mr Trevaskis is an accredited exercise physiologist
| | - Eva M Zopf
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring St, Melbourne, Victoria, 3000, Australia,Address all correspondence to Dr Zopf at:
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Brunet J, Barrett-Bernstein M, Zadravec K, Taljaard M, LeVasseur N, Srikanthan A, Bland KA, Collins B, Kam JWY, Handy TC, Hayden S, Simmons C, Smith AM, Virji-Babul N, Campbell KL. Study protocol of the Aerobic exercise and CogniTIVe functioning in women with breAsT cancEr (ACTIVATE) trial: a two-arm, two-centre randomized controlled trial. BMC Cancer 2020; 20:711. [PMID: 32736542 PMCID: PMC7393840 DOI: 10.1186/s12885-020-07196-3] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/19/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Up to 75% of women diagnosed with breast cancer report chemotherapy-related cognitive changes (CRCC) during treatment, including decreased memory, attention, and processing speed. Though CRCC negatively impacts everyday functioning and reduces overall quality of life in women diagnosed with breast cancer, effective interventions to prevent and/or manage CRCC are elusive. Consequently, women seldom receive advice on how to prevent or manage CRCC. Aerobic exercise is associated with improved cognitive functioning in healthy older adults and adults with cognitive impairments. Accordingly, it holds promise as an intervention to prevent and/or manage CRCC. However, evidence from randomized controlled trials (RCTs) supporting a beneficial effect of aerobic exercise on CRCC is limited. The primary aim of the ACTIVATE trial is to evaluate the impact of supervised aerobic exercise on CRCC in women receiving chemotherapy for breast cancer. METHODS The ACTIVATE trial is a two-arm, two-centre RCT. Women diagnosed with stage I-III breast cancer and awaiting neo-adjuvant or adjuvant chemotherapy are recruited from hospitals in Ottawa (Ontario) and Vancouver (British Columbia), Canada. Recruits are randomized to the intervention group (aerobic exercise during chemotherapy) or the wait-list control group (usual care during chemotherapy and aerobic exercise post-chemotherapy). The primary outcome is cognitive functioning as measured by a composite cognitive summary score (COGSUM) of several neuropsychological tests. Secondary outcomes are self-reported cognitive functioning, quality of life, and brain structure and functioning (measured by magnetic resonance imaging (MRI)/functional MRI and electroencephalography). Assessments take place pre-chemotherapy (pre-intervention), mid-way through chemotherapy (mid-intervention/mid-wait period), end of chemotherapy (post-intervention/post-wait period; primary endpoint), 16-weeks post-chemotherapy, and at 1-year post-baseline. DISCUSSION Aerobic exercise is a promising intervention for preventing and/or managing CRCC and enhancing quality of life among women diagnosed with breast cancer. The ACTIVATE trial tests several novel hypotheses, including that aerobic exercise can prevent and/or mitigate CRCC and that this effect is mediated by the timing of intervention delivery (i.e., during versus post-chemotherapy). Findings may support prescribing exercise during (or post-) chemotherapy for breast cancer and elucidate the potential role of aerobic exercise as a management strategy for CRCC in women with early-stage breast cancer. TRIAL REGISTRATION The trial was registered with the ClinicalTrials.gov database ( NCT03277898 ) on September 11, 2017.
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Affiliation(s)
- Jennifer Brunet
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, 125 University Private, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada.
| | - Meagan Barrett-Bernstein
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, 125 University Private, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada
| | - Kendra Zadravec
- Rehabiliation Sciences Graduate Program, Faculty of Medicine, University of British Columbia, T114-2211 Wesbrook Mall, Vancouver, BC, V6T 1Z7, Canada
| | - Monica Taljaard
- The Ottawa Hospital Research Institute, Clinical Epidemiology Program, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Nathalie LeVasseur
- British Columbia Cancer Agency, Vancouver, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada
| | - Amirrtha Srikanthan
- Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Kelcey A Bland
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Barbara Collins
- School of Psychology, Faculty of Social Sciences, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON, K1N 6N5, Canada
| | - Julia W Y Kam
- Department of Psychology & Hotchkiss Brain Institute, University of Calgary, 2500 Campus Drive, Calgary, AB, T2N 1N4, Canada
| | - Todd C Handy
- Department of Psychology, University of British Columbia, 3406-2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Sherri Hayden
- Division of Neurology/Faculty of Medicine, University of British Columbia, P213-2211 Westbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Christine Simmons
- British Columbia Cancer Agency, Vancouver, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada
| | - Andra M Smith
- School of Psychology, Faculty of Social Sciences, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON, K1N 6N5, Canada
| | - Naznin Virji-Babul
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 2215 Westbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 2215 Westbrook Mall, Vancouver, BC, V6T 1Z3, Canada
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Rafn BS, Midtgaard J, Camp PG, Campbell KL. Shared concern with current breast cancer rehabilitation services: a focus group study of survivors' and professionals' experiences and preferences for rehabilitation care delivery. BMJ Open 2020; 10:e037280. [PMID: 32723743 PMCID: PMC7389511 DOI: 10.1136/bmjopen-2020-037280] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Breast cancer survivors experience a wide spectrum of physical sequelae from cancer treatment. National and international guidelines recommend that rehabilitation is offered from the point of diagnosis. However, there is a lack of data on the translation of these recommendations into clinical care. The objective of this study was to explore the experiences of breast cancer survivors, rehabilitation professionals and breast surgeons on current rehabilitation services including preferences for care delivery, specific ways to promote early detection and timely management of upper body issues and attitudes towards self-managed surveillance and rehabilitation. DESIGN Qualitative focus groups. Breast cancer survivors completed a questionnaire about rehabilitation services received and experience of upper body issues. These quantitative data were collected to provide context for the qualitative data and increase transferability. Transcripts were analysed using content analysis. SETTING Five geographically distinct health authorities in British Columbia, Canada. PARTICIPANTS Eleven focus groups were conducted with 35 breast cancer survivors, 29 rehabilitation professionals and 5 breast surgeons. RESULTS Three categories captured participants' concern and wish for improved care: (1) cut the cancer out and goodbye; (2) you have to look out for yourself and (3) in a perfect world. All breast cancer survivors reported chronic upper body issues (mean 4.5 unique issues). Breast cancer survivors expressed worry and uncertainty in their solo management of the rehabilitation. The current services were reported to not enable early detection and timely management. Suggestions included reorganising the timing of patient education and improving the quality of and access to rehabilitation services by elevating the knowledge among healthcare professionals and providing multimodal self-management resources. CONCLUSIONS The results revealed a gap between oncology guidelines and the current clinical reality. The rehabilitation services were reported in need of revamping to increase equity of care. Multiple upper body issues were reported by many breast cancer survivors.
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Affiliation(s)
- Bolette Skjødt Rafn
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julie Midtgaard
- The University Hospitals' Centre for Health Research (UCSF), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pat G Camp
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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