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Sweegers MG, Depenbusch J, Kampshoff CS, Aaronson NK, Hiensch A, Wengström Y, Backman M, Gunasekara N, Clauss D, Pelaez M, Lachowicz M, May AM, Steindorf K, Stuiver MM. Perspectives of patients with metastatic breast cancer on physical exercise programs: results from a survey in five European countries. Support Care Cancer 2023; 31:694. [PMID: 37955790 PMCID: PMC10643348 DOI: 10.1007/s00520-023-08124-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND To successfully implement exercise programs for patients with metastatic breast cancer (MBC), services and patient education should consider patients' knowledge, preferences, values, and goals. Hence, gaining insight into their perspectives on exercise and exercise programming is important. METHOD In this cross-sectional survey, we recruited patients with MBC from the Netherlands, Germany, Poland, Spain, and Sweden. We collected data on patients' knowledge and skills about exercise and outcome expectations. We identified barriers to and facilitators of participation in exercise programs, and patients' preferences for program content and modes of exercise delivery. RESULTS A total of 420 patients participated in the survey. Respondents were, on average, 56.5 years old (SD 10.8) and 70% had bone metastases. Sixty-eight percent reported sufficient skills to engage in aerobic exercise, but only 35% did so for resistance exercise. Respondents expected exercise to have multiple physical benefits, but a few patients expected exercise to worsen their pain (5%). Not having access to an exercise program for cancer patients (27%), feeling too tired (23%), and/or weak (23%) were the most often reported barriers. Facilitators for exercising regularly were previous positive physical (72%) and emotional (68%) experiences with exercising, and receiving personalized advice from a physiotherapist or sport/fitness instructor (62%). Patients were most interested in walking and preferred exercising at a public gym, although there were differences by country. Fifty-seven percent did not know whether their insurance company reimburses exercise programs and only 9% would be willing to pay more than €50 per month to participate. CONCLUSION A large percentage of patients with MBC lack the skills to engage in regular exercise as recommended by exercise guidelines for people with cancer. Patients may benefit from personalized advice and appropriate training facilities to overcome barriers. When implementing exercise interventions, attention should be given to reimbursement and the relatively low willingness-to-pay.
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Affiliation(s)
- Maike G Sweegers
- Center for Quality of Life, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Johanna Depenbusch
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Caroline S Kampshoff
- Center for Quality of Life, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Neil K Aaronson
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Anouk Hiensch
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Yvonne Wengström
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, and Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Malin Backman
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, and Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Nadira Gunasekara
- Department for Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Dorothea Clauss
- Department for Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Mireia Pelaez
- R&D department, Fundación Onkologikoa, Donostia-San Sebastian, Spain and Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain
| | - Milena Lachowicz
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Martijn M Stuiver
- Center for Quality of Life, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Hiensch AE, Beckhaus J, Witlox L, Monninkhof EM, Schagen SB, van Vulpen JK, Sweegers MG, Newton RU, Aaronson NK, Galvão DA, Steindorf K, Stuiver MM, Mesters I, Knoop H, Goedendorp MM, Bohus M, Thorsen L, Schulz KH, Schmidt ME, Ulrich CM, Sonke GS, van Harten WH, Winters-Stone KM, Velthuis MJ, Taaffe DR, van Mechelen W, Kersten MJ, Nollet F, Wiskemann J, Buffart LM, May AM. Moderators of exercise effects on self-reported cognitive functioning in cancer survivors: an individual participant data meta-analysis. J Cancer Surviv 2023:10.1007/s11764-023-01392-3. [PMID: 37160571 DOI: 10.1007/s11764-023-01392-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE This individual participant data meta-analysis (IPD-MA) assesses exercise effects on self-reported cognitive functioning (CF) and investigates whether effects differ by patient-, intervention-, and exercise-related characteristics. METHODS IPD from 16 exercise RCTs, including 1987 patients across multiple types of non-metastatic cancer, was pooled. A one-stage IPD-MA using linear mixed-effect models was performed to assess exercise effects on self-reported CF (z-score) and to identify whether the effect was moderated by sociodemographic, clinical, intervention- and exercise-related characteristics, or fatigue, depression, anxiety, and self-reported CF levels at start of the intervention (i.e., baseline). Models were adjusted for baseline CF and included a random intercept at study level to account for clustering of patients within studies. A sensitivity analysis was performed in patients who reported cognitive problems at baseline. RESULTS Minimal significant beneficial exercise effects on self-reported CF (β=-0.09 [-0.16; -0.02]) were observed, with slightly larger effects when the intervention was delivered post-treatment (n=745, β=-0.13 [-0.24; -0.02]), and no significant effect during cancer treatment (n=1,162, β=-0.08 [-0.18; 0.02]). Larger effects were observed in interventions of 12 weeks or shorter (β=-0.14 [-0.25; -0.04]) or 24 weeks or longer (β=-0.18 [-0.32; -0.02]), whereas no effects were observed in interventions of 12-24 weeks (β=0.01 [-0.13; 0.15]). Exercise interventions were most beneficial when provided to patients without anxiety symptoms (β=-0.10 [-0.19; -0.02]) or after completion of treatment in patients with cognitive problems (β=-0.19 [-0.31; -0.06]). No other significant moderators were identified. CONCLUSIONS This cross-cancer IPD meta-analysis observed small beneficial exercise effects on self-reported CF when the intervention was delivered post-treatment, especially in patients who reported cognitive problems at baseline. IMPLICATIONS FOR CANCER SURVIVORS This study provides some evidence to support the prescription of exercise to improve cognitive functioning. Sufficiently powered trials are warranted to make more definitive recommendations and include these in the exercise guidelines for cancer survivors.
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Affiliation(s)
- Anouk E Hiensch
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Julia Beckhaus
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lenja Witlox
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jonna K van Vulpen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maike G Sweegers
- Division of Psychosocial Research and Epidemiology & Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Martijn M Stuiver
- Division of Psychosocial Research and Epidemiology & Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ilse Mesters
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Martine M Goedendorp
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany
- Faculty of Health, University of Antwerp, Antwerp, Belgium
| | - Lene Thorsen
- National Advisory Unit on Late Effects after Cancer, Department of Oncology, Oslo University Hospital, Oslo, Norway
- Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Karl-Heinz Schulz
- Athleticum - Competence Center for Sports- and Exercise Medicine and Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martina E Schmidt
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Cornelia M Ulrich
- Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, USA
| | - Gabe S Sonke
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Kerri M Winters-Stone
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Miranda J Velthuis
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Willem van Mechelen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, location: Vrije Universiteit, Amsterdam, The Netherlands
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Centers, Location University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Joachim Wiskemann
- Working Group Exercise Oncology, Division of Medical Oncology, University Clinic Heidelberg and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Laurien M Buffart
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.
- Department of Physiology, Radboudumc, Nijmegen, The Netherlands.
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Depenbusch J, Sweegers MG, Aaronson NK, Wengström Y, Backman M, Arraras JI, Schranz M, Büchler B, Lachowicz M, May AM, Steindorf K, Stuiver MM. PERSPECTIVEs on supervised exercise programs in people with metastatic breast cancer- a qualitative study in four European countries. Support Care Cancer 2023; 31:281. [PMID: 37074497 PMCID: PMC10115708 DOI: 10.1007/s00520-023-07739-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/06/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE Supervised exercise is a potentially promising supportive care intervention for people with metastatic breast cancer (MBC), but research on the patients' perspective is limited. The aim of the current focus group study was to gain an in-depth understanding of MBC patients' perceived barriers, facilitators, and preferences for supervised exercise programs. METHODS Eleven online focus groups with, in total, 44 MBC patients were conducted in four European countries (Germany, Poland, Spain, Sweden). Main topics of the semi-structured discussions covered attitudes towards participation in supervised exercise programs, perceived facilitators, experienced barriers, and exercise preferences. Interviews were transcribed verbatim, translated into English, and coded based on a preliminary coding framework, supplemented by themes emerging during the sessions. The codes were subsequently examined for interrelations and re-organized into overarching clusters. RESULTS Participants had positive attitudes towards exercise, but experienced physical limitations and insecurities that inhibited their participation. They expressed a strong desire for exercise tailored to their needs, and supervision by an exercise professional. Participants also highlighted the social nature of group training as an important facilitator. They had no clear preference for exercise type, but rather favored a mixture of different activities. Flexible training modules were considered helpful to increase exercise program adherence. CONCLUSIONS MBC patients were generally interested in supervised exercise programs. They preferred group exercise that facilitates social interaction, but also expressed a need for individualized exercise programs. This suggests the relevance to develop flexible exercise programs that are adjusted to the individual's needs, abilities, and preferences.
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Affiliation(s)
- Johanna Depenbusch
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Maike G Sweegers
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Yvonne Wengström
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute and Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Malin Backman
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute and Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Juan I Arraras
- Oncology Departments, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Melanie Schranz
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Britta Büchler
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Milena Lachowicz
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Martijn M Stuiver
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
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4
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Akdemir E, Sweegers MG, Vrieling A, Rundqvist H, Meijer RP, Leliveld-Kors AM, van der Heijden AG, Rutten VC, Koldewijn EL, Bos SD, Wijburg CJ, Marcelissen TAT, Bongers BC, Retèl VP, van Harten WH, May AM, Groen WG, Stuiver MM. EffectiveNess of a multimodal preHAbilitation program in patieNts with bladder canCEr undergoing radical cystectomy: protocol of the ENHANCE multicentre randomised controlled trial. BMJ Open 2023; 13:e071304. [PMID: 36882246 PMCID: PMC10008243 DOI: 10.1136/bmjopen-2022-071304] [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] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION Radical cystectomy (RC) is the standard treatment for patients with non-metastatic muscle-invasive bladder cancer, as well as for patients with therapy refractory high-risk non-muscle invasive bladder cancer. However, 50-65% of patients undergoing RC experience perioperative complications. The risk, severity and impact of these complications is associated with a patient's preoperative cardiorespiratory fitness, nutritional and smoking status and presence of anxiety and depression. There is emerging evidence supporting multimodal prehabilitation as a strategy to reduce the risk of complications and improve functional recovery after major cancer surgery. However, for bladder cancer the evidence is still limited. The aim of this study is to investigate the superiority of a multimodal prehabilitation programme versus standard-of-care in terms of reducing perioperative complications in patients with bladder cancer undergoing RC. METHODS AND ANALYSIS This multicentre, open label, prospective, randomised controlled trial, will include 154 patients with bladder cancer undergoing RC. Patients are recruited from eight hospitals in The Netherlands and will be randomly (1:1) allocated to the intervention group receiving a structured multimodal prehabilitation programme of approximately 3-6 weeks, or to the control group receiving standard-of-care. The primary outcome is the proportion of patients who develop one or more grade ≥2 complications (according to the Clavien-Dindo classification) within 90 days of surgery. Secondary outcomes include cardiorespiratory fitness, length of hospital stay, health-related quality of life, tumour tissue biomarkers of hypoxia, immune cell infiltration and cost-effectiveness. Data collection will take place at baseline, before surgery and 4 and 12 weeks after surgery. ETHICS AND DISSEMINATION Ethical approval for this study was granted by the Medical Ethics Committee NedMec (Amsterdam, The Netherlands) under reference number 22-595/NL78792.031.22. Results of the study will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05480735.
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Affiliation(s)
- Emine Akdemir
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Center for Quality of Life, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maike G Sweegers
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Center for Quality of Life, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alina Vrieling
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helene Rundqvist
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annemarie M Leliveld-Kors
- Department of Urology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Vera C Rutten
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Evert L Koldewijn
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | - Siebe D Bos
- Department of Urology, Noordwest Hospital Group, Alkmaar, The Netherlands
| | - Carl J Wijburg
- Department of Urology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Tom A T Marcelissen
- Department of Urology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Bart C Bongers
- Department of Nutrition and Movement Sciences, Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Valesca P Retèl
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wim G Groen
- Department of Medicine for Older People, Amsterdam University Medical Center Locatie VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
| | - Martijn M Stuiver
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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Karregat J, Sweegers MG, Quee FA, Weekamp HH, Swinkels DW, Novotny VMJ, Zaaijer HL, van den Hurk K. Ferritin-guided iron supplementation in whole blood donors: optimal dosage, donor response, return and efficacy (FORTE)-a randomised controlled trial protocol. BMJ Open 2022; 12:e056316. [PMID: 35264362 PMCID: PMC8915278 DOI: 10.1136/bmjopen-2021-056316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/03/2023] Open
Abstract
BACKGROUND Frequent whole blood donors have an increased risk of developing iron deficiency. Iron deficiency can have detrimental health effects when left untreated. Donation intervals are commonly too short to replenish iron stores and extending these reduces donor availability. Oral iron supplementation is known to shorten iron store recovery time but may also induce gastrointestinal complaints. We aim to optimise the effectiveness of iron supplements while minimising the risks of side effects. Therefore, we will evaluate the impact of different iron supplementation protocols in terms of dosage and frequency on ferritin and haemoglobin levels, gastrointestinal side effects, iron deficiency-related symptoms and donor return compared with placebo supplementation. METHODS Twelve hundred whole blood donors with ferritin levels ≤30 µg/L are included into a double-blind, randomised controlled trial. Participants are randomly allocated to one of six arms, administering capsules containing 0 mg, 30 mg or 60 mg of iron, either on alternate days or daily for 56 days. At baseline and 56, 122 and 182 days of follow-up, ferritin and haemoglobin levels are measured, and compliance, donor return, dietary iron intake, gastrointestinal, iron deficiency-related symptoms and general health are assessed by questionnaire. ETHICS AND DISSEMINATION This study will provide a comprehensive overview of the effects of different frequencies and dosages of administration of iron supplements on iron status and health effects, thereby considering individual differences in treatment adherence and lifestyle. The outcome will provide scientific evidence to guide the debate if and how oral iron supplements may support the recovery of whole blood donors with low ferritin levels. TRIAL REGISTRATION NUMBER NL8590; The Dutch trial registry.
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Affiliation(s)
- Jan Karregat
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Maike G Sweegers
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Franke A Quee
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Henriëtte H Weekamp
- Medical Donor Affairs, Sanquin Blood Supply Foundation, Zwolle, Noord-Holland, The Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
- Center for Iron Disorders Sanquin, Sanquin Blood Supply Foundation, Amsterdam, Noord-Holland, The Netherlands
| | - Vĕra M J Novotny
- Department of Transfusion Medicine, Sanquin Blood Supply Foundation, Amsterdam, Noord-Holland, The Netherlands
| | - Hans L Zaaijer
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Clinical Virology, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands
| | - Katja van den Hurk
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
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Toffoli EC, Sweegers MG, Bontkes HJ, Altenburg TM, Verheul HMW, van der Vliet HJ, de Gruijl TD, Buffart LM. Effects of physical exercise on natural killer cell activity during (neo)adjuvant chemotherapy: A randomized pilot study. Physiol Rep 2021; 9:e14919. [PMID: 34110712 PMCID: PMC8191403 DOI: 10.14814/phy2.14919] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/14/2021] [Accepted: 05/10/2021] [Indexed: 12/23/2022] Open
Abstract
Natural killer (NK) cells are a population of innate immune cells known to play a pivotal role against tumor spread. In multiple murine models, it was shown that physical exercise had the potential to increase NK cell antitumor activity through their mobilization and tissue redistribution in an interleukin (IL)‐6 and epinephrine‐dependent manner. The translation of this finding to patients is unclear. In this randomized pilot trial, we analyzed blood samples of patients with resectable breast or colon cancer who were randomized into an evidence‐based moderate‐high intensity resistance and aerobic exercise intervention (n = 8) or a control group (n = 6) during the first 9–12 weeks of (neo)adjuvant chemotherapy. In this pilot, we did not solely focus on statistical significance, but also explored whether average between‐group differences reached 10%. NK cell degranulation was preserved in the exercise group whereas it decreased in the control group resulting in a between‐group difference of 11.4% CD107a+ degranulated NK cells (95%CI = 0.57;22.3, p = 0.04) in the presence and 13.8% (95%CI = −2.5;30.0, p = 0.09) in the absence of an anti‐epidermal growth factor receptor monoclonal antibody (EGFR‐mAb). In line, the between‐group difference of tumor cell lysis was 7.4% (95%CI = −9.1;23.9, p = 0.34), and 13.7% (95%CI = −10.1;37.5, p = 0.23) in favor of the exercise group in the presence or absence of EGFR mAb, respectively. Current explorative analyses showed that exercise during (neo)adjuvant chemotherapy may benefit NK cell activity. Future studies with a larger sample size are needed to confirm this finding and to establish its clinical potential. Trial registration: Dutch trial register number NTR4105.
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Affiliation(s)
- Elisa C Toffoli
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maike G Sweegers
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Hetty J Bontkes
- Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Teatske M Altenburg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Hans J van der Vliet
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Lava Therapeutics, Utrecht, Netherlands
| | - Tanja D de Gruijl
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Laurien M Buffart
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Sweegers MG, Twisk JWR, Quee FA, Ferguson E, van den Hurk K. Whole blood donors' post-donation symptoms diminish quickly but are discouraging: Results from 6-day symptom diaries. Transfusion 2021; 61:811-821. [PMID: 33483960 DOI: 10.1111/trf.16220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/23/2020] [Accepted: 10/23/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Whole blood donors may experience post-donation symptoms such as fatigue, dizziness, or headache after blood donation, which could influence donor retention. We aimed to examine post-donation symptoms during 1 week after whole blood donation, investigate donor characteristics associated with symptoms, and evaluate associations between symptoms and donor return. METHODS During 1 week, whole blood donors who donated successfully at one of the collection centers in The Netherlands were invited to participate. Three thousand seventy six donors filled in a diary, assessing post-donation symptoms during days 1 to 6 after donation. We used linear mixed models analyses to determine the change in post-donation symptoms after donation for male and female donors separately. Furthermore, we investigated associations between post-donation symptoms and donors' physical characteristics using multivariable regression and determined associations between symptoms and donor return. RESULTS Donors reported fatigue as the most common symptom, with approximately 3% of donors experiencing severe problems at the first day after donation. Multiple symptoms improved significantly up to day 3 after whole blood donation. Age, BMI, blood pressure (male donors), and blood volume (female donors) were significantly associated with post-donation symptoms. Donors with less fatigue after whole blood donation were more likely to return for their next donation within 31 days after receiving an invitation. CONCLUSION Post-symptoms improve up to 3 days after whole blood donation. Our results may help blood collection centers to identify donors more prone to post-donation symptoms and provide personalized information about the presence and course of post-donation symptoms, possibly increasing donor return rates.
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Affiliation(s)
- Maike G Sweegers
- Donor Studies, Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Centre, Amsterdam, The Netherlands
| | - Franke A Quee
- Donor Studies, Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Eamonn Ferguson
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Katja van den Hurk
- Donor Studies, Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
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8
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Spekman MLC, Ramondt S, Sweegers MG. Whole blood donor behavior and availability after deferral: Consequences of a new ferritin monitoring policy. Transfusion 2020; 61:1112-1121. [PMID: 33368385 PMCID: PMC8048847 DOI: 10.1111/trf.16235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 09/02/2020] [Revised: 11/12/2020] [Accepted: 11/12/2020] [Indexed: 01/07/2023]
Abstract
Background To prevent (negative consequences of) temporary deferral due to low hemoglobin, the Dutch national blood service Sanquin introduced a ferritin monitoring policy in 2017. Ferritin is measured after the donation (as opposed to before donation for hemoglobin), and low ferritin levels lead to deferral of 6 (ferritin 15‐30 ng/mL) or 12 months (ferritin <15 ng/mL). We explored the consequences of this policy on donor behavior and availability. Study Design and Methods We included all Dutch whole blood donors who made a donation (attempt) between 13 November and 31 December 2017. At that point, the ferritin monitoring policy was randomly implemented in 8 of 29 regional clusters of collection centers. We extracted information from Sanquin's donor database about donors' deferrals, subsequent donation attempts, and donation cessation (up to 31 December 2019). Donors deferred for low ferritin were compared to those deferred for low hemoglobin or other reasons, as well as to donors who were not deferred. Results A total of 55 644 donors were included (11% deferred). For donor behavior, we found that donors deferred for low ferritin less often unsubscribed and switched to other donation types, yet also made fewer donations in the follow‐up period. For availability, we found they were less often deferred, yet they were unavailable to donate for a longer period. Conclusion Results suggest that the implementation of a ferritin monitoring policy may lead to a decrease in donor availability and reduced donations. However, the policy is successful in retaining more donors and reducing low hemoglobin deferrals.
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Affiliation(s)
- Marloes L C Spekman
- Donor Studies, Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.,Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Steven Ramondt
- Donor Studies, Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.,Department of Communication Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maike G Sweegers
- Donor Studies, Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
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9
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Sweegers MG, Zalpuri S, Quee FA, Huis In 't Veld EMJ, Prinsze FJ, Hoogendijk EO, Twisk JWR, van Weert AWM, de Kort WLAM, van den Hurk K. Ferritin measurement IN Donors-Effectiveness of iron Monitoring to diminish iron deficiency and low haemoglobin in whole blood donors (FIND'EM): study protocol for a stepped wedge cluster randomised trial. Trials 2020; 21:823. [PMID: 32998766 PMCID: PMC7528293 DOI: 10.1186/s13063-020-04648-w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 07/31/2020] [Indexed: 11/15/2022] Open
Abstract
Background Blood donors are at risk for reduced iron stores, because of which donor iron monitoring received increased attention in the last decade. Despite the importance for donor health, international consensus on an appropriate policy for iron monitoring is lacking. Therefore, we conduct a trial to evaluate to what extent ferritin-guided donation intervals are effective in increasing haemoglobin and ferritin levels, decreasing low-haemoglobin deferral, increasing donor return and improving the health of whole blood donors in the Netherlands. Methods Sanquin Blood Bank is implementing ferritin-guided donation intervals to prevent donors from increasing iron loss at repeated donations. Using a stepped wedge cluster randomised trial approach, the design involves a random crossover of 29 clusters of blood collection centres from the existing policy without ferritin measurements to a ferritin-guided donation interval policy. This new policy includes ferritin measurements for all new donors and at every 5th whole blood donation, extending donation intervals to 6 months if ferritin is 15–≤ 30 ng/mL and to 12 months if ferritin is < 15 ng/mL. We measure ferritin levels of whole blood donors from stored plasma samples and collect haemoglobin levels and information on low-haemoglobin deferral and donor return from the donor database before, during and after the implementation period. We measure donor health during and after the implementation period using questionnaires, assessing physical and mental wellbeing and iron deficiency- and donation-related symptoms. We use multilevel analyses to investigate differences in ferritin and haemoglobin levels, low-haemoglobin deferral rates, donor return and donor health from whole blood donors, between blood collection centres that have versus those that have not yet implemented the ferritin-guided donation interval policy. Discussion This stepped wedge cluster randomised trial will provide insight into the effectiveness of ferritin-guided donation intervals in lowering iron deficiency, decreasing donor deferrals due to low haemoglobin and improving donor health. We will evaluate a policy that is implemented nationwide in a real-life setting. Our study is therefore not limited to a small experimental setting and the results will guide policymakers seeking an appropriate policy for iron monitoring. Trial registration The Dutch trial registry NTR6738. Registered on 29 September 2017. Retrospectively registered.
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Affiliation(s)
| | | | - Franke A Quee
- Donor Studies, Sanquin Research, Amsterdam, The Netherlands
| | - Elisabeth M J Huis In 't Veld
- Donor Studies, Sanquin Research, Amsterdam, The Netherlands.,Department of Cognitive Science & Artificial Intelligence, Tilburg University, Tilburg, The Netherlands
| | | | - Emiel O Hoogendijk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Centre, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Centre, Amsterdam, The Netherlands
| | - Anton W M van Weert
- National Screening Laboratory Sanquin, Sanquin Research and Labservices, Amsterdam, The Netherlands
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10
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VAN Vulpen JK, Sweegers MG, Peeters PHM, Courneya KS, Newton RU, Aaronson NK, Jacobsen PB, Galvão DA, Chinapaw MJ, Steindorf K, Irwin ML, Stuiver MM, Hayes S, Griffith KA, Mesters I, Knoop H, Goedendorp MM, Mutrie N, Daley AJ, McConnachie A, Bohus M, Thorsen L, Schulz KH, Short CE, James EL, Plotnikoff RC, Schmidt ME, Ulrich CM, VAN Beurden M, Oldenburg HS, Sonke GS, VAN Harten WH, Schmitz KH, Winters-Stone KM, Velthuis MJ, Taaffe DR, VAN Mechelen W, Kersten MJ, Nollet F, Wenzel J, Wiskemann J, Verdonck-DE Leeuw IM, Brug J, May AM, Buffart LM. Moderators of Exercise Effects on Cancer-related Fatigue: A Meta-analysis of Individual Patient Data. Med Sci Sports Exerc 2020; 52:303-314. [PMID: 31524827 DOI: 10.1249/mss.0000000000002154] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Fatigue is a common and potentially disabling symptom in patients with cancer. It can often be effectively reduced by exercise. Yet, effects of exercise interventions might differ across subgroups. We conducted a meta-analysis using individual patient data of randomized controlled trials (RCT) to investigate moderators of exercise intervention effects on cancer-related fatigue. METHODS We used individual patient data from 31 exercise RCT worldwide, representing 4366 patients, of whom 3846 had complete fatigue data. We performed a one-step individual patient data meta-analysis, using linear mixed-effect models to analyze the effects of exercise interventions on fatigue (z score) and to identify demographic, clinical, intervention- and exercise-related moderators. Models were adjusted for baseline fatigue and included a random intercept on study level to account for clustering of patients within studies. We identified potential moderators by testing their interaction with group allocation, using a likelihood ratio test. RESULTS Exercise interventions had statistically significant beneficial effects on fatigue (β = -0.17; 95% confidence interval [CI], -0.22 to -0.12). There was no evidence of moderation by demographic or clinical characteristics. Supervised exercise interventions had significantly larger effects on fatigue than unsupervised exercise interventions (βdifference = -0.18; 95% CI -0.28 to -0.08). Supervised interventions with a duration ≤12 wk showed larger effects on fatigue (β = -0.29; 95% CI, -0.39 to -0.20) than supervised interventions with a longer duration. CONCLUSIONS In this individual patient data meta-analysis, we found statistically significant beneficial effects of exercise interventions on fatigue, irrespective of demographic and clinical characteristics. These findings support a role for exercise, preferably supervised exercise interventions, in clinical practice. Reasons for differential effects in duration require further exploration.
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Affiliation(s)
- Jonna K VAN Vulpen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, THE NETHERLANDS
| | | | - Petra H M Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, THE NETHERLANDS
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, CANADA
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, THE NETHERLANDS
| | - Paul B Jacobsen
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - Mai J Chinapaw
- Amsterdam UMC, Vrije Universiteit, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, THE NETHERLANDS
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, GERMANY
| | | | - Martijn M Stuiver
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, THE NETHERLANDS
| | - Sandi Hayes
- School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, AUSTRALIA
| | | | - Ilse Mesters
- Department of Epidemiology, Maastricht University, THE NETHERLANDS
| | - Hans Knoop
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam, THE NETHERLANDS
| | | | - Nanette Mutrie
- Physical Activity for Health Research Center, University of Edinburgh, Edinburgh, UNITED KINGDOM
| | - Amanda J Daley
- School of Sport, Exercise and Health Sciences, University of Loughborough, Loughborough, Leicestershire, UNITED KINGDOM
| | - Alex McConnachie
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UNITED KINGDOM
| | | | | | - Karl-Heinz Schulz
- Athleticum-Competence Center for Sports- and Exercise Medicine and Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, GERMANY
| | - Camille E Short
- Freemasons Foundation Centre of Men's Health, School of Medicine, University of Adelaide, SA, AUSTRALIA
| | - Erica L James
- School of Medicine & Public Health, the University of Newcastle, Callaghan, NSW, AUSTRALIA
| | - Ronald C Plotnikoff
- Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, Callaghan, NSW, AUSTRALIA
| | - Martina E Schmidt
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, GERMANY
| | - Cornelia M Ulrich
- Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | | | | | - Gabe S Sonke
- Netherlands Cancer Institute, Amsterdam, THE NETHERLANDS
| | | | - Kathryn H Schmitz
- Department of Public Health Science, College of Medicine and Cancer Institute, Pennsylvania State University, Hershey, PA
| | - Kerri M Winters-Stone
- Knight Cancer Institute, School of Nursing, Oregon Health & Science University, Portland, OR
| | - Miranda J Velthuis
- Netherlands comprehensive cancer organisation (IKNL), Utrecht, THE NETHERLANDS
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - Willem VAN Mechelen
- Amsterdam UMC, Vrije Universiteit, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, THE NETHERLANDS
| | - Marie José Kersten
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Amsterdam, THE NETHERLANDS
| | - Frans Nollet
- Amsterdam UMC, University of Amsterdam Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, THE NETHERLANDS
| | - Jennifer Wenzel
- Johns Hopkins School of Nursing, Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | | | | | | | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, THE NETHERLANDS
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11
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Buffart LM, Sweegers MG, de Ruijter CJ, Konings IR, Verheul HMW, van Zweeden AA, Grootscholten C, Chinapaw MJ, Altenburg TM. Muscle contractile properties of cancer patients receiving chemotherapy: Assessment of feasibility and exercise effects. Scand J Med Sci Sports 2020; 30:1918-1929. [PMID: 32599670 PMCID: PMC7540386 DOI: 10.1111/sms.13758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
Abstract
Background This pilot trial explores the feasibility of measuring muscle contractile properties in patients with cancer, effects of exercise during chemotherapy on muscle contractile properties and the association between changes in contractile muscle properties and perceived fatigue. Method Patients who received (neo)adjuvant chemotherapy for breast or colon cancer were randomized to a 9‐12 week exercise intervention or a waitlist‐control group. At baseline and follow‐up, we measured knee extensor strength using maximal voluntary contraction (MVC), contractile muscle properties of the quadriceps muscle using electrical stimulation, and perceived fatigue using the Multidimensional Fatigue Inventory. Feasibility was assessed by the proportion of patients who successfully completed measurements of contractile muscle properties. Exercise effects on muscle contractile properties were explored using linear regression analyses. Between‐group differences >10% were considered potentially relevant. Pearson correlation (rp) of changes in contractile muscle properties and changes in perceived fatigue was calculated. Results Twenty two of 30 patients completed baseline and follow‐up assessments. Measurements of contractile properties were feasible except for muscle fatigability. We found a potentially relevant between‐group difference in the rate of force development favoring the intervention group (1192 N/s, 95% CI = −335; 2739). Change in rate of force development was negatively correlated with change in perceived general (rp = −0.54, P = .04) and physical (rp = −0.59, P = .02) fatigue. Conclusion Chemotherapy induces a decrease in the rate of force development, which may reflect a larger loss in type II muscle fibers. This may be attenuated with (resistance) exercise. The increase in the rate of force development was related to a decrease in perceived fatigue.
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Affiliation(s)
- Laurien M Buffart
- Department of Physiology, Radboudumc, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Maike G Sweegers
- Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cornelis J de Ruijter
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Inge R Konings
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, Radboudumc, Nijmegen, The Netherlands
| | - Annette A van Zweeden
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands.,Department of Internal Medicine, Amstelland Hospital, Amstelveen, The Netherlands
| | - Cecile Grootscholten
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mai J Chinapaw
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Teatske M Altenburg
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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12
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Affiliation(s)
| | - Marian G.J. Kraaij
- Centre for Clinical Transfusion Research Sanquin Research Leiden the Netherlands
- Department of Transfusion Medicine and Department of Donor Affairs Sanquin Blood Bank Amsterdam the Netherlands
| | - Katja Hurk
- Donor Studies Sanquin Research Amsterdam the Netherlands
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13
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Sweegers MG, Buffart LM, Huijsmans RJ, Konings IR, van Zweeden AA, Brug J, Chinapaw MJM, Altenburg TM. From accelerometer output to physical activity intensities in breast cancer patients. J Sci Med Sport 2019; 23:176-181. [PMID: 31537492 DOI: 10.1016/j.jsams.2019.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 08/30/2019] [Accepted: 09/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We aimed to investigate accelerometer output corresponding to physical activity intensity cut-points based on percentage of peak oxygen consumption (%VO2peak) and Metabolic Equivalent of Task (MET) value in women treated for breast cancer. DESIGN Laboratory study. METHODS Fifty female patients shortly after completion of treatment for breast cancer were included. VO2peak was determined during a cardiopulmonary exercise test. Subsequently, patients performed ten activities with different intensities while wearing an accelerometer on the right hip and a mobile oxycon to assess oxygen consumption. We studied the relationship between energy expenditure (expressed as %VO2peak and MET-value) and accelerometer output (in counts per minute (cpm)) with linear regression analyses. We determined accelerometer output corresponding to physical activity intensity cut-points (40% and 60%VO2peak; 3 and 6 MET) using regression equations. RESULTS VO2peak was 22.4mL/kg/min (SD 5.2) and resting metabolic rate was 3.1mL/kg/min (SD 0.6). Accelerometer output corresponding to the cut-points for moderate (40% VO2peak) and vigorous intensity (60% VO2peak) were 1123 and 1911, respectively. The analyses based on MET-values resulted in accelerometer output of 1189cpm for the moderate (3 MET) and 2768 cpm for the vigorous intensity cut-point (6 MET). CONCLUSIONS Accelerometer outputs for moderate and vigorous intensity physical activity were lower than commonly used cut-points (i.e. 1952 and 5724 cpm), irrespective of the method used to express energy expenditure (%VO2peak versus MET-value). Thus, categorizing physical activity intensities based on general-population cut-points, may underestimate physical activity intensities for women treated for breast cancer.
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Affiliation(s)
- Maike G Sweegers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Laurien M Buffart
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, The Netherlands
| | - Rosalie J Huijsmans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, The Netherlands
| | - Inge R Konings
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, The Netherlands
| | - Annette A van Zweeden
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, The Netherlands; Amstelland Hospital, Department of Internal Medicine, The Netherlands
| | - Johannes Brug
- National Institute for Public Health and the Environment (RIVM), The Netherlands
| | - Mai J M Chinapaw
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational health, Amsterdam Public Health, The Netherlands
| | - Teatske M Altenburg
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational health, Amsterdam Public Health, The Netherlands.
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14
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Bernard P, Savard J, Steindorf K, Sweegers MG, Courneya KS, Newton RU, Aaronson NK, Jacobsen PB, May AM, Galvao DA, Chinapaw MJ, Stuiver MM, Griffith KA, Mesters I, Knoop H, Goedendorp MM, Bohus M, Thorsen L, Schmidt ME, Ulrich CM, Sonke GS, van Harten W, Winters-Stone KM, Velthuis MJ, Taaffe DR, van Mechelen W, Kersten MJ, Nollet F, Wenzel J, Wiskemann J, Verdonck-de Leeuw IM, Brug J, Buffart LM. Effects and moderators of exercise on sleep in adults with cancer: Individual patient data and aggregated meta-analyses. J Psychosom Res 2019; 124:109746. [PMID: 31443811 DOI: 10.1016/j.jpsychores.2019.109746] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/14/2019] [Accepted: 06/16/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate the effects of exercise interventions on sleep disturbances and sleep quality in patients with mixed cancer diagnoses, and identify demographic, clinical, and intervention-related moderators of these effects. METHODS Individual patient data (IPD) and aggregated meta-analyses of randomized controlled trials (RCTs). Using data from the Predicting OptimaL cAncer RehabIlitation and Supportive care project, IPD of 2173 adults (mean age = 54.8) with cancer from 17 RCTs were analyzed. A complementary systematic search was conducted (until November 2018) to study the overall effects and test the representativeness of analyzed IPD. Effect sizes of exercise effects on self-reported sleep outcomes were calculated for all included RCTs. Linear mixed-effect models were used to evaluate the effects of exercise on post-intervention outcome values, adjusting for baseline values. Moderator effects were studied by testing interactions for demographic, clinical and intervention-related characteristics. RESULTS For all 27 eligible RCTs from the updated search, exercise interventions significantly decreased sleep disturbances in adults with cancer (g = -0.09, 95% CI [-0.16; -0.02]). No significant effect was obtained for sleep quality. RCTs included in IPD analyses constituted a representative sample of the published literature. The intervention effects on sleep disturbances were not significantly moderated by any demographic, clinical, or intervention-related factor, nor by sleep disturbances. CONCLUSIONS This meta-analysis provides some evidence that, compared to control conditions, exercise interventions may improve sleep disturbances, but not sleep quality, in cancer patients, although this effect is of a small magnitude. Among the investigated variables, none was found to significantly moderate the effect of exercise interventions on sleep disturbances.
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Affiliation(s)
- P Bernard
- Université Laval Cancer Research Center, Québec, Québec, Canada; School of Psychology, Université Laval, Québec, Québec, Canada; CHU de Québec - Université Laval Research Center, Québec, Québec, Canada; Physical Activity Sciences Department, Université du Québec à Montréal, Montréal, Quebec, Canada; Research centre, University Institute of Mental Health at Montreal, Montréal, Quebec, Canada.
| | - J Savard
- Université Laval Cancer Research Center, Québec, Québec, Canada; School of Psychology, Université Laval, Québec, Québec, Canada; CHU de Québec - Université Laval Research Center, Québec, Québec, Canada
| | - K Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany
| | - M G Sweegers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - K S Courneya
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada
| | - R U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P B Jacobsen
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - A M May
- Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - D A Galvao
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - M J Chinapaw
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - M M Stuiver
- Department of Physiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - K A Griffith
- School of Nursing, University of Maryland, Baltimore, USA
| | - I Mesters
- Department of Epidemiology, Maastricht University, The Netherlands
| | - H Knoop
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - M M Goedendorp
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Heidelberg t University, Mannheim, Germany
| | - M Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Heidelberg t University, Mannheim, Germany; Faculty of Health, University of Antwerp, Belgium
| | - L Thorsen
- National Advisory Unit on Late Effects after Cancer, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - M E Schmidt
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany
| | - C M Ulrich
- Huntsman Cancer Institute and University of Utah, Department of Population Health Sciences, Salt Lake City, USA
| | - G S Sonke
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - W van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Huntsman Cancer Institute and University of Utah, Department of Population Health Sciences, Salt Lake City, USA
| | | | - M J Velthuis
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - D R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - W van Mechelen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - M J Kersten
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Amsterdam, The Netherlands
| | - F Nollet
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - J Wenzel
- Johns Hopkins School of Nursing, Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, USA
| | - J Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
| | - I M Verdonck-de Leeuw
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology-Head and Neck Surgery, The Netherlands; Department of Clinical Psychology, Vrije Universiteit Amsterdam, The Netherlands
| | - J Brug
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam, The Netherlands; National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - L M Buffart
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
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15
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Sweegers MG, Boyle T, Vallance JK, Chinapaw MJ, Brug J, Aaronson NK, D'Silva A, Kampshoff CS, Lynch BM, Nollet F, Phillips SM, Stuiver MM, van Waart H, Wang X, Buffart LM, Altenburg TM. Which cancer survivors are at risk for a physically inactive and sedentary lifestyle? Results from pooled accelerometer data of 1447 cancer survivors. Int J Behav Nutr Phys Act 2019; 16:66. [PMID: 31420000 PMCID: PMC6698042 DOI: 10.1186/s12966-019-0820-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/18/2019] [Indexed: 12/22/2022] Open
Abstract
Background Physical activity has beneficial effects on the health of cancer survivors. We aimed to investigate accelerometer-assessed physical activity and sedentary time in cancer survivors, and describe activity profiles. Additionally, we identify demographic and clinical correlates of physical activity, sedentary time and activity profiles. Methods Accelerometer, questionnaire and clinical data from eight studies conducted in four countries (n = 1447) were pooled. We calculated sedentary time and time spent in physical activity at various intensities using Freedson cut-points. We used latent profile analysis to identify activity profiles, and multilevel linear regression analyses to identify demographic and clinical variables associated with accelerometer-assessed moderate to vigorous physical activity (MVPA), sedentary time, the highly active and highly sedentary profile, adjusting for confounders identified using a directed acyclic graph. Results Participants spent on average 26 min (3%) in MVPA and 568 min (66%) sedentary per day. We identified six activity profiles. Older participants, smokers and participants with obesity had significantly lower MVPA and higher sedentary time. Furthermore, men had significantly higher MVPA and sedentary time than women and participants who reported less fatigue had higher MVPA time. The highly active profile included survivors with high education level and normal body mass index. Haematological cancer survivors were less likely to have a highly active profile compared to breast cancer survivors. The highly sedentary profile included older participants, males, participants who were not married, obese, smokers, and those < 12 months after diagnosis. Conclusions Cancer survivors engage in few minutes of MVPA and spend a large proportion of their day sedentary. Correlates of MVPA, sedentary time and activity profiles can be used to identify cancer survivors at risk for a sedentary and inactive lifestyle. Electronic supplementary material The online version of this article (10.1186/s12966-019-0820-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M G Sweegers
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - T Boyle
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia Cancer Research Institute, Adelaide, Australia
| | - J K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
| | - M J Chinapaw
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J Brug
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A D'Silva
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - C S Kampshoff
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - B M Lynch
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global health, The University of Melbourne, Melbourne, Australia.,Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - F Nollet
- Department of Rehabilitation, Amsterdam Movement Sciences institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S M Phillips
- Department of Behavioural Medicine, Northwestern University, Chicago, USA
| | - M M Stuiver
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H van Waart
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Anesthesiology, University of Auckland, Auckland, New Zealand
| | - X Wang
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - L M Buffart
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - T M Altenburg
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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Buffart LM, Sweegers MG, Huijsmans R, Brug J, Chin A Paw MJ, Altenburg TM. Relationship Between Accelerometer Output And Oxygen Consumption In Patients With Breast Cancer After Chemotherapy Treatment. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000563127.84926.c3] [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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Bjørke ACH, Sweegers MG, Buffart LM, Raastad T, Nygren P, Berntsen S. Which exercise prescriptions optimize V̇O 2 max during cancer treatment?-A systematic review and meta-analysis. Scand J Med Sci Sports 2019; 29:1274-1287. [PMID: 31034665 DOI: 10.1111/sms.13442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/31/2019] [Accepted: 04/18/2019] [Indexed: 12/22/2022]
Abstract
The aims of the present systematic review and meta-analysis were to investigate the effect of exercise on maximal oxygen uptake ( V ˙ O 2 m a x ) and to investigate whether exercise frequency, intensity, duration, and volume are associated with changes in V ˙ O 2 m a x among adult patients with cancer undergoing treatment. Medline and Embase through OvidSP were searched to identify randomized controlled trials. Two reviewers extracted data and assessed the risk of bias. The overall effect size and differences in effects for different intensities and frequencies were calculated on change scores and post-intervention V ˙ O 2 m a x data, and the meta-regression of exercise duration and volumes was analyzed using the Comprehensive Meta-Analysis software. Fourteen randomized controlled trials were included in the systematic review, comprising 1332 patients with various cancer types receiving (neo-)adjuvant chemo-, radio-, and/or hormone therapy. Exercise induced beneficial changes in V ˙ O 2 m a x compared to usual care (effect size = 0.46, 95% Confidence Interval = 0.23-0.69). Longer session duration (P = 0.020), and weekly duration (P = 0.010), larger weekly volume (P < 0.001), and shorter intervention duration (P = 0.005) were significantly associated with more beneficial changes in V ˙ O 2 m a x . No differences in effects between subgroups with respect to frequency and intensity were found. In conclusion, exercise has beneficial effects on V ˙ O 2 m a x in patients with cancer undergoing (neo-)adjuvant treatment. As interventions with larger exercise volumes and longer session durations resulted in larger beneficial changes in V ˙ O 2 m a x , exercise frequency, intensity, and duration should be considered carefully for sufficient exercise volume to induce changes in V ˙ O 2 m a x for this patient group.
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Affiliation(s)
| | - Maike G Sweegers
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Laurien M Buffart
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.,Department of Medical Oncology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Peter Nygren
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Sveinung Berntsen
- Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway.,Department of Public Health and Caring Sciences, Lifestyle and Rehabilitation in Long Term Illness, Uppsala University, Uppsala, Sweden
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Kalter J, Sweegers MG, Verdonck-de Leeuw IM, Brug J, Buffart LM. Development and use of a flexible data harmonization platform to facilitate the harmonization of individual patient data for meta-analyses. BMC Res Notes 2019; 12:164. [PMID: 30902064 PMCID: PMC6431032 DOI: 10.1186/s13104-019-4210-7] [Citation(s) in RCA: 10] [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: 10/25/2018] [Accepted: 03/18/2019] [Indexed: 12/13/2022] Open
Abstract
Objective Harmonizing individual patient data (IPD) for meta-analysis has clinical and statistical advantages. Harmonizing IPD from multiple studies may benefit from a flexible data harmonization platform (DHP) that allows harmonization of IPD already during data collection. This paper describes the development and use of a flexible DHP that was initially developed for the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) study. Results The DHP that we developed (I) allows IPD harmonization with a flexible approach, (II) has the ability to store data in a centralized and secured database server with large capacity, (III) is transparent and easy in use, and (IV) has the ability to export harmonized IPD and corresponding data dictionary to a statistical program. The DHP uses Microsoft Access as front-end application and requires a relational database management system such as Microsoft Structured Query Language (SQL) Server or MySQL as back-end application. The DHP consists of five user friendly interfaces which support the user to import original study data, to harmonize the data with a master data dictionary, and to export the harmonized data into a statistical software program of choice for further analyses. The DHP is now also adopted in two other studies. Electronic supplementary material The online version of this article (10.1186/s13104-019-4210-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joeri Kalter
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Maike G Sweegers
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Clinical- Developmental- and Neuro Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johannes Brug
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.,Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Laurien M Buffart
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands. .,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. .,Cancer Center Amsterdam, Amsterdam, The Netherlands. .,Department of Medical Oncology, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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Sweegers MG, Buffart LM, van Veldhuizen WM, Geleijn E, Verheul HMW, Brug J, Chinapaw MJM, Altenburg TM. How Does a Supervised Exercise Program Improve Quality of Life in Patients with Cancer? A Concept Mapping Study Examining Patients' Perspectives. Oncologist 2018; 24:e374-e383. [PMID: 30425179 DOI: 10.1634/theoncologist.2017-0613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 08/31/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Previous systematic reviews and meta-analyses demonstrated beneficial effects of exercise during or following cancer treatment on quality of life (QoL). Aiming to understand how exercise contributes to a patient's QoL, we examined patients' perspectives via a process called concept mapping. This unique method provides structure and objectivity to rich qualitative data. METHODS Patients with cancer who were participating in an exercise program were invited to enroll. Eleven meetings with 3-10 patients were organized in which patients generated ideas in response to the question "How has participating in a supervised exercise program contributed positively to your QoL?" Next, patients individually clustered (based on similarity) and rated (based on importance) the ideas online. The online assessments were combined, and one concept map was created, visualizing clusters of ideas of how patients perceive that participating in a supervised exercise program improved their QoL. The research team labelled the clusters of ideas, and physiotherapists reflected on the clusters during semistructured interviews. RESULTS Sixty patients attended the meetings; of these, one patient was not able to generate an idea in response to the statement. Forty-four patients completed the online clustering and rating of ideas. The resulting concept map yielded six clusters: personalized care, coaching by a physiotherapist, social environment, self-concept, coping, and physical fitness and health. Personalized care was rated as most important. Overall, physiotherapists recognized these clusters in practice. CONCLUSION Patients with cancer reported that participating in a supervised exercise program improved their physical fitness and influenced social, mental, and cognitive factors, resulting in improvements in QoL. These results can be used to increase the awareness of the importance of supervised exercise programs for the QoL of patients with cancer. IMPLICATIONS FOR PRACTICE According to patients, a supervised exercise program contributes positively to their quality of life by improving physical fitness and health and providing personalized care, coaching by a physiotherapist, and improved social environment, self-concept, and coping. This knowledge could help to increase physicians' and patients' awareness of the importance of an exercise program during or following cancer treatment, possibly improving referral, participation, and adherence rates to these programs. Furthermore, patients' perspectives may be used to improve supervised exercise programs, taking into account the importance of personalized care, the supervision of a physiotherapist, the social environment, self-concept, and coping.
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Affiliation(s)
- Maike G Sweegers
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Laurien M Buffart
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Wouke M van Veldhuizen
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Edwin Geleijn
- Department of Rehabilitation, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Johannes Brug
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Mai J M Chinapaw
- Department of Public and Occupational Health, Amsterdam Public Health Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Teatske M Altenburg
- Department of Public and Occupational Health, Amsterdam Public Health Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Buffart LM, Sweegers MG, May AM, Chinapaw MJ, van Vulpen JK, Newton RU, Galvão DA, Aaronson NK, Stuiver MM, Jacobsen PB, Verdonck-de Leeuw IM, Steindorf K, Irwin ML, Hayes S, Griffith KA, Lucia A, Herrero-Roman F, Mesters I, van Weert E, Knoop H, Goedendorp MM, Mutrie N, Daley AJ, McConnachie A, Bohus M, Thorsen L, Schulz KH, Short CE, James EL, Plotnikoff RC, Arbane G, Schmidt ME, Potthoff K, van Beurden M, Oldenburg HS, Sonke GS, van Harten WH, Garrod R, Schmitz KH, Winters-Stone KM, Velthuis MJ, Taaffe DR, van Mechelen W, José Kersten M, Nollet F, Wenzel J, Wiskemann J, Brug J, Courneya KS. Targeting Exercise Interventions to Patients With Cancer in Need: An Individual Patient Data Meta-Analysis. J Natl Cancer Inst 2018; 110:1190-1200. [PMID: 30299508 PMCID: PMC6454466 DOI: 10.1093/jnci/djy161] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/23/2018] [Accepted: 08/14/2018] [Indexed: 12/12/2022] Open
Abstract
Background Exercise effects in cancer patients often appear modest, possibly because interventions rarely target patients most in need. This study investigated the moderator effects of baseline values on the exercise outcomes of fatigue, aerobic fitness, muscle strength, quality of life (QoL), and self-reported physical function (PF) in cancer patients during and post-treatment. Methods Individual patient data from 34 randomized exercise trials (n = 4519) were pooled. Linear mixed-effect models were used to study moderator effects of baseline values on exercise intervention outcomes and to determine whether these moderator effects differed by intervention timing (during vs post-treatment). All statistical tests were two-sided. Results Moderator effects of baseline fatigue and PF were consistent across intervention timing, with greater effects in patients with worse fatigue (Pinteraction = .05) and worse PF (Pinteraction = .003). Moderator effects of baseline aerobic fitness, muscle strength, and QoL differed by intervention timing. During treatment, effects on aerobic fitness were greater for patients with better baseline aerobic fitness (Pinteraction = .002). Post-treatment, effects on upper (Pinteraction < .001) and lower (Pinteraction = .01) body muscle strength and QoL (Pinteraction < .001) were greater in patients with worse baseline values. Conclusion Although exercise should be encouraged for most cancer patients during and post-treatments, targeting specific subgroups may be especially beneficial and cost effective. For fatigue and PF, interventions during and post-treatment should target patients with high fatigue and low PF. During treatment, patients experience benefit for muscle strength and QoL regardless of baseline values; however, only patients with low baseline values benefit post-treatment. For aerobic fitness, patients with low baseline values do not appear to benefit from exercise during treatment.
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Affiliation(s)
- Laurien M Buffart
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Maike G Sweegers
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Mai J Chinapaw
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jonna K van Vulpen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Rob U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | | | - Martijn M Stuiver
- Division of Psychosocial Research and Epidemiology (NKA) and Center for Quality of life, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Paul B Jacobsen
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD
| | - Irma M Verdonck-de Leeuw
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, the Netherlands
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health Research Institute and Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | | | - Sandi Hayes
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | | | | | | | - Ilse Mesters
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Ellen van Weert
- University Medical Centre Groningen, University of Groningen, Center for Rehabilitation, Groningen, the Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Martine M Goedendorp
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Nanette Mutrie
- Physical Activity for Health Research Center, University of Edinburgh, Edinburgh, UK
| | - Amanda J Daley
- School of Sports, Exercise and Health Sciences, University of Loughborough, Loughborough, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany
- Faculty of Health, University of Antwerp, Antwerp, Belgium
| | - Lene Thorsen
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology (LT) and Department of Clinical Service (LT), Oslo University Hospital, Oslo, Norway
| | - Karl-Heinz Schulz
- Athleticum – Competence Center for Sports- and Exercise Medicine and Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Camille E Short
- Freemasons Foundation Centre of Men’s Health, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | | | - Ronald C Plotnikoff
- School of Medicine & Public Health (ELJ) and Priority Research Centre for Physical Activity and Nutrition (RCP), The University of Newcastle, Callaghan, NSW, Australia
| | - Gill Arbane
- Lane Fox Respiratory Research Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Martina E Schmidt
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Karin Potthoff
- Department of Medical Oncology (KP, JmW) and Department of Radiation Oncology (KP), National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
| | - Marc van Beurden
- Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Hester S Oldenburg
- Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Gabe S Sonke
- Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology (NKA) and Center for Quality of life, Netherlands Cancer Institute, Amsterdam, the Netherlands
- University of Twente, Enschede, the Netherlands
| | - Rachel Garrod
- Department of Respiratory Medicine, Kings College London, London, UK
| | - Kathryn H Schmitz
- Department of Public Health Science, College of Medicine and Cancer Institute, Pennsylvania State University, Hershey, PA
| | - Kerri M Winters-Stone
- Knight Cancer Institute and School of Nursing, Oregon Health & Science University, Portland, OR
| | - Miranda J Velthuis
- Department of Medical Oncology (KP, JmW) and Department of Radiation Oncology (KP), National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
- Department of Public Health Science, College of Medicine and Cancer Institute, Pennsylvania State University, Hershey, PA
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - Willem van Mechelen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Frans Nollet
- Department of Rehabilitation, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands
| | - Jennifer Wenzel
- Johns Hopkins School of Nursing, Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | | | - Johannes Brug
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, the Netherlands
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
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Sweegers MG, Altenburg TM, Brug J, May AM, van Vulpen JK, Aaronson NK, Arbane G, Bohus M, Courneya KS, Daley AJ, Galvao DA, Garrod R, Griffith KA, Van Harten WH, Hayes SC, Herrero-Román F, Kersten MJ, Lucia A, McConnachie A, van Mechelen W, Mutrie N, Newton RU, Nollet F, Potthoff K, Schmidt ME, Schmitz KH, Schulz KH, Sonke G, Steindorf K, Stuiver MM, Taaffe DR, Thorsen L, Twisk JW, Velthuis MJ, Wenzel J, Winters-Stone KM, Wiskemann J, Chin A Paw MJ, Buffart LM. Effects and moderators of exercise on muscle strength, muscle function and aerobic fitness in patients with cancer: a meta-analysis of individual patient data. Br J Sports Med 2018; 53:812. [DOI: 10.1136/bjsports-2018-099191] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2018] [Indexed: 01/10/2023]
Abstract
ObjectiveTo optimally target exercise interventions for patients with cancer, it is important to identify which patients benefit from which interventions.DesignWe conducted an individual patient data meta-analysis to investigate demographic, clinical, intervention-related and exercise-related moderators of exercise intervention effects on physical fitness in patients with cancer.Data sourcesWe identified relevant studies via systematic searches in electronic databases (PubMed, Embase, PsycINFO and CINAHL).Eligibility criteriaWe analysed data from 28 randomised controlled trials investigating the effects of exercise on upper body muscle strength (UBMS) and lower body muscle strength (LBMS), lower body muscle function (LBMF) and aerobic fitness in adult patients with cancer.ResultsExercise significantly improved UBMS (β=0.20, 95% Confidence Interval (CI) 0.14 to 0.26), LBMS (β=0.29, 95% CI 0.23 to 0.35), LBMF (β=0.16, 95% CI 0.08 to 0.24) and aerobic fitness (β=0.28, 95% CI 0.23 to 0.34), with larger effects for supervised interventions. Exercise effects on UBMS were larger during treatment, when supervised interventions included ≥3 sessions per week, when resistance exercises were included and when session duration was >60 min. Exercise effects on LBMS were larger for patients who were living alone, for supervised interventions including resistance exercise and when session duration was >60 min. Exercise effects on aerobic fitness were larger for younger patients and when supervised interventions included aerobic exercise.ConclusionExercise interventions during and following cancer treatment had small effects on UBMS, LBMS, LBMF and aerobic fitness. Demographic, intervention-related and exercise-related characteristics including age, marital status, intervention timing, delivery mode and frequency and type and time of exercise sessions moderated the exercise effect on UBMS, LBMS and aerobic fitness.
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Sweegers MG. How Does a Supervised Exercise Program Improve Quality Of Life In Patients With Cancer? Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536347.52446.19] [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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Kalter J, Verdonck-de Leeuw IM, Sweegers MG, Aaronson NK, Jacobsen PB, Newton RU, Courneya KS, Aitken JF, Armes J, Arving C, Boersma LJ, Braamse AMJ, Brandberg Y, Chambers SK, Dekker J, Ell K, Ferguson RJ, Gielissen MFM, Glimelius B, Goedendorp MM, Graves KD, Heiney SP, Horne R, Hunter MS, Johansson B, Kimman ML, Knoop H, Meneses K, Northouse LL, Oldenburg HS, Prins JB, Savard J, van Beurden M, van den Berg SW, Brug J, Buffart LM. Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer: An individual patient data meta-analysis of 22 RCTs. Psychooncology 2018; 27:1150-1161. [PMID: 29361206 PMCID: PMC5947559 DOI: 10.1002/pon.4648] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [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: 05/26/2017] [Revised: 01/02/2018] [Accepted: 01/10/2018] [Indexed: 01/25/2023]
Abstract
Objective This individual patient data (IPD) meta‐analysis aimed to evaluate the effects of psychosocial interventions (PSI) on quality of life (QoL), emotional function (EF), and social function (SF) in patients with cancer, and to study moderator effects of demographic, clinical, personal, and intervention‐related characteristics. Methods Relevant studies were identified via literature searches in 4 databases. We pooled IPD from 22 (n = 4217) of 61 eligible randomized controlled trials. Linear mixed‐effect model analyses were used to study intervention effects on the post‐intervention values of QoL, EF, and SF (z‐scores), adjusting for baseline values, age, and cancer type. We studied moderator effects by testing interactions with the intervention for demographic, clinical, personal, and intervention‐related characteristics, and conducted subsequent stratified analyses for significant moderator variables.Results: PSI significantly improved QoL (β = 0.14,95%CI = 0.06;0.21), EF (β = 0.13,95%CI = 0.05;0.20), and SF (β = 0.10,95%CI = 0.03;0.18). Significant differences in effects of different types of PSI were found, with largest effects of psychotherapy. The effects of coping skills training were moderated by age, treatment type, and targeted interventions. Effects of psychotherapy on EF may be moderated by cancer type, but these analyses were based on 2 randomized controlled trials with small sample sizes of some cancer types. Conclusions PSI significantly improved QoL, EF, and SF, with small overall effects. However, the effects differed by several demographic, clinical, personal, and intervention‐related characteristics. Our study highlights the beneficial effects of coping skills training in patients treated with chemotherapy, the importance of targeted interventions, and the need of developing interventions tailored to the specific needs of elderly patients.
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Affiliation(s)
- J Kalter
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - I M Verdonck-de Leeuw
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands.,Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health research institute and Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - M G Sweegers
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P B Jacobsen
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, Maryland, FL, USA
| | - R U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - K S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - J F Aitken
- Menzies Health Institute Queensland, Griffith University, Southport, Australia.,Cancer Council Queensland, Brisbane, Australia.,Institute for Resilient Regions, University of Southern Queensland, Brisbane, Australia
| | - J Armes
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - C Arving
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - L J Boersma
- Department of Radiation Oncology, Maastricht University Medical Center (MAASTRO clinic), Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A M J Braamse
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - Y Brandberg
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S K Chambers
- Menzies Health Institute Queensland, Griffith University, Southport, Australia.,Cancer Council Queensland, Brisbane, Australia.,Prostate Cancer Foundation of Australia, Sydney, NSW, Australia
| | - J Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - K Ell
- Department of Adults and Healthy Aging, University of Southern California, Los Angeles, CA, USA
| | - R J Ferguson
- Division of Hematology-Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - M F M Gielissen
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - B Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - M M Goedendorp
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - K D Graves
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - S P Heiney
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - R Horne
- UCL School of Pharmacy, University College London, London, UK
| | - M S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - B Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - M L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - H Knoop
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - K Meneses
- University of Alabama at Birmingham, School of Nursing, Birmingham, AL, USA
| | - L L Northouse
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - H S Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - J B Prins
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Savard
- School of Psychology, Université Laval and Laval University Cancer Research Center, Québec, QC, Canada
| | - M van Beurden
- Department of Gynecology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - S W van den Berg
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Brug
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - L M Buffart
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,Department of Medical Oncology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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van Vulpen JK, Sweegers MG, Kalter J, Peeters PH, Courneya KS, Newton RU, Aaronson NK, Jacobsen PB, Steindorf K, Stuiver MM, Hayes S, Mesters I, Knoop H, Goedendorp M, Mutrie N, Thorsen L, Schmidt M, Sonke GS, Bohus M, James EL, Oldenburg HS, Velthuis MJ, Nollet F, Wenzel J, Wiskemann J, Galvão DA, Chinapaw MJ, Irwin ML, Griffith KA, van Weert E, Daley AJ, McConnachie A, Schulz KH, Short CE, Plotnikoff RC, Potthoff K, van Beurden M, van Harten WH, Schmitz KH, Winters-Stone KM, Taaffe DR, van Mechelen W, Kersten MJ, Verdonck-de Leeuw IM, Brug J, Buffart LM, May AM. Abstract P6-12-06: Effect and moderators of exercise on fatigue in patients with breast cancer: Meta-analysis of individual patient data. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-12-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background - Fatigue is one of the most common and disabling complaints in patients with breast cancer and can effectively be reduced by physical exercise, with small to moderate effect sizes. To identify heterogeneity in responses to exercise and to further personalize exercise prescriptions, moderators of exercise effects on fatigue should be investigated. However, most randomized controlled trials (RCTs) are not adequately powered for such analyses. Therefore we conducted meta-analyses using the individual patient data of several exercise RCTs. The aim is to investigate the effect and moderators of physical exercise on cancer-related fatigue in patients with breast cancer.
Methods - Within the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) consortium, principal investigators of 34 exercise RCTs worldwide have shared their individual patient data. Twenty-two of these RCTs included patients with breast cancer with a total sample size of 3,061. Different questionnaires to assess level of fatigue were used, which was acknowledged by using z-scores in the analysis. A one-step individual patient data meta-analysis, using a linear mixed-effect model adjusted for baseline fatigue, with a random intercept on study (to account for study clustering) was undertaken to investigate effect of exercise on fatigue. The result, a between-group difference in z-scores, corresponds to a Cohen's d effect size. An interaction term was included in the model to assess potential moderators including demographic (age, marital status, education), clinical (body mass index, presence of distant metastasis), intervention-related (intervention timing, delivery mode and duration), and exercise-related (exercise type, frequency, intensity, duration) characteristics.
Results – Exercise significantly reduced fatigue reported by women with breast cancer (β= -0.15, 95% CI -0.21;-0.09). This effect did not differ significantly between patients with different demographic and clinical characteristics (p-valuesinteraction >0.05). Also, neither timing (during or post-treatment) and duration of the intervention, nor exercise-related factors moderated intervention effects on fatigue. Supervised exercise had significantly larger effects on fatigue than unsupervised exercise (βdifference= -0.17, 95%CI -0.28;-0.05). Compared to the control group, supervised exercise significantly improved fatigue (β = -0.21, 95%CI = -0.28;-0.14), while unsupervised exercise did not (β = -0.04, 95%CI = -0.14;0.06).
Conclusion – Exercise significantly reduces fatigue in patients with breast cancer across subgroups formed on the basis of age, marital status, education level, body mass index, and presence of distant metastasis. The effect of exercise is significantly larger when performed under supervision. Hence, exercise, and preferably supervised exercise, represents a viable intervention for the prevention and treatment of fatigue among patients with breast cancer.
Citation Format: van Vulpen JK, Sweegers MG, Kalter J, Peeters PH, Courneya KS, Newton RU, Aaronson NK, Jacobsen PB, Steindorf K, Stuiver MM, Hayes S, Mesters I, Knoop H, Goedendorp M, Mutrie N, Thorsen L, Schmidt M, Sonke GS, Bohus M, James EL, Oldenburg HS, Velthuis MJ, Nollet F, Wenzel J, Wiskemann J, Galvão DA, Chinapaw MJ, Irwin ML, Griffith KA, van Weert E, Daley AJ, McConnachie A, Schulz K-H, Short CE, Plotnikoff RC, Potthoff K, van Beurden M, van Harten WH, Schmitz KH, Winters-Stone KM, Taaffe DR, van Mechelen W, Kersten M-J, Verdonck-de Leeuw IM, Brug J, Buffart LM, May AM. Effect and moderators of exercise on fatigue in patients with breast cancer: Meta-analysis of individual patient data [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-06.
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Affiliation(s)
- JK van Vulpen
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - MG Sweegers
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - J Kalter
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - PH Peeters
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - KS Courneya
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - RU Newton
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - NK Aaronson
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - PB Jacobsen
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - K Steindorf
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - MM Stuiver
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - S Hayes
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - I Mesters
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - H Knoop
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - M Goedendorp
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - N Mutrie
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - L Thorsen
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - M Schmidt
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - GS Sonke
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - M Bohus
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - EL James
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - HS Oldenburg
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - MJ Velthuis
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - F Nollet
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - J Wenzel
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - J Wiskemann
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - DA Galvão
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - MJ Chinapaw
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - ML Irwin
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - KA Griffith
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - E van Weert
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - AJ Daley
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - A McConnachie
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - K-H Schulz
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - CE Short
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - RC Plotnikoff
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - K Potthoff
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - M van Beurden
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - WH van Harten
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - KH Schmitz
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - KM Winters-Stone
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - DR Taaffe
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - W van Mechelen
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - M-J Kersten
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - IM Verdonck-de Leeuw
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - J Brug
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - LM Buffart
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - AM May
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
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25
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Sweegers MG, Buffart LM. [Training to improve quality of life and physical functioning in cancer; which type of training, for which patient, and at which moment?]. Ned Tijdschr Geneeskd 2018; 162:D2443. [PMID: 29676716] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate whether the effects of exercise on quality of life and physical functioning in patients with cancer is dependent upon certain patient characteristics or on specific training programmes. DESIGN Meta-analysis of individual patient data (IPD) and a standard meta-analysis of randomized interventional studies. METHOD Results from various randomized interventional studies were pooled for the analysis. Differences in effects of exercise among patients with different demographic and clinical characteristics were investigated using interaction terms applied to IPD. Differences in the effects of different training programmes were studied via subgroup analyses on published data. RESULTS We found a small but significant positive effect of physical training on quality of life and physical functioning. In the IPD meta-analysis, we found no differences in the effects of physical training among patients with different demographic and clinical characteristics. In both the IPD and the standard meta-analysis we found a significant difference in the effect on quality of life (p < 0.01) and physical functioning (p = 0.01) between supervised and non-supervised training. In the standard meta-analysis we found a significantly greater effect of non-supervised training when the predetermined weekly energy use was higher. CONCLUSION Results showed that physical training during and after cancer treatment can lead to improvement in quality of life and physical functioning. There was no difference in effect among different patient groups. Supervised training programmes resulted in greater effects than non-supervised training programmes. The effects of non-supervised training programmes were greater when the predetermined weekly energy use was higher.
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Affiliation(s)
- M G Sweegers
- *Dit onderzoek werd deels eerder gepubliceerd in Cancer Treatment Reviews (2017;52:91-104) met als titel 'Effects and moderators of exercise on quality of life and physical function in patients with cancer: An individual patient data meta-analysis of 34 RCTs', en deels in British Journal of Sports Medicine (2017; epub 27 september) met als titel 'Which exercise prescriptions improve quality of life and physical function in patients with cancer during and following treatment? A systematic review and meta-analysis of randomised controlled trials'. Afgedrukt met toestemming
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26
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Sweegers MG, Altenburg TM, Chinapaw MJ, Kalter J, Verdonck-de Leeuw IM, Courneya KS, Newton RU, Aaronson NK, Jacobsen PB, Brug J, Buffart LM. Which exercise prescriptions improve quality of life and physical function in patients with cancer during and following treatment? A systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 2017; 52:505-513. [PMID: 28954800 DOI: 10.1136/bjsports-2017-097891] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Certain exercise prescriptions for patients with cancer may improve self-reported quality of life (QoL) and self-reported physical function (PF). We investigated the effects of exercise on QoL and PF in patients with cancer and studied differences in effects between different intervention-related and exercise-related characteristics. DESIGN We searched four electronic databases to identify randomised controlled trials investigating exercise effects on QoL and PF in patients with cancer. Pooled effects (Hedges' g) were calculated using Comprehensive Meta-Analysis software. Subgroup analyses were conducted based on intervention dimensions, including timing, duration and delivery mode, and exercise dimensions, including frequency, intensity, type and time (FITT factors). RESULTS We included 74 exercise arms. Patients who were randomised to exercise interventions had significantly improved QoL (g=0.15, 95% CI (0.10 to 0.20), n=67 exercise arms) and PF (g=0.21, 95% CI (0.15 to 0.27), n=59 exercise arms) compared with patients in control groups. We found a significant between-group difference for exercise delivery mode, with significant beneficial effects for supervised exercise interventions (g=0.20, 95% CI (0.14 to 0.26) for QoL and g=0.27, 95% CI (0.20 to 0.33) for PF), but not for unsupervised interventions (g=0.04, 95% CI (-0.06 to 0.13) for QoL and g=0.09, 95% CI (-0.01 to 0.19) for PF). No statistically significant differences in intervention effects were found for variations in intervention timing, duration or exercise FITT factors. Unsupervised exercise with higher weekly energy expenditure was more effective than unsupervised exercise with lower energy expenditure (z=2.34, p=0.02). CONCLUSIONS Exercise interventions, especially when supervised, have statistically significant and small clinical benefit on self-reported QoL and PF in patients with cancer. Unsupervised exercise intervention effects on PF were larger when prescribed at a higher weekly energy expenditure.
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Affiliation(s)
- Maike G Sweegers
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, The Netherlands.,Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Teatske M Altenburg
- Department of Public and Occupational Health, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Mai J Chinapaw
- Department of Public and Occupational Health, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Joeri Kalter
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, The Netherlands.,Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.,Department of Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Kerry S Courneya
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Paul B Jacobsen
- Division of Population Science, Moffitt Cancer Center and Research Institute, Amsterdam, The Netherlands
| | - Johannes Brug
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Laurien M Buffart
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, The Netherlands.,Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
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