Effects of a 12-Week Multimodal Exercise Intervention Among Older Patients with Advanced Cancer: Results from a Randomized Controlled Trial

Enhancing cognitive and emotional well-being in older adults through aerobic, strength, or balance training: insights from a randomized controlled trial

BACKGROUND

Late-life depression (LLD) poses a significant public health challenge, profoundly affecting cognitive function and emotional well-being in the elderly. Current pharmacological treatments often have side effects, increasing interest in non-pharmacological interventions.

OBJECTIVE

This study evaluates the effectiveness of a 12-week aerobic, strength, or balance training intervention on depressive symptoms and cognitive function in older adults with mild to moderate LLD while also investigating the impact of different training frequencies (3×/week or 5×/week).

METHODS

We conducted a randomized controlled trial (RCT) involving 121 community-dwelling older adults aged 60 years and above diagnosed with mild to moderate LLD. Stratified randomization will be conducted based on baseline depression severity and key characteristics, dividing patients into the intervention groups (drug therapy and standard care combined with aerobic exercise, strength training, or balance training interventions, respectively) and the control group (drug therapy and standard care). The exercise intervention comprised aerobic, strength or balance exercises conducted 3×/week or 5×/week. Depression severity and cognitive function were assessed using the Hamilton Depression Rating Scale (HAMD-17) and Mini-Mental State Examination (MMSE) at baseline, after 12 weeks, and after a four-week follow-up. Additionally, physiological parameters, including weight, blood pressure (systolic and diastolic), resting heart rate, and fasting blood glucose levels, were assessed simultaneously to evaluate overall health improvements. Statistical analysis was performed using repeated measures ANOVA to assess within- and between-group changes.

RESULTS

The intervention group significantly improved depressive symptoms, cognitive function, and physiological parameters. Specifically, the HAMD-17 scores decreased by 6.5 ± 2.8 points (p < 0.001), while the MMSE scores increased by 5.7 ± 2.4 points (p < 0.001), indicating reduced depressive symptom severity and improved cognitive function, respectively. These improvements were significantly greater than those observed in the control group. Notably, high-frequency aerobic exercise (5×/week) yielded the most significant benefits, showing a reduction of 8.6 ± 2.7 points in HAMD-17 and an increase of 6.8 ± 2.1 points in MMSE (both p < 0.001).

CONCLUSION

The aerobic, strength, or balance training regimen effectively reduces depressive symptoms and improves cognitive function in older adults with LLD, offering a promising non-pharmacological treatment option. This study underscores the potential of exercise interventions to complement traditional therapies, paving the way for more holistic treatment strategies for late-life depression.

Effectiveness of Baduanjin exercise on pulmonary function, quality of life, psychological well-being and exercise tolerance in postoperative patients with non-small cell lung cancer: Systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

To evaluate the influence of engaging in Baduanjin exercise on pulmonary function, quality of life (QoL), mental well-being and exercise tolerance among postoperative individuals diagnosed with non-small cell lung cancer (NSCLC).

METHODS

A comprehensive search of randomized controlled trials (RCTs) in eleven different electronic databases, spanning from their inception up until July 3, 2024, was conducted. Following this exhaustive search, the literature was thoroughly screened, relevant information was carefully extracted, and the potential for bias within the selected studies was critically evaluated by two independent researchers. Employing Revman 5.4 software, statistical analyses were then carried out.

RESULTS

A comprehensive compilation of 6 RCTs, involving a collective 540 patients diagnosed with NSCLC, was analyzed. The pooled findings revealed that engaging in Baduanjin exercise leads to a significant enhancement in forced vital capacity (FVC) (WMD=0.23, 95% CI=0.06 ∼ 0.41, P = 0.009), forced expiratory volume in the first second (FEV1) (WMD=0.16, 95% CI=0.00 ∼ 0.32, P = 0.05) in NSCLC patients, as well as QoL (WMD=24.09, 95% CI=20.68 ∼ 27.51, P<0.00001) and functional well-being (WMD=6.70, 95% CI=5.50 ∼ 7.90, P < 0.00001). Meanwhile, Baduanjin exercise reduced Self-Rating Anxiety Scale (SAS) (WMD=-9.58, 95% CI=-10.58 ∼ -8.58, P < 0.00001) scores in patients with NSCLC. However, sensitivity analyses revealed that the results for physical well-being, social/family well-being, emotional well-being, lung cancer subscales, Self-Rating Depression Scale (SDS) scores, and 6 min walk distance (6MWD) lacked robustness. Subgroup analysis was conducted based on the intervention frequency, revealed that both 3 and 10 weekly training sessions improved 6MWD in NSCLC patients. Notably, 10 weekly training sessions (WMD=54.72, 95% CI=28.76 ∼ 80.69, P<0.0001) were found to be twice as effective as 3 weekly training sessions (WMD=26.96, 95% CI=17.31 ∼ 36.61, P<0.00001) in enhancing 6MWD . However, no improvement in 6MWD was observed in the 8 weekly training sessions (WMD=-18.34, 95%CI=-41.55 ∼ 4.87, P<0.00001).

CONCLUSION

The meta-analysis revealed that for individuals diagnosed with NSCLC, Baduanjin exercise demonstrated significant effectiveness in terms of pulmonary function enhancement, QoL elevation, anxiety alleviation and exercise endurance improvement. However, the methodological limitations significantly constrain the strength of clinical evidence. Meanwhile, the lack of robustness in some outcomes as indicated by sensitivity analyses, suggest significant constraints in the external validity and generalizability of the findings to broader populations.

Analysis of Factors Related to Physical Activity Levels Among Lung Cancer Survivors Who Underwent Nonsurgical Treatment: A Cross-Sectional Study

AIM(S)

The study aimed to investigate the current status of physical activity (PA) levels and associated factors among lung cancer survivors who have undergone nonsurgical treatments.

BACKGROUND

PA has been incorporated as a nonpharmacological intervention in the rehabilitation programmes of cancer patients, playing a crucial role in alleviating symptom burden and enhancing the quality of life among lung cancer survivors. Understanding the potential influencing factors of PA levels aids in formulating targeted intervention strategies.

DESIGN

A multicentre cross-sectional study.

METHODS

Convenience sampling was utilised to survey lung cancer survivors from the respiratory and oncology departments of 12 hospitals across Eastern, Central and Western China, spanning from June 2023 to January 2024. Social demographic characteristics, disease-related features, health behaviour abilities, psychological factors and levels of PA were collected through a combination of clinical case systems used to record patients' treatment and medical conditions and self-reported questionnaires. Additionally, measurements of grip strength and the 6-min walk test were conducted for patients. Descriptive analysis, bivariate analysis and multivariate logistic regression were conducted.

RESULTS

Only 109 patients (16.2%) achieved high PA levels. Multivariate logistic regression analysis indicated differences in age, residential location, employment status, religion, lung cancer stage, grip strength, albumin concentration, blood urea, Anderson symptom, depression and health behaviour capacity among lung cancer survivors with varying PA levels.

CONCLUSIONS

Significant associations were observed between age ≥ 75 years, residing in urban areas, unemployment, absence of religious beliefs, Stage IV lung cancer, lower grip strength, lower albumin concentration, higher blood urea, higher Anderson symptom scores, lower health behaviour capacity scores, higher depression scores and lower PA levels among lung cancer survivors. These potential factors should be considered when developing PA intervention plans.

RELEVANCE TO CLINICAL PRACTICE

This study offers insights for developing subsequent PA intervention programmes. In clinical practice, healthcare professionals should continuously educate patients about the benefits of exercise and help them incorporate PA into their daily lives. Additionally, emphasising multidisciplinary collaboration involving physical therapists, nutritionists and mental health experts is crucial for ensuring safe and effective PA, thereby improving patients' quality of life.

REPORTING METHOD

Our study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist: cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION

At the phase of collecting data, participants were recruited to fill the questionnaires.

TRIAL REGISTRATION

Chinese Clinical Trial Registry: ChiCTR2300072609.

Exercise interventions for older adults with advanced cancer: A scoping review

INTRODUCTION

The feasibility, safety, acceptability, and perceptions of exercise in older adults with advanced disease are not well understood due to the scarcity of evidence. This scoping review aimed to (1) summarize evidence on the feasibility, acceptability, and safety of exercise interventions for older adults with advanced cancer and (2) explore this population's perceptions on participating in exercise programs.

MATERIALS AND METHODS

A systematic search was conducted by an expert research librarian in Medline, CINAHL, EMBASE, Cochrane CENTRAL, and SPORTDiscus (inception through November 2023). Eligible studies included older adults with advanced (stage IV or receiving treatment with non-curative intent) solid cancers and intervention or qualitative studies on physical activity/exercise in older adults pertaining to our objectives.

RESULTS

A total of 36 studies were included: 28 (78 %) intervention studies, seven (19 %) qualitative studies, and one (3 %) cross-sectional study. The Frequency/Intensity/Time/Type (FITT) principle was described in 18 studies (64 %). Feasibility was examined in 15 of the 28 intervention studies (54 %) using various definitions. Four studies had predetermined feasibility thresholds, yielding mixed results. One intervention study reported on two intervention-related severe adverse events. Nineteen of the 28 intervention studies (68 %) examined acceptability, reporting high levels of participant satisfaction. Qualitative data revealed several barriers and facilitators to exercise.

DISCUSSION

Exercise appears to be feasible, acceptable, and safe in older adults with advanced cancer. Consistent reporting on the FITT principle and feasibility operationalization are areas of improvement in exercise studies in older adults with advanced disease.

Impact of different exercise types on depression and anxiety in individuals with cancer: A systematic review and network meta-analysis of randomized controlled trials

OBJECTIVE

Various exercise modalities have been demonstrated to be effective in alleviating anxiety and depression among individuals with cancer. However, it remains unclear which specific exercise intervention is the optimal choice. This study aimed to systematically evaluate the impact of different exercise intervention types on anxiety and depression in individuals with cancer.

METHODS

Eligible randomized controlled trials were identified through searches of PubMed, Web of Science, and EBSCOHost, with the search period up to December 2024. Two researchers independently conducted the literature screening, data extraction, and assessment. Statistical analyses and visualizations were performed using Stata 15.0 software and RevMan5.4 software.

RESULTS

A total of 26 randomized controlled trials (involving 2118 individuals with cancer) examining three types of exercise interventions were included. Compared to usual care, mind-body exercise (SMD = -0.58, 95 % CI (-0.99, -0.17)), followed by resistance training (SMD = -0.52, 95 % CI (-1.12, 0.09)), and aerobic exercise (SMD = -0.51, 95 % CI (-0.89, -0.13)) significantly decreased depression levels among individuals with cancer. Additionally, resistance training (SMD = -0.66, 95 % CI (-1.59, 0.27)), followed by aerobic exercise (SMD = -0.59, 95 % CI (-1.08, -0.10)), and mind-body exercise (SMD = -0.48, 95 % CI (-0.96, 0.00)) significantly decreased anxiety levels among individuals with cancer compared to usual care.

CONCLUSION

The findings of this network meta-analysis suggest that mind-body exercise, resistance training, and aerobic exercise are all effective interventions for reducing anxiety and depression among individuals with cancer.

Enhancing quality of life in older adults with cancer: Outcomes of a 12-week supervised remote exercise intervention

INTRODUCTION

Exercise in oncology improves health outcomes in patients with cancer. Remote programs offer a promising alternative to in-person sessions, overcoming barriers such as mobility, geography, and treatment-related fatigue. This study assessed the impact of a 12-week supervised remote exercise program on health-related quality of life (HRQOL) as the primary endpoint, and feasibility and acceptability as secondary outcomes in older patients (65+ years) undergoing systemic treatment in Brazil.

MATERIALS AND METHODS

This is a pilot, single-arm trial (June 2023 to January 2024) of a 12-week remote exercise program for older adults. Participants received individualized aerobic, resistance, and mobility exercises, completed at home. The program was facilitated through WhatsApp® and the Vedius platform for real-time monitoring and support. Patients were assessed using the Functional Assessment of Cancer Therapy - General and the Edmonton Symptom Assessment System. Linear mixed models were employed. Adherence was measured by the completion percentage of prescribed exercises, and acceptability was assessed via a satisfaction question.

RESULTS

Of 48 patients approached, 41 enrolled (median age 70 years, 56.1 % female). Significant improvements were observed in HRQOL (baseline: 83.2; post-intervention: 94.4, P = 0.001). Symptom reductions included pain (1.6 to 0.7, P = 0.001), fatigue (3.8 to 1.3, P = 0.001), nausea (0.8 to 0.2, P = 0.01), depression (2.6 to 0.8, P = 0.001), anxiety (3.2 to 1.2, P = 0.001), and drowsiness (1.8 to 0.4, P = 0.001). Notably, 87.8 % of patients adhered to the prescribed exercise program, and reported high satisfaction, particularly with its convenience and flexibility.

DISCUSSION

A 12-week remote exercise program is feasible and acceptable for older patients with cancer. High adherence and satisfaction suggest that remote exercise interventions can improve HRQOL and symptom management, offering a low-cost, accessible solution for cancer care in resource-limited settings. Future studies should explore long-term outcomes and integrate exercise with other supportive care services.

Multicomponent Interventions for Adults With Cancer Cachexia: A Systematic Review

BACKGROUND

Cancer cachexia has substantial impacts on people's quality of life. There is no current gold standard treatment, but the complex pathophysiology of cachexia suggests that a multitargeted and individualised treatment approach is needed. We aimed to evaluate the extent to which multicomponent interventions have targeted the key features of cachexia and been tailored to individuals, and differential effects on quality of life.

METHODS

We conducted a systematic review of multicomponent interventions for adults with cancer cachexia. We searched four databases, two clinical trial registers and MedRxiv on 20 June 2024. Intervention components were classified by intervention category (nutritional, exercise/physical activity, pharmacological and psychosocial), cachexia feature(s) targeted (reduced energy intake, altered metabolism, involuntary weight loss and decline in physical function) and level of tailoring. Within-arm standardised mean changes in quality of life over time, as well as standardised mean differences between study arms, were calculated.

RESULTS

Sixty-two multicomponent interventions were included, of which two combined components from all four intervention categories, and nine targeted all four key features of cachexia. Eighteen multicomponent interventions were fully tailored and 30 were partly tailored to individuals. Within-arm standardised mean changes in quality of life were calculated for thirteen studies; all had a high risk of bias or raised concerns. In eleven studies, quality of life scores improved following the intervention, whereas in two studies they declined. Standardised mean differences between study arms were calculated for four studies; in three, the intervention arm showed a greater improvement in quality of life scores than the usual care arm. Amongst these data, there was no indication that the number of cachexia features targeted, or the extent of tailoring, was associated with a greater improvement in quality of life scores; however, the heterogeneity prevented us from concluding on our hypothesis.

CONCLUSIONS

This review mapped out in detail the combinations of intervention categories used, the key features of cachexia targeted, and the extent of tailoring across multicomponent interventions for adults with cancer cachexia. Only a small proportion of the multicomponent interventions targeted all four key features of cachexia, but most were either partly or fully tailored to individuals. Despite sixty-two multicomponent interventions being investigated, only four studies compared these to usual care and reported quality of life outcomes. High risk of bias, low sample sizes and variable outcome data remain challenges to the interpretability of results in this field.

Feasibility, safety, and adherence of home-based exercise interventions in people diagnosed with cancer: a systematic review

PURPOSE

This systematic review aims to evaluate the feasibility, safety, and adherence of home-based exercise interventions in people diagnosed with cancer. The primary research question is: Are home-based exercise interventions safe and feasible for people diagnosed with cancer?

METHODS

A comprehensive search of databases including PubMed, EMBASE, and Cochrane Library was conducted in January 2025, focusing on randomized controlled trials (RCTs) that involved home-based exercise interventions people diagnosed with cancer. Studies were included if they reported on safety, feasibility, and health-related outcomes. The Physiotherapy Evidence Database (PEDro) scale was used to assess study quality and risk of bias. Adverse events were categorized by severity, and feasibility which was determined based on recruitment, withdrawal, and adherence rates.

RESULTS

From 127 eligible studies involving 10,562 participants, the review found that home-based exercise interventions are generally safe, with less than 3.2% of participants experiencing exercise-related adverse events, most of which were minor. Feasibility was supported by an average recruitment rate of 50.1%, which was calculated as the proportion of eligible participants who consented to participate across the included studies. Additionally, the review found a withdrawal rate of 13.7%, and an adherence rate of 76.2%. However, significant variability in these rates were observed across the studies, highlighting the challenges in maintaining participant engagement.

CONCLUSIONS

Home-based exercise interventions are feasible and safe for people diagnosed with cancer, with minor adverse events being the most common. However, there is a need for standardized protocols in reporting adverse events and better strategies to improve recruitment and adherence.

IMPLICATIONS FOR CANCER SURVIVORS

These findings support the integration of home-based exercise into standard cancer care, offering a practical and safe option for enhancing the health and well-being of cancer survivors. However, the successful implementation of these programs may require additional support from exercise professionals within primary care or community settings to ensure appropriate guidance and adherence. Personalized exercise programs, developed by qualified exercise professionals such as physiotherapists or clinical exercise physiologists, and improved reporting standards are essential to optimizing these interventions.

Mitigation of decline with virtual exercise with lung cancer (MoVE with lung cancer) - A promising approach to enhance physiological strength, improve body composition, and build upon current evidence

INTRODUCTION

Exercise can mitigate declines in physical function for patients with cancer, but in-person exercise programs for patients with advanced lung cancer often face low recruitment and retention. This prospective study assessed the feasibility of virtual exercise for patients with advanced lung cancer.

METHODS

Mitigation of decline with Virtual Exercise (MoVE) with Lung Cancer was a prospective, single-arm, feasibility study. Patients with advanced lung cancer undergoing systemic therapy in British Columbia, Canada participated in a 12-week group exercise program delivered twice weekly via Zoom. Feasibility measures included accrual, recruitment rate, attendance, adherence, attrition, adverse events, and group belongingness. Efficacy was assessed via effect on physical function, cardiovascular fitness, body composition, and quality of life (QoL).

RESULTS

Twenty-seven patients were enrolled (median age = 66 years). Most had adenocarcinoma (92 %) and were on targeted therapy (73 %). Recruitment rate was 61 %, attrition 4 %, attendance 87 %, and adherence 96 %. Significant improvements were seen in gait speed (Z = 2.759, p = 0.006), 30-second chair stand (Z = 3.810, p < 0.001), 30-second bicep curl (Z = 4.209, p < 0.001), 8-foot timed up and go (Z = -3.148, p = 0.002), six minute walk test (Z = 3.124, p = 0.002), and QoL (FACT-G post hoc p = 0.005). Participants' skeletal muscle index increased by 0.9 cm2 (p = 0.033). Participant satisfaction was high (4.6/5).

CONCLUSIONS

A 12-week virtually supervised exercise program for patients with advanced lung cancer showed high attendance and adherence, with significant improvements in physical function and positive participant feedback. These results demonstrate that physical function can be maintained or improved during systemic treatments for advanced lung cancer.

Exercise Interventions for Depression, Anxiety, and Quality of Life in Older Adults With Cancer: A Systematic Review and Meta-Analysis

Importance

Cancer and its treatment negatively impact the mental health of older adults. The potential of exercise interventions as a complementary treatment to alleviate the psychological impacts of cancer is promising, but there are gaps in the current literature.

Objective

To determine if exercise interventions are associated with improvements in psychological outcomes among older adults with cancer.

Data Sources

PubMed, Embase, PsycINFO, and Cochrane databases were searched from database inception to November 5, 2024. Search terms used were geriatrics, cancer, depression, anxiety, quality of life, and exercise interventions.

Study Selection

English-language randomized clinical trials (RCTs) that analyzed the association of various exercise interventions with at least 1 of 3 psychological outcomes (depression, anxiety, or health-related quality-of-life [HRQOL]) were included. The control groups were given usual care. Studies were included if the mean age of participants was older than 60 years and had participants with a diagnosis of any cancer regardless of comorbidities.

Data Extraction and Synthesis

Studies were screened, and data were extracted by 2 independent authors. Random-effects meta-analyses and meta-regressions were used for analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed.

Main Outcomes and Measures

The primary outcomes were depression, anxiety, and HRQOL. Standardized mean difference (SMD) was used to quantify the association of exercise interventions with outcomes.

Results

A total of 27 RCTs with 1929 participants were included. Meta-analyses observed an association of exercise with a significant reduction in levels of depression (SMD = -0.53; 95% CI, -0.79 to -0.28) and anxiety (SMD = -0.39; 95% CI, -0.66 to -0.12) and improvements in overall HRQOL (SMD = 0.63; 95% CI, 0.10 to 1.17). Subgroup analyses revealed that mind-body exercise interventions were significantly associated with improved depression (SMD = -0.89; 95% CI, -1.51 to -0.27) and anxiety levels (SMD = -0.77; 95% CI, -1.54 to -0.01) compared with conventional exercise interventions.

Conclusion

In this systematic review and meta-analysis of 27 RCTs, exercise interventions were found to be associated with significantly reduced levels of depression and anxiety and significantly improved HRQOL in older adults with cancer. These findings suggest that health care professionals and policymakers should focus more on implementing exercise interventions to improve mental health outcomes in this vulnerable population.

Preliminary Effectiveness of a Telehealth-Delivered Exercise Program in Older Adults Living With and Beyond Cancer: Retrospective Study

Background

Exercise can attenuate the deleterious combined effects of cancer treatment and aging among older adults with cancer, yet exercise participation is low. Telehealth exercise may improve exercise engagement by decreasing time and transportation barriers; however, the utility of telehealth exercise among older adults with cancer is not well established.

Objective

We aimed to evaluate the preliminary effectiveness of a one-on-one, supervised telehealth exercise program on physical function, muscular endurance, balance, and flexibility among older adults with cancer.

Methods

In this retrospective study, we analyzed electronic health record data collected from the Personal Optimism With Exercise Recovery clinical exercise program delivered via telehealth among older adults with cancer (≥65 y) who completed a virtual initial program telehealth assessment between March 2020 and December 2021. The virtual initial assessment included the following measures: 30-second chair stand test, 30-second maximum push-up test, 2-minute standing march, single leg stance, plank, chair sit and reach, shoulder range of motion, and the clock test. All baseline measures were repeated after 12-weeks of telehealth exercise. Change scores were calculated for all assessments and compared to minimal clinically important difference (MCID) values for assessments with published MCIDs. Paired samples t tests (2-tailed) were conducted to determine change in assessment outcomes.

Results

Older adults with cancer who chose to participate in the telehealth exercise program (N=68) were 71.8 (SD 5.3) years of age on average (range 65-92 y). The 3 most common cancer types in this sample were breast (n=13), prostate (n=13), and multiple myeloma (n=8). All cancer stages were represented in this sample with stage II (n=16, 23.5%) and III (n=18, 26.5%) being the most common. A follow-up telehealth assessment was completed by 29.4% (n=20) of older adults with cancer. Among those who completed a follow-up telehealth assessment, there were significant increases in the 30-second chair stand (n=19; mean change +2.00 repetitions, 95% CI 0.12 to 3.88) and 30-second maximum push-up scores (n=20; mean change +2.85 repetitions, 95% CI 1.60 to 4.11). There were no significant differences for the 2-minute standing march, plank, single leg stance, sit and reach, shoulder mobility, or clock test (P>.05). Nine (47.3%) older adults with cancer had a change in 30-second chair stand scores greater than the MCID of 2 repetitions.

Conclusions

Our findings suggest a one-on-one, supervised telehealth exercise program may positively influence measures of physical function, muscular endurance, balance, and flexibility among older adults with cancer, but more adequately powered trials are needed to confirm these findings.

Exercise in cancer care for people with lung cancer: A narrative synthesis

OBJECTIVES

Lung cancer is the second most common cancer diagnosed worldwide, resulting in significant physical and psychological consequences. In this narrative review, we explore the role of exercise as an adjunct therapy to counteract health issues experienced by people before, during and after treatment for lung cancer, and offer recommendations for exercise prescription and future research.

DESIGN

Narrative cornerstone review.

METHODS

A narrative review was conducted to explore the role of exercise in cancer care for people diagnosed with lung cancer.

RESULTS

Improvements in fitness, strength and quality of life have been demonstrated in people with lung cancer following participation in exercise programmes before, during and post treatment. Whilst combined aerobic (50-100 % heart rate maximum) and resistance (50-85 % of 1 repetition maximum) training, 2-5 times per week across the cancer continuum is typically prescribed, few people with lung cancer currently access exercise services. 'Optimal' exercise prescription is unclear, although is likely individual-specific. The immediate priority is to identify a tolerable starting exercise dosage, with the side effects of lung cancer and its treatment on the respiratory system, particularly shortness of breath (dyspnoea), likely driving the initial maximum threshold for session mode, duration and intensity. To date, exercise safety for people with lung cancer has been poorly evaluated and reported - few trials report it, but those that do report small numbers of serious adverse events.

CONCLUSIONS

Recommendations for health professionals prescribing exercise therapy to people with lung cancer are provided, with consideration of the strengths and limitations of the current evidence base.

Use of commercial WAMs for monitoring individual with lung cancer. A systematic review

This systematic review explored the feasibility and impact of interventions using commercial activity monitors to track physical activity and health-related outcomes during lung cancer treatment. Inclusion criteria focused on studies involving commercially available activity trackers that provided monitoring feedback to lung cancer patients. The devices selected were popular models, including Fitbit, Garmin, Apple, Samsung, and Polar. Studies assessing the reliability or validity of these trackers, as well as qualitative studies, protocols, non-English publications, and those featuring non-commercial devices, were excluded. Additionally, studies incorporating physical activity with other interventions (e.g., robotic surgery) were excluded if exercise outcomes could not be analysed independently. Searches were conducted across various electronic databases, including the Cochrane Database of Systematic Reviews, CINAHL Complete®, Science Citation Index, Google Scholar, Scopus, IEEE Xplore, and PubMed, covering the period from January 2000 to November 2023. The quality of the studies was assessed using the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) and the Risk of Bias in Randomised Trials (RoB 2.0) tools. Twelve studies met the inclusion criteria, utilising commercial wearable technology for monitoring lung cancer patients over an average of 6.3 ± 4.7 weeks. A key limitation of this review was the wide variation in how interventions were implemented across studies. Yet, the interventions significantly improved daily activity levels and intensity, quality of life, psychological impact, and physical function compared to usual care. These monitors show promise in predicting, monitoring, and detecting physical activity, motivating patients, and aiding in recovery. However, limitations exist, and further evidence is needed to confirm their efficacy as primary monitoring tools in lung cancer treatment.

A scoping review of diet and exercise interventions for older cancer survivors' physical function

Lifestyle (diet and exercise) interventions across the cancer care continuum among younger cancer survivors (<60 years of age) demonstrate utility in improving physical function, and other cancer relevant health outcomes. However, the impact of lifestyle interventions on physical function in older (≥60 years) cancer survivors is not entirely clear. This scoping review aims to map and characterize the existing literature on the effect of diet and exercise interventions on physical function in older cancer survivors. Conducted to the JBI Manual for Evidence Synthesis and reported to the PRISMA guidelines, the literature search was performed on multiple databases through March 2024. A total of 19,901 articles were identified for screening with 49 articles published between 2006 and 2024 selected for full-text review. Of these, 36 studies included an exercise intervention, two focused on diet intervention, while 11 studies included both diet and exercise intervention. These 49 studies included various cancer types, cancer stages, and timepoints across the cancer care continuum. Most studies described physical function as their primary outcome and demonstrated maintenance or improvement in physical function. We identified several gaps in the current evidence including lack of (adequately powered) trials focused only on older cancer survivors, and trials focused on dietary interventions alone or dietary interventions combined with exercise interventions within this population vulnerable for nutritional inadequacies and declining physical function. Considering the growing population of older cancer survivors, this represents an important area for further research.

Association Between Physical Activity and Pancreatic Cancer Risk and Mortality: A Systematic Review and Meta-Analysis

Background: Physical activity has been associated with a lower risk of various types of cancer and reduced cancer-specific mortality. Less is known about its impact on pancreatic cancer. The aim of this systematic review and meta-analysis was to summarize evidence on the association between physical activity and pancreatic cancer risk and mortality. Methods: PubMed and Embase were searched until May 2024 for studies examining physical activity in relation to pancreatic cancer incidence and mortality. Summary risk estimates for highest vs. lowest physical activity levels were calculated using a random-effects model. The risk of publication bias was assessed with a funnel plot and Egger's regression test. Results: A total of seven case-control and eighteen prospective cohort studies were included that investigated the association between physical activity and pancreatic cancer incidence. Our meta-analysis showed a summary estimate of 0.75 (95% CI 0.64-0.88) for case-control studies (I2 = 23%, n = 7) and a summary estimate of 0.91 (95% CI 0.86-0.97) for prospective cohort studies (I2 = 5%, n = 18). Among the six prospective cohort studies that assessed pancreatic cancer mortality, the summary estimate was 1.03 (95% CI 0.83-1.27), I2 = 50%. Conclusions: Higher levels of physical activity were associated with reduced pancreatic cancer risk. Evidence from a limited number of studies suggests that pre-diagnosis physical activity does not affect pancreatic cancer mortality.

Effect of a Physical Exercise Intervention on Physical Function Parameters and Blood Analytical Changes in Lung Cancer Survivors: A Feasibility Study

Background: Lung cancer carries a high burden of systemic symptoms, including in survivors, leading to a reduced quality of life (QoL). We assessed whether a 12-week multicomponent supervised exercise programme, including muscular strength and aerobic training, was beneficial in patients who had undergone surgery for early non-small cell lung cancer (NSCLC) in terms of physical performance, QoL, and metabolic and nutritional analytical parameters. Methods: Physical performance was measured by gait speed, handgrip strength, 30 s sit-to-stand (30s-STS) test repetitions, distance covered in the 6 min walk test (6MWT), and the Short Physical Performance Battery (SPPB) score. QoL was assessed with the EORTC-QLQ-C30 questionnaire. Blood glucose, cholesterol, triglycerides, total proteins, albumin, pre-albumin, creatinine, c-reactive protein, insulin-growth factor 1 (IGF-1), and the haemoglobin and hematocrit percentages were measured before and after the intervention in order to observe any beneficial effects related to metabolic markers. Results: After the intervention, the mean scores for the 6MWT (p < 0.001), STS (p < 0.001), 6MWT (p < 0.01), and SPPB (p < 0.01) had significantly improved. However, handgrip strength and nutritional analytical were unchanged. The EORTC-QLQ-C30 functions and symptoms significantly improved after the intervention (p < 0.05 and p < 0.01, respectively). A significant decrease in cholesterol, triglycerides, and IGF-1 and a significant increase in pre-albumin in blood was also observed post-intervention (p < 0.05). Conclusions: This supervised, community-based 12-week multicomponent was feasible (adherence rate 70.35%) and provided benefits not only to physical performance but also to the quality of life of patients with NSCLC.

A rapid review of nutrition and exercise approaches to managing unintentional weight loss, muscle loss, and malnutrition in cancer

PURPOSE

This narrative review summarizes the evidence for nutrition, exercise, and multimodal interventions to maintain weight and muscle mass and prevent malnutrition from meta-analysis, systematic reviews, and randomized controlled trials published within the last 5 years, and in comparison to future research priority areas identified by international guidelines.

RECENT FINDINGS

Dietary counseling with oral nutrition support (ONS), escalated to enteral nutrition if weight loss continues, is the gold standard treatment approach to maintaining weight and preventing malnutrition. Recent ONS trials with dietary counseling show promising findings for weight maintenance, extending the literature to include studies in chemoradiotherapy, however, change in body composition is rarely evaluated. Emerging trials have evaluated the impact of isolated nutrients, amino acids, and their derivatives (ie, β-hydroxy β-methylbutyrate) on muscle mass albeit with mixed effects. There is insufficient evidence evaluating the effect of exercise interventions on unintentional weight loss, muscle mass, and malnutrition, however, our knowledge of the impact of multimodal nutrition and exercise interventions is advancing. Prehabilitation interventions may attenuate weight and muscle loss after surgery, particularly for patients having gastrointestinal and colorectal surgery. Multimodal trials that commence during treatment show mixed effects on weight and muscle mass when measured.

SUMMARY

This review highlights that the evidence for preventing unintentional weight loss and malnutrition from cancer treatment is strong within nutrition. Multimodal interventions are emerging as effective interventions to prevent unintentional weight loss. Promising interventions are demonstrating improvements in muscle mass, however further exploration through studies designed to determine the effect on muscle is required.

The effects of exercise with or without dietary advice on muscle mass, muscle strength, and physical functioning among older cancer survivors: a meta-analysis of randomized controlled trials

PURPOSE

To evaluate the effect of exercise with or without dietary advice on muscle mass, muscle strength and physical functioning (including perceived physical functioning and physical performance) in old cancer survivors.

METHODS

A systematic literature search was undertaken in May 2022 by searching multiple databases. Randomized controlled trials (RCTs) that compared exercise with or without dietary advice to control group among old cancer survivors were screened. Meta-analyses were conducted to evaluate the effects of exercise with or without dietary advice on muscle mass, muscle strength, and physical functioning.

RESULTS

Data from 21 trials were included in this study, including 16 exercise trials and 5 exercise + dietary advice studies. Regarding exercise, evidence supported its significant benefits on muscle strength among old cancer survivors, while no effect was seen on physical functioning and muscle mass. Concerning exercise combined with dietary advice, meta-analysis showed overall benefits on physical functioning, while limited study examined muscle mass and strength. As for safety and feasibility of interventions, low recruitment rate, moderate compliance, and few adverse events were reported.

CONCLUSIONS

Exercise combined with dietary advice is a more effective approach for old cancer survivors in improving physical functioning compared with exercise alone. Future study is needed to explore the effects of exercise combined with dietary advice on combating sarcopenia. As recruitment and compliance among old cancer survivors were challenging, strategies to stimulate their motivation and promote habitual healthy behaviour are warranted.

IMPLICATIONS FOR CANCER SURVIVORS

It is necessary for old cancer survivors to receive exercise and dietary support to improve physical functioning.

Effect of Combined Exercise and Nutrition Interventions During Inpatient Chemotherapy in Acute Leukemia and Malignant Lymphoma Patients: A Randomized Controlled Trial

The aim of the present study was to determine the effectiveness of combined exercise and nutrition interventions on physical function and quality of life (QOL) in patients with acute leukemia or malignant lymphoma (ML) during inpatient chemotherapy. The study was a randomized controlled trial where patients with acute leukemia or ML who were receiving inpatient chemotherapy and exercise therapy were divided into an intervention group (IG) and a control group (CG). Both groups underwent resistance training and aerobic exercise. The patients in the IG were instructed to take nutritional supplements twice a day. Assessment items were muscle strength (handgrip strength and knee extension strength), 6-min walking test, skeletal muscle mass, QOL, nutritional status, and fatigue. Two-way analysis of variance showed a significant interaction for bilateral handgrip strength and knee extension strength. No significant interactions were found for the other items. The results of the present study showed improved muscle strength in the IG compared to the CG, indicating the effectiveness of combined exercise and nutrition interventions during inpatient chemotherapy in patients with acute leukemia or ML.

Effect of comprehensive geriatric assessment on hospitalizations in older adults with frailty initiating curatively intended oncologic treatment: The PROGNOSIS-RCT study

INTRODUCTION

Frailty constitutes a risk for unplanned hospitalizations in older adults with cancer. This study examines whether comprehensive geriatric assessment (CGA) as an add-on to standard oncologic care can prevent unplanned hospitalizations in older adults with frailty and cancer who initiate curative oncological treatment.

MATERIALS AND METHODS

This randomized controlled trial included older adults aged ≥70 with frailty (Geriatric 8 [G8] ≤14), and solid cancers who initiated curative oncological treatment. Participants were randomized 1:1 to either standard oncologic care (control) or standard oncologic care supplemented with CGA-guided interventions (intervention). Baseline characteristics were retrieved prior to randomization. The primary endpoint, the between-group rate ratio of unplanned hospitalizations within six months of treatment initiation, was analyzed using negative binominal regression. Analyses were performed using an intention-to-treat approach, followed by per-protocol analysis, including participants receiving CGA within 30 days of randomization, and preplanned subgroup analyses based on treatment modality and Geriatric 8 screening. Secondary endpoints included acute hospital contacts, treatment adherence, and toxicity.

RESULTS

From November 1, 2020 to May 31, 2023, 173 participants were enrolled. Median age was 75 (interquartile range 72-79), 51.5% were female, 58% had a G8 score > 12, and 84% had Eastern Cooperative Oncology Group performance status 0-1. The most common cancer sites were lung (23%), upper gastrointestinal (15%), and breast (13%). The rate (per person-years) of unplanned hospitalization was 1.32 in the intervention group and 1.81 in the control group, with a between-group rate ratio of 0.74 (95% confidence interval [CI] 0.45-1.23, P = 0.25) favoring the intervention. The between-group rate ratio increased in the per-protocol analysis (0.64 [95% CI 0.37-1.10, P = 0.10]). Similarly, no significant between group differences were found in treatment adherence, rate of acute hospital contacts, or toxicity.

DISCUSSION

In this study, CGA did not significantly reduce the rate of unplanned hospitalizations. Furthermore, no between-group differences were found in treatment adherence, toxicity lead hospitalizations, or treatment completion in older adults with cancer and frailty. However, per-protocol analysis suggests that increasing adherence to CGA may improve the outcome. Larger studies ensuring higher CGA adherence are warranted to confirm our findings.

Resiliency among older adults receiving lung cancer treatment (ROAR-LCT): A novel supportive care intervention for older adults with advanced lung cancer

INTRODUCTION

Novel supportive care interventions designed for an aging population with lung cancer are urgently needed. We aimed to determine the feasibility of a novel supportive care physical therapy (PT) plus progressive muscle relaxation (PMR) intervention delivered to older adults with advanced lung cancer in the United States (US).

MATERIALS AND METHODS

This clinical trial, Resiliency Among Older Adults Receiving Lung Cancer Treatment (ROAR-LCT: NCT04229381), recruited adults aged ≥60 years with unresectable stage III/IV non-small cell (NSCLC) or small cell lung cancer (SCLC) receiving cancer treatment at The James Thoracic Oncology Center (planned enrollment, N = 20). There were no exclusion criteria pertaining to performance status, laboratory values, prior cancer diagnoses, comorbidities, or brain metastases. Participants were evaluated by PT and psychology and given an exercise pedaler, resistance bands, a relaxation voice recording, and instructions at study initiation. Participants were evaluated in-person by PTs and psychologists at the start and end of the 12-session intervention, with the intervening sessions conducted via virtual health. Participants completed self-reported measures of functional status, symptoms, and mood longitudinally with the following instruments: EQ-5D-5L, Patient Health Questionnaire-9, and General Anxiety Disorder-7. PT assessments included the Short Physical Performance Battery (SPPB) and the two-minute walk test. Feasibility was defined as at least 60% of participants completing at least 70% of all intervention sessions. Optional gut microbiome samples and activity monitoring data (ActiGraph®) were also collected.

RESULTS

The ROAR-LCT study concluded after consenting 22 patients. Among the 22 consented, 18 (81.8%) started the intervention; 11 participants (61.1%) completed at least 70% of all study sessions. All participants with SCLC completed the intervention. Reasons for withdrawal included progression of disease or hospitalization. The majority (88.9%) of patients who started were able to complete at least one virtual health session. Participants' functional status, SPPB, depression, and anxiety scores were stable from pre- to post-intervention. Participants who withdrew had worse baseline scores across domains. Seven microbiome and six ActiGraph® samples were collected.

DISCUSSION

This is one of the first PT + PMR supportive care interventions using virtual health among older adults with advanced lung cancer to achieve feasibility in the US.

Non-pharmacological interventions targeting mobility among people with advanced cancer: a systematic review

PURPOSE

To synthesise evidence evaluating non-pharmacological interventions targeting mobility among people with advanced cancer, considering the type, efficacy and contextual factors that may influence outcome.

METHODS

Systematic review of studies of non-pharmacological interventions in adults (≥ 18 years) with advanced (stage III-IV) cancer, and assessing mobility using clinical or patient-reported outcome measures. Searches were conducted across three electronic databases (MEDLINE, EMBASE and CINAHL) up to June 2024. Methodological quality was assessed using Joanna Briggs Institute tools and contextual factors were evaluated through the Context and Implementation of Complex Interventions framework. A narrative synthesis was conducted due to clinical heterogeneity of included studies.

RESULTS

38 studies encompassing 2,464 participants were included. The most frequent mobility outcome measure was the 6-min walk test (26/38 studies). Exercise was the most common intervention, (33 studies: 27 aerobic and resistance, 5 aerobic, 1 resistance versus aerobic training) and improvements in mobility were found in 21/33 outcomes. Electrotherapy interventions led to significant improvements in mobility in 3/5 studies. Geographical factors (e.g. distance, transport, parking requirements) potentially limited participation in 18/38 studies. A lack of ethnic diversity among populations was evident and language proficiency was an inclusion criterion in 12 studies.

CONCLUSION

Exercise and neuromuscular electrical stimulation appear to improve mobility outcomes in advanced cancer. The evaluation of other non-pharmacological interventions targeting mobility should consider access and inclusivity, and be adaptable to the needs of this population.

Development and feasibility of an exercise therapy intervention for older women with advanced epithelial ovarian cancer referred to neoadjuvant chemotherapy prior to possible interval debulking surgery

Objective

This study describes the development and examines the feasibility of an exercise therapy program for women aged 70 years or older with advanced EOC, receiving neoadjuvant chemotherapy (NACT) before possible major surgery.

Methods

In this feasibility study, patients participated in a mainly home-based exercise therapy program, including progressive resistance training, physical activity, and support from the supervising physiotherapist. The program included both supervised virtual and face-to-face sessions and self-administered daily exercise. Clinician-reported, patient-reported and physical performance measures were collected before and after NACT. Retention, adherence, and compliance to the program was monitored, and patient acceptability was explored in semi-structured interviews.

Results

Fifteen patients, median age of 77 years (range 70-85) completed the exercise therapy program concurrently to receiving NACT lasting a median of 12 weeks. Patients were physically frail at baseline but improved at follow-up on measures of performance status, level of frailty, patient-reported physical fitness, lower body strength, aerobic functional capacity, basic mobility, balance, and number of steps per day. High levels of participation were found to both supervised and self-administered exercise. Patient interviews highlighted the homebased setting, the individualised tailoring of exercises and the support from the physiotherapist as reasons to complete the exercise therapy program as prescribed.

Conclusions

The exercise therapy program was found to be feasible and acceptable in women aged 70 years or older with advanced EOC, receiving NACT before possible major surgery. The observed improvements and the positive experiences perceived by the patients support future application in research and clinical practice.

Effect of physical activity for reducing anxiety symptoms in older adults: a meta-analysis of randomized controlled trials

BACKGROUND

Anxiety symptoms in older adults can significantly impact their well-being. Physical activity is increasingly recognized as a potential intervention to alleviate anxiety in this population. We conducted a systematic review and meta-analysis to explore the impact of physical activity on anxiety symptoms in geriatric individuals.

METHODS

A systematic search was conducted in MEDLINE (via PubMed), Scopus, and Embase databases until November 29, 2023. Two independent reviewers screened articles based on predefined inclusion criteria.

RESULTS

Eleven randomized controlled trials were included. These trials, involving 770 geriatric participants, demonstrated a significant overall effect of physical activity on reducing anxiety symptoms (SMD =-0.60, 95% CI: -0.88 to -0.32). Subgroup analysis based on type of intervention and duration of follow-up was performed. The results showed all types of exercises reduced anxiety symptoms compared to the control group. Furthermore, those studies with shorter follow-up (less than 10 weeks) did not show a statistically significant reduction in anxiety symptoms. Moderate heterogeneity was observed (I2 = 67%). Sensitivity analyses confirmed the robustness of the overall effect size. Funnel plot inspection and Egger's test (p = 0.36) suggested no signs of publication bias or small study effects.

CONCLUSION

This meta-analysis provides strong evidence that physical activity significantly reduces anxiety symptoms in older adults. The study highlights the differential effects of cardio and strength exercises and underscores the high quality of evidence supporting the anxiolytic benefits of physical activity in geriatric populations.

Effect of Physical Activity on Health-Related Quality of Life among Cancer Patients and Survivors: A Systematic Review and Meta-Analysis

OBJECTIVES

To manage chronic illnesses and enhance health-related quality of life (HRQOL), exercise is essential. This research attempts to determine how different forms of exercise affect cancer patients' and survivors' HRQOL and its physical, mental, emotional and social components separately.

METHODOLOGY

This study was prepared following PRISMA guidelines for systematic review and meta-analysis. Databases like PubMed, Scopus, Embase, and Google Scholar were searched. Only randomized control trials in the English language were included in the review. The authors obtained the standardized mean difference (SMD) and 95% confidence interval (CI) of the aggregated intervention effect estimate by pooling every study for a random-effects meta-analysis. Risk of Bias was assessed using Cochrane's Risk of Bias tool 2.0 for randomized control trials. Publication bias was expressed using funnel plots.

RESULTS AND CONCLUSION

The pooled standardized mean difference of physical, mental, emotional and social components of the health-related quality of life index, as determined by the meta-analysis, was 0.61 [0.13;1.09] (p<0.01), 0.27 [-0.17; 0.7] (p<0.01), 0.54 [-0.30;1.38] (p<0.01) and, 0.38 [-0.27; 1.02] (p<0.01) respectively. There was an overall low risk of bias in the included RCTs. The publication bias showed overall symmetry in funnel plots. The review's conclusions show that exercise therapies improve HRQOL significantly overall as well as a few specific HRQOL dimensions, such as social, mental, emotional, and physical functioning. However, not all types of cancers have been included in the study therefore more research can be done for all other cancer types separately.

Feasibility of an exercise-nutrition-psychology integrated rehabilitation model based on mobile health and virtual reality for cancer patients: a single-center, single-arm, prospective phase II study

OBJECTIVE

Explore the feasibility of a mobile health(mHealth) and virtual reality (VR) based nutrition-exercise-psychology integrated rehabilitation model in Chinese cancer patients.

METHODS

We recruited cancer patients in the Oncology department of the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University from October 2022 to April 2023. The rehabilitation program was provided by a team of medical oncologists, dietitians, psychotherapists, and oncology specialist nurses. Participants received standard anti-cancer therapy and integrated intervention including hospitalized group-based exercise classes, at-home physical activity prescription, behavior change education, oral nutrition supplements, and psychological counseling. An effective intervention course includes two consecutive hospitalization and two periods of home-based rehabilitation (8 weeks). Access the feasibility as well as changes in aspects of physical, nutritional, and psychological status.

RESULTS

At the cutoff date of April 2023, the recruitment rate was 75% (123/165). 11.4%patients were lost to follow-up, and 3.25% withdrew halfway. Respectively, the completion rate of nutrition, exercise, and psychology were 85%,55%, and 63%. Nutrition interventions show the highest compliance. The parameters in nutrition, psychology, muscle mass, and quality of life after the rehabilitation showed significant improvements (P < .05). There was no significant statistical difference (P > .05) in handgrip strength and 6-minute walking speed.

CONCLUSION

It is feasible to conduct mHealth and VR-based nutrition-exercise-psychology integrated rehabilitation model in Chinese cancer patients. A larger multi-center trial is warranted in the future.

TRIAL REGISTRATION

ChiCTR2200065748 Registered 14 November 2022.

P-move: a randomized control trial of exercise in patients with advanced pancreatic or biliary tract cancer (aPBC) receiving beyond first-line chemotherapy

PURPOSE

Patients with advanced pancreatic and biliary tract cancer (aPBC) frequently suffer from high symptom burden. Exercise can reduce treatment side effects and improve patient-related outcomes (PROMs). However, evidence from prospective studies regarding feasibility and efficacy in advanced settings are sparse. The primary aim of this prospective, randomized-controlled study was to evaluate the feasibility and effects of exercise (ET) in patients with aPBC.

METHODS

Patients with aPBC beyond first-line therapy were randomized according to the minimization procedure with stratification by gender, age, and loss of body weight in the past six months. The intervention group (IG) completed 3 training units/week for 8 weeks (1x supervised strength sessions, 2x individualized home-based sessions). Control group (CG) received recommendations on physical activity during cancer.

RESULTS

41 patients (stage IV pancreatic or biliary tract cancer) were included no adverse events related to exercise occurred during the trial. Physical function increased significantly in IG in 5 out of 7 physical domains. Comparison of IG and CG at 8 weeks (t2) showed significant differences in favour of IG in leg press (p=0.001), bench press (p=0.011), sit-to-stand (p=0.001) and crunch (0.006). Constipation revealed a significant difference in favour of IG at t2 (p=0.033). Quality of life stabilized/increased in IG during the study period compared to a decrease in CG. Throughout/Over the 8 weeks, fatigue notably reduced in the IG (p=0.028).

CONCLUSION

Exercise is safe and feasible in patients with aPBC undergoing further line therapy. Significant improvements in physical functioning and increased quality of life were achieved. German Clinical Trials Register ID: DRKS00021179; Registration date 15.05.2020.

Multidisciplinary Standards and Evolving Therapies for Patients With Pancreatic Cancer

Pancreatic ductal adenocarcinoma (PDA) is a challenging disease that presents at an advanced stage and results in many symptoms that negatively influence patients' quality of life and reduce their ability to receive effective treatment. Early implementation of expert multidisciplinary care with nutritional support, exercise, and palliative care for both early-stage and advanced disease promises to maintain or improve the patients' physical, social, and psychological well-being, decrease aggressive interventions at the end of life, and ultimately improve survival. Moreover, advances in treatment strategies in the neoadjuvant and metastatic setting combined with novel therapeutic agents targeting the key drivers of the disease are leading to improvements in the care of patients with pancreatic cancer. Here, we emphasize the multidisciplinary supportive and therapeutic care of patients with PDA, review current guidelines and new developments of neoadjuvant and perioperative treatments for localized disease, as well as the treatment standards and the evolving field of precision oncology and immunotherapies for advanced PDA.

E-PROOF: E-intervention for protein intake and resistance training to optimize function: A study protocol

BACKGROUND

Accounting for more than 60% of cancer survivors, older (≥65 years) cancer survivors have a 2- to 5-fold risk of physical function impairment, compared to cancer-free peers. One strategy to improve physical function is dietary and resistance training interventions, which improve muscle strength and mass by stimulating muscle protein synthesis. The E-PROOF (E-intervention for Protein Intake and Resistance Training to Optimize Function) study will examine the feasibility, acceptability, and preliminary efficacy of a 12-week randomized controlled trial of an online, tailored nutritional and resistance training education and counseling intervention to improve physical function and associated health outcomes (muscle strength, health-related quality of life (HRQoL), self-efficacy, and weight management).

METHODS

In this study, 70 older cancer survivors will be randomized to one of two groups: experimental (receiving remote behavioral counseling and evidence-based education and resources), and control (general survivorship education). We will examine the intervention effects on physical function, muscle strength, HRQoL, self-efficacy, weight, and waist circumference during a 12-week period between the experimental and control groups. Three months following the end of the intervention, we will conduct a follow-up assessment to measure physical function, muscle strength, and HRQoL.

SIGNIFICANCE AND IMPACT

This study is the first synchronous, online protein-focused diet and resistance training intervention among older cancer survivors. This novel study advances science by promoting independent health behaviors among older cancer survivors to improve health outcomes, and provide foundational knowledge to further address this growing problem on a wider scale through online platforms.

Tailored Self-Management App to Support Older Adults With Cancer and Multimorbidity: Development and Usability Testing

BACKGROUND

Globally, cancer predominates in adults aged older than 60 years, and 70% of older adults have ≥1 chronic condition. Cancer self-management interventions can improve symptom management and confidence, but few interventions target the complex needs of older adults with cancer and multimorbidity. Despite growing evidence of digital health tools in cancer care, there is a paucity of theoretically grounded digital self-management supports for older adults. Many apps for older adults have not been co-designed with older adults to ensure that they are tailored to their specific needs, which would increase usability and uptake.

OBJECTIVE

We aim to report on the user evaluations of a self- and symptom-management app to support older adults living with cancer and multimorbidity.

METHODS

This study used Grey's self-management framework, a design thinking approach, and involved older adults with lived experiences of cancer to design a medium-fidelity app prototype. Older adults with cancer or caregivers were recruited through community organizations or support groups to participate in co-designing or evaluations of the app. Data from interviews were iteratively integrated into the design process and analyzed using descriptive statistics and thematic analyses.

RESULTS

In total, 15 older adults and 3 caregivers (n=18) participated in this study: 10 participated (8 older adults and 2 caregivers) in the design of the low-fidelity prototype, and 10 evaluated (9 older adults and 1 caregiver) the medium-fidelity prototype (2 older adults participated in both phases). Participants emphasized the importance of tracking functions to make sense of information across physical symptoms and psychosocial aspects; a clear display; and the organization of notes and reminders to communicate with care providers. Participants also emphasized the importance of medication initiation or cessation reminders to mitigate concerns related to polypharmacy.

CONCLUSIONS

This app has the potential to support the complex health care needs of older adults with cancer, creating a "home base" for symptom management and support. The findings from this study will position the researchers to conduct feasibility testing and real-world implementation.

"It gave me a sense of achievement and a sense of purpose"-a qualitative study of patient experiences of a virtually supervised exercise program for adults with advanced cancer and cachexia

People with advanced cancer and cachexia experience significant body weight loss, adversely impacting physical function and quality of life (QOL). Effective, evidence-based treatments for cancer cachexia are lacking, leaving patients with unmet needs. Exercise holds promise to improve patient QOL. However, information on patients' experiences of exercise, including their ability to cope with structured exercise, is limited.

PURPOSE

To explore patient experiences completing a structured, supervised exercise program for people with cachexia due to advanced cancer.

METHODS

Semi-structured interviews were conducted with participants enrolled in a phase II feasibility, randomized controlled trial to explore their experiences of an 8-week virtually supervised exercise program delivered via videoconference technology. Interviews were analysed using reflexive thematic analysis.

RESULTS

Seventeen participants completed interviews (female n = 9, 53%). Main interview themes included the following: (1) Deciding to exercise involves balancing concerns and expectations, (2) the exercise program is a positive experience, and (3) moving forward after the exercise program. While some participants initially held doubts about their physical capabilities and exercise safety, most wanted to exercise to enhance their wellbeing. Participants described the exercise program as a positive experience, offering diverse benefits. Some would have preferred in-person exercise, but all agreed the virtual format increased convenience. Participants emphasized the need to recommend the program to others in similar circumstances. They underscored the necessity and desire for ongoing support to sustain their new exercise habits.

CONCLUSION

Based on patient experiences, virtually supervised exercise programming appears to be feasible and meaningful to people with advanced cancer and cachexia.

The SaVe project - Sarcopenia and Vertigo in aging patients with colorectal cancer: A study protocol for three randomized controlled trials

INTRODUCTION

Older patients with cancer range from fit to frail with various comorbidities and resilience to chemotherapy. Besides nausea and fatigue, a significant number of patients experience dizziness and impaired walking balance after chemotherapy, which can have great impact on their functional ability and health related quality of life. Symptoms are easily overlooked and therefore often underreported and managed, which is why symptoms could end up as long-lasting side effects. The aim of this study is to investigate the development of dizziness, decline in walking balance, and sarcopenia and the effect of a comprehensive geriatric assessment and 12 weeks of group-based exercise on these symptoms. The exercise intervention includes vestibular and balance exercises, and progressive resistance training, to counteract the symptoms in older patients with colorectal cancer treated with chemotherapy.

MATERIALS AND METHODS

This is a randomized controlled trial including patients ≥65 years initiating (neo)adjuvant or first-line palliative chemotherapy for colorectal cancer. Patients will undergo a comprehensive assessment program including measures of vestibular function, balance, muscle strength, mass, and endurance, peripheral and autonomic nerve function, and subjective measures of dizziness, concern of falling, and health related quality of life. Tests will be performed at baseline, 12, and 24 weeks. Patients will be placed in three different randomized controlled trials depending on chemotherapy regimen and randomized 1:1 to comprehensive geriatric assessment and exercise three times/week or control. Participants in both groups will continue with usual care, including standardized oncological treatment. In total, 150 patients are needed to assess the two primary outcomes of (1) maintenance of walking balance assessed with Dynamic Gait Index and (2) lower limb strength and endurance assessed with 30 Second Sit-to-Stand Test at 12 weeks. The primary outcomes will be analyzed using a mixed linear regression model investigating the between-group differences.

DISCUSSION

Trial enrollment began in April 2023 and is the first trial to evaluate reasons for dizziness, decline in walking balance, and sarcopenia in older patients receiving chemotherapy. The trial will provide new and valuable knowledge in how to assess, manage, and prevent dizziness, decline in walking balance, and sarcopenia in older patients with colorectal cancer.

TRIAL REGISTRATION

The Regional Ethics Committee (j.nr. H-22064206). Danish Data Protection Agency (P-2023-86) and ClinicalTrials.gov (NCT05710809).

Impact of FRAilty screening and Geriatric assessment and INtervention in older patients with epithelial Ovarian Cancer: A multicenter randomized clinical trial protocol (FRAGINOC)

INTRODUCTION

Radical surgery combined with chemotherapy is the only potential curative treatment of patients with advanced epithelial ovarian cancer (EOC). However, 43% of older Danish patients with EOC are not referred to surgery due to frailty, age, or fear of complications. Comprehensive geriatric assessment (CGA) has demonstrated ability to reduce frailty in older patients, but there is a knowledge gap regarding its effect before or during treatment in older adults with EOC. This protocol presents a randomized controlled trial (RCT), which evaluates the effect of CGA-based interventions including individualized physical exercise therapy in older adults with EOC during neoadjuvant chemotherapy (NACT).

MATERIALS AND METHODS

This RCT will include patients aged ≥70 years with primary EOC referred to NACT. Patients will be randomized 1:1 to intervention or standard of care, along with neoadjuvant antineoplastic treatment. Stratification for performance status and center of inclusion will be performed. In the intervention arm, a geriatrician will perform CGA and corresponding geriatric interventions and patients will undergo an individualized home-based exercise program managed by a physiotherapist. All patients will be evaluated with Geriatric-8, modified Geriatric-8, clinical frailty scale, and physical tests at randomization. Predictive values (positive/negative) will be evaluated for CGA detected impairments. The primary endpoint is the proportion of patients referred to interval debulking surgery (IDS). Secondary endpoints include the proportion who complete oncological treatment, improvements in physical tests, quality of life measured by European Organization for Research and Treatment of Cancer-Quality of Life questionnaires at inclusion, after three cycles of chemotherapy, and at end of chemotherapy treatment. Furthermore, the association between results of geriatric screening tests, CGA, and physical tests with complication rate and progression free survival will be examined. The primary outcome will be analyzed with logistic regression in the intention-to-treat population. Power calculations reveal the need to enroll 216 patients.

DISCUSSION

The present study examines whether CGA-based interventions including individualized physical exercise can increase the referral rate for potential curative IDS in older patients with EOC. If successful, this will result in more patients undergoing surgery and completing chemotherapy, preventing complications, and ultimately improving quality of life and survival. The study setup may establish the basis for direct clinical implementation if proven effective.

Impact of exercise interventions on quality of life and depression in lung cancer patients: A systematic review and meta-analysis

INTRODUCTION

Lung cancer is a leading cause of cancer-related mortality worldwide. Depression is also a common concern for lung cancer patients and is of concern because it negatively impacts overall well-being. This study summarizes the existing literature on the impact of exercise interventions on quality of life and depression in patients diagnosed with lung cancer.

METHODS

A systematic search of electronic databases was performed to identify relevant randomized controlled trials (RCTs) investigating the effects of exercise interventions on depression and quality of life in patients with lung cancer. Two evaluators collected information from the chosen studies utilizing a standardized data extraction form. The quality of the studies was evaluated using the Cochrane risk of bias tool.

RESULTS

Nine RCTs were included in the meta-analysis, with 798 participants. The pooled standardized mean difference (SMD) for the effect of exercise interventions on depression was -0.60, representing a statistically significant reduction in depression levels following exercise interventions (p < 0.001). The pooled SMD for the effect of exercise interventions on quality of life was 0.61, indicating a statistically significant association between quality of life and exercise interventions (p < 0.001).

CONCLUSION

There is evidence that exercise may benefit the mental health of individuals with lung cancer, including improvements in depression symptoms and quality of life, based on the intervention studies reviewed here. Given the heterogeneity in findings, however, additional randomized controlled trials are needed to augment the existing findings. Nevertheless, there appears to be sufficient evidence for now to encourage primary care physicians to recommend exercise for patients with lung cancer, while offering guidelines on how to gradually and safely increase physical activity depending on the patient's health status.

Application of IMB model in preventing venous thromboembolism in elderly lung cancer patients

Objective

This study aims to explore the effects of the Information-Motivation-Behavioral (IMB) Skills Model on the prevention of Venous Thromboembolism (VTE) in elderly lung cancer patients.

Methods

A convenience sampling method was used to select study participants who were hospitalized for treatment between November 2022 and August 2023 at a tertiary hospital in Neijiang and met the inclusion and exclusion criteria. The control group (n = 41) received conventional health education, while the intervention group (n = 40) received health education based on the IMB Skills Model over three months. The scores of the Venous Thrombosis Knowledge, Participation in Thrombosis Prevention Willingness and Behavior Questionnaire, and Quality of Life Measurement Scale (QLQ-C30) were compared before the intervention and after three months. After three months of intervention, the hospital satisfaction and VTE incidence rates in both groups were investigated and compared.

Results

After three months of intervention, the scores for the Venous Thrombosis Knowledge, (Participation in Thrombosis Prevention Willingness and Behavior Questionnaire in the intervention group were higher than those in the control group (P < 0.05). The QLQ-C30 scores in the intervention group for physical function, role function, emotional function, insomnia, appetite loss, and overall health status were higher than those in the control group (P < 0.05). The intervention group rated higher in doctor's professional skills, information provision, accessibility; nurse's professional skills, humanistic care, information provision, accessibility; team communication, services of other personnel, overall satisfaction compared to the control group (P < 0.05). The rate of VTE in the intervention group was 2.5%(1/40), and that in the control group was 19.5%(8/41). There was a significant difference (χ2 = 4.336, P = 0.037).

Conclusion

Nursing interventions based on the IMB Skills Model for elderly lung cancer patients can enhance patients' understanding of venous thrombosis, increase willingness and active participation in thrombosis prevention, improve quality of life, increase hospital satisfaction, and reduce the incidence of VTE.

Effects of comprehensive geriatric assessment-guided interventions on physical performance and quality of life in older patients with advanced cancer: A randomized controlled trial (PROGNOSIS-RCT)

INTRODUCTION

Older patients with frailty starting oncological treatment are at higher risk of experiencing declining physical performance, loss of independence, and quality of life (QoL). This study examines whether comprehensive geriatric assessment (CGA)-guided interventions added to standard oncological care can prevent declining physical performance and QoL in older patients with frailty initiating palliative treatment.

MATERIALS AND METHODS

Patients aged ≥70 years, with a Geriatric-8 score of ≤14, initiating palliative oncological treatment were enrolled in an open label randomized controlled trial and randomized 1:1 to receive either CGA-guided interventions in addition to oncological standard care or oncological care alone. Baseline characteristics, physical performance measures, and QoL questionnaires were retrieved before group allocation. CGA was performed using a fixed set of domains and validated tests by a geriatrician-led team. The primary endpoint, physical performance, was measured by the 30-s chair stand test (30s-CST) at three months. Additional outcomes included 30s-CST at six months, handgrip strength test, and QoL. Outcomes were analyzed using linear mixed regression models. The trial was registered at clinicaltrials.org (NCT04686851).

RESULTS

From November 1, 2020 to May 31, 2022, 181 patients were included; 88 in the interventional arm and 93 in the control arm. Median age was 77 (interquartile range [IQR] 73-81) years, 69% were male, median Geriatric-8 score was 12 (IQR 10-13), 69% had a Performance Status of 0-1, and the median 30s-CST was 9 (IQR 5-11) repetitions. The between-group difference in 30s-CST at three months was 0.67 (95%CI: -0.94 - 2.29) and 1.57 (95%CI: -0.20 - 3.34) at six months, which were not statistically significant. Subgroup analysis including participants with a baseline Geriatric-8 of 12-14 found borderline significant between-group differences in 30s-CST scores at three and six months of 2.04 (95% confidence interval [CI]: -0.07 - 4.2, P = 0.06) and 2.25 (95%CI: 0.01-4.5, P = 0.05), respectively. No within-group or between-group differences in the summary score or the Elderly Functional Index score (measuring QoL) were found.

DISCUSSION

This study did not find significant between-group differences in the 30s-CST in older patients receiving palliative care. However, a tendency towards improved physical performance was seen in the least frail. These patients may represent a target group wherein CGA interventions provide particular benefit.

Exercise to transform tumours from cold to hot and improve immunotherapy responsiveness

Exercise provides significant health benefits to patients diagnosed with cancer including improved survival outcomes, quality of life and reduced cancer recurrence. Across multiple murine cancer models, aerobic exercise and resistance training has exhibited anti-tumour properties illustrated by inhibited tumour growth, reduced metastatic potential and modulation of the tumour microenvironment to allow the recognition and destruction of cancer cells. Clinical studies have demonstrated the rapid mobilisation and circulatory release of mature lymphoid populations, myokines and cytokines that occurs with exercise along with tumour vasculature normalisation. Tumour microenvironments enriched with immune cells with anti-cancer potential, such as CD8+ T cells, are termed 'hot', whilst those favouring an immunosuppressive environment and lacking in effector immune cells are classed as 'cold'. Pre-clinical evidence suggests exercise training has the potential to reprogramme cold tumours to become hot, although this requires validation in clinical studies. This hot environment could potentiate immunotherapy responsiveness, improving survival outcomes of patients undergoing cancer immunotherapy and allow those with typically cold tumours to benefit from immunotherapy. This review discusses the complex interactions between exercise and cancer, including exercise-induced alterations within the tumour microenvironment and systemic immunity. The potential role exercise may play in improving cancer immunotherapy responsiveness is explored. This review also highlights the need for translational studies exploring the role of exercise in patients with cancer with the potential to widen the spectrum of tumours that derive significant benefit from immunotherapy.

Body composition parameters predict survival in pancreatic cancer-A retrospective multicenter analysis

BACKGROUND

Parameters to adapt individual treatment strategies for patients with pancreatic ductal adenocarcinoma (PDAC) are urgently needed. The present study aimed to evaluate body composition parameters as predictors of overall survival (OS) in PDAC patients.

METHODS

Measurements of body composition parameters were performed on computed tomography scans at diagnosis. Height-standardized and Body Mass Index- and sex-adjusted regression formulas deriving cut-offs from a healthy population were used. The Kaplan-Meier method with the log-rank test was performed for survival analysis. Independent prognostic factors were identified with uni- and multivariable Cox regression analyses.

RESULTS

In total, 354 patients were analyzed. In a multivariable Cox model, besides tumor stage and resection status, only myosteatosis (HR 1.53; 95% CI 1.10-2.14, p = 0.01) was an independent prognostic factor of OS among body composition parameters. Subgroup analyses revealed that the prognostic impact of myosteatosis was higher in patients ≤68 years of age, with advanced tumor stages and patients without curative intended resection.

CONCLUSIONS

The analysis of one of the largest Caucasian cohorts to date, demonstrated myosteatosis to be an independent prognostic factor of OS in PDAC. To improve outcomes, prospective trials aiming to investigate the utility of an early assessment of myosteatosis with subsequent intervention by dieticians, sports medicine physicians, and physiotherapists are warranted.

Exploring the feasibility of a combined exercise program for patients with advanced lung or pancreatic cancer

Objective

This study aims to assess the safety, feasibility, and potential benefits of a combined aerobic and resistance exercise intervention for patients diagnosed with advanced pancreatic or lung cancer.

Methods

A prospective, single-arm study was conducted, enrolling patients with advanced lung or pancreatic cancer. Participants engaged in a 12-week exercise intervention comprising personalized bi-weekly aerobic and resistance training tailored to individual baseline conditions. The primary study outcomes focused on safety (absence of serious adverse events) and feasibility. Secondary outcomes included assessments of functional capacity using the "Six minutes walking test", strength measured through handgrip and leg press tests, anthropometric measures including body mass index and waist-hip ratio, quality of life (QoL), and changes in blood parameters.

Results

The study involved twelve patients (mean age 57.66 ​± ​7.40 years), with seven having pancreatic cancer and five having lung cancer. The recruitment rate was 50%, and assessment adherence was 100%, with an 84% adherence to the exercise program and no dropouts. No exercise-related adverse events were recorded, while three non-severe, non-exercise-related adverse events were observed: treatment-related dermatitis (Grade 2), axillary lymphadenopathy (Grade 2), and migraine (Grade 1). Significant enhancements in functional capacity, emotional well-being, and social functioning within the QoL domains were observed. Anthropometric measures, specifically waist-hip ratio and body mass index, remained stable.

Conclusions

The findings suggest that a tailored 12-week exercise intervention is both feasible and safe for patients with advanced lung or pancreatic cancer. This intervention appears to enhance functional capacity, specific aspects of QoL, and contribute to maintaining body weight.

Exercise Rehabilitation and Chronic Respiratory Diseases: Effects, Mechanisms, and Therapeutic Benefits

Chronic respiratory diseases (CRD), is a group of disorders, primarily chronic obstructive pulmonary disease and asthma, which are characterized by high prevalence and disability, recurrent acute exacerbations, and multiple comorbidities, resulting in exercise limitations and reduced health-related quality of life. Exercise training, an important tool in pulmonary rehabilitation, reduces adverse symptoms in patients by relieving respiratory limitations, increasing gas exchange, increasing central and peripheral hemodynamic forces, and enhancing skeletal muscle function. Aerobic, resistance, and high-intensity intermittent exercises, and other emerging forms such as aquatic exercise and Tai Chi effectively improve exercise capacity, physical fitness, and pulmonary function in patients with CRD. The underlying mechanisms include enhancement of the body's immune response, better control of the inflammatory response, and acceleration of the interaction between the vagus and sympathetic nerves to improve gas exchange. Here, we reviewed the new evidence of benefits and mechanisms of exercise intervention in the pulmonary rehabilitation of patients with chronic obstructive pulmonary disease, bronchial asthma, bronchiectasis, interstitial lung disease, and lung cancer.

A randomized phase II study of full dose gemcitabine versus reduced dose gemcitabine and nab-paclitaxel in vulnerable patients with non-resectable pancreatic cancer (DPCG-01)

BACKGROUND

According to current evidence, the best treatment for fit patients with non-resectable pancreatic cancer (PC) is combination chemotherapy, whereas frail patients are recommended gemcitabine (Gem) monotherapy. Randomized controlled trials in colorectal cancer and a post-hoc analysis of gemcitabine and nab-paclitaxel (GemNab) in PC suggest, however, that reduced dose of combination chemotherapy may be feasible and more efficient compared to monotherapy in frail patients. The aim of this study is to investigate whether reduced dose GemNab is superior to full dose Gem in patients with resectable PC, who are not candidates for full dose combination chemotherapy in first line.

METHODS

The Danish Pancreas Cancer Group (DPCG)-01 trial is a national multicenter prospective randomized phase II trial. A total of 100 patients in ECOG performance status 0-2 with non-resectable PC, not candidate for full dose combination chemotherapy in first line, but eligible for full dose Gem, will be included. Patients are randomized 1:1 to either full dose Gem or GemNab in 80% of recommended dose. The primary endpoint is progression-free survival. Secondary endpoints are overall survival, overall response rate, quality of life, toxicity and rate of hospitalizations during treatment. The correlation between blood inflammatory markers, including YKL-40 and IL-6, circulating tumor DNA, and tissue biomarkers of resistance to chemotherapy and outcome will be explored. Finally, the study will include measures of frailty (G8, modified G8, and chair-stand-test) to assess whether scoring would enable a personalized allocation to different treatments or indicates a possibility for interventions.

DISCUSSION

Single-drug treatment with Gem has for frail patients with non-resectable PC been the main treatment option for more than thirty years, but the impact on outcome is modest. If improved results and sustained tolerability with reduced dose combination chemotherapy can be shown, this could change the future practice for this increasing group of patients.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05841420. Secondary Identifying No: N-20210068. EudraCT No: 2021-005067-52.

PROTOCOL VERSION

1.5, 16-MAY-2023.

Harms of exercise training in patients with cancer undergoing systemic treatment: a systematic review and meta-analysis of published and unpublished controlled trials

Background

Exercise is recommended for people with cancer. The aim of this study was to evaluate the harms of exercise in patients with cancer undergoing systemic treatment.

Methods

This systematic review and meta-analysis included published and unpublished controlled trials comparing exercise interventions versus controls in adults with cancer scheduled to undergo systemic treatment. The primary outcomes were adverse events, health-care utilization, and treatment tolerability and response. Eleven electronic databases and trial registries were systematically searched with no date or language restrictions. The latest searches were performed on April 26, 2022. The risk of bias was judged using RoB2 and ROBINS-I, and the certainty of evidence for primary outcomes was assessed using GRADE. Data were statistically synthesised using pre-specified random-effect meta-analyses. The protocol for this study was registered in the PROESPERO database (ID: CRD42021266882).

Findings

129 controlled trials including 12,044 participants were eligible. Primary meta-analyses revealed evidence of a higher risk of some harms, including serious adverse events (risk ratio [95% CI]: 1.87 [1.47-2.39], I2 = 0%, n = 1722, k = 10), thromboses (risk ratio [95% CI]: 1.67 [1.11-2.51], I2 = 0%, n = 934, k = 6), and fractures (risk ratio [95% CI]: 3.07 [3.03-3.11], I2 = 0%, n = 203, k = 2) in intervention versus control. In contrast, we found evidence of a lower risk of fever (risk ratio [95% CI]: 0.69 [0.55-0.87], I2 = 0% n = 1109, k = 7) and a higher relative dose intensity of systemic treatment (difference in means [95% CI]: 1.50% [0.14-2.85], I2 = 0% n = 1110, k = 13) in intervention versus control. For all outcomes, we downgraded the certainty of evidence due to imprecision, risk of bias, and indirectness, resulting in very low certainty of evidence.

Interpretation

The harms of exercise in patients with cancer undergoing systemic treatment are uncertain, and there is currently insufficient data on harms to make evidence-based risk-benefits assessments of the application of structured exercise in this population.

Funding

There was no funding for this study.

Exercise Training in Elderly Cancer Patients: A Systematic Review

Due to the aging of the population, in 70% of cases, a new cancer diagnosis equals a cancer diagnosis in a geriatric patient. In this population, beyond the concept of mortality and morbidity, functional capacity, disability, and quality of life remain crucial. In fact, when the functional status is preserved, the pathogenetic curve towards disability will stop or even regress. The present systematic review investigated the effectiveness of physical exercise, as part of a holistic assessment of the patient, for preventing disability and improving the patient’s quality of life, and partially reducing all-cause mortality. This evidence must point towards decentralization of care by implementing the development of rehabilitation programs for elderly cancer patients either before or after anti-cancer therapy.

The Effect of Exercise and Nutritional Interventions on Body Composition in Patients with Advanced or Metastatic Cancer: A Systematic Review

Advanced and metastatic cancers significantly alter body composition, leading to decreased lean mass and variable effects on fat mass. These effects on body composition are associated with significant physical dysfunction and poor prognosis in patients with cancer. Whilst exercise and nutritional interventions are likely to be of benefit in counteracting these effects, relatively little is known about using such interventions in patients with advanced or metastatic cancer. Therefore, in this systematic review we examine the effect of exercise and combined exercise and nutritional interventions on lean mass and fat mass among patients diagnosed with advanced or metastatic cancer. Following PRISMA guidelines, we identified 20 articles from PubMed, EMBASE, CINAHL, Cochrane CENTRAL, PEDro, SPORTDiscus, and REHABDATA. Overall, advanced or metastatic cancer populations comprising of mixed cancer types were most commonly examined (n = 8) with exercise or combined exercise and nutritional interventions being well-tolerated with few adverse effects. Both intervention approaches may preserve lean mass, while only combined interventions may lead to alterations in fat mass. However, further exercise and nutritional studies are needed to definitively understand their effects on body composition. As exercise and nutrition-related research continues in this understudied population, the knowledge gained will help guide supportive clinical treatments.

“I want to get myself as fit as I can and not die just yet” – Perceptions of exercise in people with advanced cancer and cachexia: a qualitative study

Cachexia is a prevalent muscle wasting syndrome among people with advanced cancer that profoundly impacts patient quality of life (QoL) and physical function. Exercise can improve QoL, physical function, and overall health in people with cancer and may be an important addition to treatment approaches for cancer cachexia. Greater understanding of patients’ perception of exercise can help elucidate the feasibility of implementing exercise interventions for cancer cachexia and facilitate the design of patient-centered interventions. We aimed to describe the perception of exercise in patients with advanced cancer and cachexia, and capture exercise motivators, barriers, and preferences, to inform the feasibility of exercise interventions. Individual interviews (n = 20) with patients with locally advanced or metastatic cancer with cachexia were conducted and analyzed using reflexive thematic analysis. Main themes from interviews were: 1) Life is disrupted by cancer and cachexia; 2) Exercise offers hope; 3) Exercise barriers are multifaceted; and 4) Exercise access and support are important. Participants reported that their cancer and cachexia had intensely altered their lives, including ability to exercise. Exercise was perceived as important and participants described a hope for exercise to improve their health and wellbeing. Yet, several complex exercise barriers, such as burdensome cancer symptoms and the overwhelming impact of the COVID-19 pandemic, hindered exercise participation and prevented participants from fully realizing the perceived benefits of exercise. Factors believed to improve exercise engagement and overcome exercise barriers included increased exercise support (e.g., professional supervision) and accessibility (e.g., convenient locations). Patient-reported exercise barriers and preferences can inform the design of exercise interventions, particularly within future research studies aiming to establish exercise feasibility and efficacy in people with advanced cancer and cachexia.

Exercise-Based Interventions to Counteract Skeletal Muscle Mass Loss in People with Cancer: Can We Overcome the Odds?

Addressing skeletal muscle mass loss is an important focus in oncology research to improve clinical outcomes, including cancer treatment tolerability and survival. Exercise is likely a necessary component of muscle-mass-preserving interventions for people with cancer. However, randomized controlled trials with exercise that include people with cancer with increased susceptibility to more rapid and severe muscle mass loss are limited. The aim of the current review is to highlight features of cancer-related skeletal muscle mass loss, discuss the impact in patients most at risk, and describe the possible role of exercise as a management strategy. We present current gaps within the exercise oncology literature and offer several recommendations for future studies to support research translation, including (1) utilizing accurate and reliable body composition techniques to assess changes in skeletal muscle mass, (2) incorporating comprehensive assessments of patient health status to allow personalized exercise prescription, (3) coupling exercise with robust nutritional recommendations to maximize the impact on skeletal muscle outcomes, and (4) considering key exercise intervention features that may improve exercise efficacy and adherence. Ultimately, the driving forces behind skeletal muscle mass loss are complex and may impede exercise tolerability and efficacy. Our recommendations are intended to foster the design of high-quality patient-centred research studies to determine whether exercise can counteract muscle mass loss in people with cancer and, as such, improve knowledge on this topic.

Impact of Cancer Cachexia on Cardiac and Skeletal Muscle: Role of Exercise Training

Simple Summary

Cachexia is a syndrome that can be present in many patients diagnosed with cancer, especially in those with metastatic or very advanced tumors. The patient may present with weight loss, loss of muscle mass, and even cardiac dysfunction as a result of it. The aim of this review is to understand how cachexia manifests and whether physical exercise has any role in trying to prevent or reverse this syndrome in cancer patients.

Abstract

Cachexia is a multifactorial syndrome that presents with, among other characteristics, progressive loss of muscle mass and anti-cardiac remodeling effect that may lead to heart failure. This condition affects about 80% of patients with advanced cancer and contributes to worsening patients’ tolerance to anticancer treatments and to their premature death. Its pathogenesis involves an imbalance in metabolic homeostasis, with increased catabolism and inflammatory cytokines levels, leading to proteolysis and lipolysis, with insufficient food intake. A multimodal approach is indicated for patients with cachexia, with the aim of reducing the speed of muscle wasting and improving their quality of life, which may include nutritional, physical, pharmacologic, and psychological support. This review aims to outline the mechanisms of muscle loss, as well as to evaluate the current clinical evidence of the use of physical exercise in patients with cachexia.