Breast cancer survivors' perspectives on a weight loss and physical activity lifestyle intervention

Living together-does it help or hinder the pursuit of a healthful diet, physical activity, and weight loss among cancer survivors and their chosen partners?

PURPOSE

Parental or spousal cohabitating relationships are often targeted in behavioral interventions, but the contribution of cohabitation is poorly understood. This study explored whether cohabitation status moderated the impact of social cognitive theory constructs on adiposity, diet, and exercise in a dyadic, web-based weight loss intervention among cancer survivors and their chosen partners.

METHODS

The 24-week weight loss intervention was conducted among 56 dyads, comprised of a cancer survivor and their chosen partner (n = 112). Baseline and 6-month data on social cognitive theory constructs (self-efficacy, social support, and perceived barriers), and study outcomes of adiposity (weight and waist circumference), diet (calories and diet quality), and moderate-to-vigorous physical activity (MVPA) were used to perform moderated-mediation analyses among cohabitating (n = 25) versus non-cohabitating (n = 31) dyads.

RESULTS

The intervention was positively associated with dietary social support (path a1: 0.36, 95% CI [0.083, 0.659]) and inversely associated with perceived dietary barriers (path a1: - 10.57, 95% CI [- 19.109, - 3.091]) and perceived exercise barriers (path a1: - 11.29, 95% CI [- 22.098, - 3.500]) among those who did not cohabitate (effects not observed among cohabitating pairs). The intervention's mediating effects through perceived barriers on weight (indirect effect (ab): - 2.21, 95% CI [- 4.794, - 0.548]), waist circumference (ab: - 1.13, 95% CI [- 2.452, - 0.171]), caloric intake (ab: - 5.09 (2.86), 95% CI [- 12.602, - 0.709]), and self-reported MVPA (ab: 0.29 (0.18), 95% CI [0.019, 0.754]) also were stronger among non-cohabitating pairs.

CONCLUSIONS

These findings suggest that social support partners outside the home substantially enhance intervention impact, though relationship quality and gender dynamics warrant further exploration.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04132219.

Barriers and facilitators for weight management interventions in breast cancer patients: a systematic review of qualitative studies

INTRODUCTION

This systematic review and meta-synthesis of qualitative studies provides an overview of barriers and facilitators that breast cancer patients experience in weight management interventions.

METHODS

We included qualitative studies describing barriers and facilitators for weight management interventions as experienced by adult breast cancer patients after the completion of initial treatment . The data was extracted and using thematic analysis.

RESULTS

After analysis, eleven themes were determined. Six of those themes could be linked to the Attitude, Social Influence and self Efficacy (ASE)-model. Physical and mental benefits, anticipated regret and a lack of motivation were linked to attitude. Integrating a weight management programme in daily life, stigma and fears were linked to self-efficacy. With regard to the social influence determinant, encouragement and discouragement by family members were developed as a theme. Four additional themes were conducted related to weight management behaviour; external barriers, economic barriers, cultural barriers and physical barriers. In addition, integrating weight management in cancer care was described as a separate theme.

CONCLUSIONS

Several disease specific issues, including feeling stigmatized after cancer treatment and treatment-related side effects and peer-support should be given specific attention to maximize adherence of weight management programmes.

Experiences of breast cancer survivors with exercise rehabilitation: qualitative systematic review and meta-synthesis

PURPOSE

This study aimed to synthesize and evaluate the available qualitative literature on posttreatment participation in exercise rehabilitation among breast cancer survivors.

METHODS

This systematic review followed the Joanna Briggs Institute (JBI) meta-aggregation approach guided by ENTREQ, graded according to the ConQual approach, and evaluated using the JBI Qualitative Assessment and Review Instrument (JBI-QARI). We searched qualitative or mixed methods studies related to the experiences of exercise rehabilitation among breast cancer survivors conducted until April 13, 2023, in nine English and Chinese databases. The selected studies were reviewed independently, and the data were collaboratively synthesized into core themes.

RESULTS

A total of 24 studies were included, and 88 findings resulted in five synthesis findings: (a) benefits of participating in exercise rehabilitation, (b) facilitators of participation in exercise rehabilitation, (c) obstacle factors for participating in exercise rehabilitation, (d) evaluation of the exercise program, and (e) recommendations.

CONCLUSION

Breast cancer survivors need exercise to recover physically and mentally and to transition from cancer treatment to a normal life. The factors affecting exercise participation in breast cancer survivors are complex. Breast cancer survivors require timely and continuous effective exercise intervention forms, including online, offline, instrumental, and emotional support from others, especially healthcare providers and family members. Moreover, multidisciplinary collaboration is required to develop more effective and convenient exercise interventions.

Comparing Outcomes of a Digital Commercial Weight Loss Program in Adult Cancer Survivors and Matched Controls with Overweight or Obesity: Retrospective Analysis

Maintaining a healthy weight is beneficial for cancer survivors. However, weight loss program effectiveness studies have primarily been in highly controlled settings. This is a retrospective study exploring real-world outcomes (weight loss and program engagement) after use of a digital commercial weight loss program (Noom) in cancer survivors and matched controls. All participants had voluntarily self-enrolled in Noom. Weight and engagement data were extracted from the program. Cancer-related quality of life was secondarily assessed in a one-time cross-sectional survey for survivors. Controls were a sample of Noom users with overweight/obesity who had no history of cancer but 0–1 chronic conditions. Primary outcomes were weight change at 16 weeks and program engagement over 16 weeks. Engagement included frequency of weight, food, and physical activity logging, as well as number of coach messages. Multiple regression controlling for baseline age, gender, engagement, and BMI showed that survivors lost less weight than controls (B = −2.40, s.e. = 0.97, p = 0.01). Survivors also weighed in less (survivors: 5.4 [2.3]; controls: 5.7 [2.1], p = 0.01) and exercised less (survivors: 1.8 [3.2]; controls: 3.2 [4.1], p < 0.001) than controls. However, survivors sent more coach messages (survivors: 2.1 [2.4]; controls: 1.7 [2.0], p < 0.001). Despite controls losing more weight than cancer survivors (−7.0 kg vs. −5.3 kg), survivors lost significant weight in 4 months (M = −6.2%). Cancer survivors can have success on digital commercial programs available outside of a clinical trial. However, they may require additional support to engage in weight management behaviors.

Postnatal Exercise Partners Study (PEEPS): a pilot randomized trial of a dyadic physical activity intervention for postpartum mothers and a significant other

Background: Research suggests dyadic interventions can increase physical activity; such interventions are untested within postpartum parent couples. Methods: A three-armed pilot randomized trial addressed this gap and tested which type of dyadic intervention is most effective. Inactive postpartum mothers and a significant other were recruited in Australia (n = 143 assessed for eligibility) and randomised in a single-blinded fashion (i.e. participants were blinded) to 1 of 3 dyadic conditions involving a single face-to-face session with access to web-based group support: a minimal treatment control (n = 34), collaborative planning group (n = 38), or collaborative planning + need supportive communication group (n = 30). Participants were asked to wear their accelerometers for 8 days and completed self-report measures at baseline, end of intervention (week 4), and follow-up (week 12). We expected dyads in the collaborative planning + need supportive communication group would have the greatest increases in Physical Activity (PA), autonomous motivation, and partners' need supportive behaviours; and decreases in controlled motivation and controlling partner behaviours. Results: Results from 51 dyads using Bayesian actor-partner interdependence models provided some evidence for a small positive effect on total PA at follow-up for postpartum mothers in the collaborative planning group and for partners in the collaborative planning + need supportive communication group. Furthermore, partners in the collaborative planning + need supportive communication group were more likely to engage in some vigorous PA. At follow-up, postpartum mothers in the collaborative planning + need supportive communication group scored lower on personal autonomous reasons. Conclusions: The impact of prior specification mean intervention effects need to be interpreted with caution. Progression to a full trial is warranted.

Acceptability of a structured diet and exercise weight loss intervention in breast cancer survivors living with an overweight condition or obesity: A qualitative analysis

BACKGROUND

Weight loss increases survivorship following breast cancer diagnosis. However, most breast cancer survivors (BCS) do not meet diet and exercise recommendations.

AIM

The purpose of this study was to explore the barriers and facilitators of BCS who had lymphedema and who participated in a 22-week weight loss lifestyle intervention.

METHODS AND RESULTS

Participants completed semi-structured interviews about barriers and facilitators to intervention adherence. Interviews were transcribed verbatim and a thematic analysis was conducted. Participants (n = 17) were 62 ± 8.0 years of age with a mean body mass index of 34.0 ± 7.1 kg/m² . Four themes emerged: (1) facilitators of intervention adherence, (2) barriers of intervention adherence, (3) continuation of healthy habits post intervention, and (4) recommendations for intervention improvements. Facilitators of intervention adherence were education, social support, routine, motivation, goal-setting, meal-provisioning, self-awareness, and supervised exercise. Barriers to intervention adherence were personal life, health, meal dissatisfaction, seasonality, unchallenging exercises, and exercising alone. All women planned to continue the acquired healthy habits post intervention. Recommendations to improve the study included addressing the exercise regime, meal-provisioning, and dietary intake monitoring methods.

CONCLUSION

Future strategies to engage BCS in weight loss interventions should promote group exercise, offer individualized meal-provisioning and exercise regimes, provide transition tools, and allow participants to choose their self-monitoring method.

Quality of Life in Women Diagnosed with Breast Cancer after a 12-Month Treatment of Lifestyle Modifications

Healthy lifestyles are associated with better health-related quality of life (HRQoL), favorable prognosis and lower mortality in breast cancer (BC) survivors. We investigated changes in HRQoL after a 12-month lifestyle modification program in 227 BC survivors participating in DEDiCa trial (Mediterranean diet, exercise, vitamin D). HRQoL was evaluated through validated questionnaires: EQ-5D-3L, EORTC-QLQ-C30 and EORTC QLQ-BR23. Baseline changes were tested using analysis of variance. Multiple regression analyses were performed to assess treatment effects on HRQoL. Increases were observed in global health status (p < 0.001), physical (p = 0.003), role (p = 0.002) and social functioning (p < 0.001), body image (p < 0.001), future perspective (p < 0.001), well-being (p = 0.001), and reductions in fatigue (p < 0.001), nausea and vomiting (p = 0.015), dyspnea (p = 0.001), constipation (p = 0.049), financial problems (p = 0.012), sexual functioning (p = 0.025), systematic therapy side effects (p < 0.001) and breast symptoms (p = 0.004). Multiple regression analyses found inverse associations between changes in BMI and global health status (p = 0.048) and between serum 25(OH)D levels and breast symptoms (p = 0.002). A healthy lifestyle treatment of traditional Mediterranean diet and exercise may impact positively on HRQoL in BC survivors possibly through reductions in body weight while vitamin D sufficiency may improve BC-related symptoms. These findings are relevant to BC survivors whose lower HRQoL negatively affects treatment compliance and disease outcomes.

"This is my home-based exercise": exploring environmental influences on home-based exercise participation in oncology

PURPOSE

Home-based exercise interventions offer many health benefits; however, the environments that constitute home-based exercise are not well-understood. The purpose of this study was to explore what constitutes the "home" for cancer survivors engaging in home-based exercise and identify factors of the environment that may impact exercise participation.

METHODS

We conducted a qualitative exploratory study of cancer survivors receiving a home-based exercise prescription to manage their cancer-related impairments. Semi-structured interviews included photo elicitation to actively involve participants in the interview process and provide opportunities to visually "observe" environments utilized for home-based exercise.

RESULTS

Sixteen participants were interviewed (n = 11 women, median age = 53.5, range = 26-74 years) and three themes emerged: (1) reasons for participating in a home-based exercise program; (2) physical environmental influences and preferences; and (3) social environmental influences and preferences. The ability to self-manage exercise and accommodate competing demands, having access to exercise facilities, feeling comfortable exercising without qualified supervision, and a desire for autonomy were reasons home-based exercise programs were preferred. Participants reported that the physical environment influenced their experience with home-based exercise and sub-themes related to a dynamic environment, indoor and outdoor characteristics, and aesthetics were identified. The social environment, with sub-themes associated with the presence of people, social climate, exercise modeling, connection, and exercise support, also related to exercise behavior.

CONCLUSION

The findings highlight the influence of the physical and social environment on exercise prescription engagement. They further indicate the need for exercise professionals to consider the environment for exercise when delivering home-based exercise interventions.

Patient and Medical Oncologists' Perspectives on Prescribed Lifestyle Intervention-Experiences of Women with Breast Cancer and Providers

This study explored the perspectives and experiences of breast cancer patients and medical oncologists with regards to participation in a lifestyle intervention at a tertiary cancer treatment center. A thematic approach was used to understand the context within which a lifestyle intervention was recommended and experienced, to inform future lifestyle programming and promote uptake. Twelve women with breast cancer receiving adjuvant chemotherapy and eight medical oncologists completed interviews. Findings suggest receiving a prescription for a lifestyle intervention from a trusted health professional was influential to women with breast cancer. The intervention offered physical, psychological, emotional, social, and informational benefits to the women and oncologists perceived both physiological and relational benefit to prescribing the intervention. Challenges focused on program access and tailored interventions. Lifestyle prescriptions are perceived by women with breast cancer to have numerous benefits and may promote lifestyle interventions and build rapport between oncologists and women. Oncology healthcare professionals play a pivotal role in motivating women’s participation in lifestyle interventions during breast cancer treatment. Maintenance programs that transition patients into community settings and provide on-going information and follow-up are needed.

Experiences of African American Breast Cancer Survivors Using Digital Scales and Activity Trackers in a Weight Gain Prevention Intervention: Qualitative Study

BACKGROUND

The use of digital tools to promote daily self-weighing and daily activity tracking may be a promising strategy for weight control among African American breast cancer survivors (AABCS). There have been no studies exploring the acceptability and feasibility of using digital tools for weight control or qualitative studies characterizing perceptions of daily self-weighing and daily activity tracking among AABCS.

OBJECTIVE

This study aimed to explore the subjective experiences of daily self-weighing and daily activity tracking using digital tools, including wireless scales and activity trackers, in a sample of AABCS participating in two technology-based weight gain prevention interventions over 6 months.

METHODS

Semistructured interviews (N=21) were conducted in person or over the phone, were audio recorded, and then transcribed verbatim. Each transcript was read to identify key themes and develop a codebook. Each transcript was coded using Atlas.ti software, and code outputs were used to identify overarching themes and patterns in the data.

RESULTS

On average, participants were 52.6 (SD 8.3) years of age, with obesity at baseline (BMI 33.1 kg/m2, SD 5.9), and weighed on 123.4 (SD 48.0) days out of the 168 days (73.5%) in the study period. Women tended to attribute their weight gain to cancer treatment and framed program benefits in terms of improved quality of life and perceptions of prolonging their survival following treatment. Using the smart scale for daily self-weighing was viewed as the tool by which participants could control their weight and improve their health and well-being posttreatment. The activity tracker increased awareness of physical activity and motivated participants to be more active.

CONCLUSIONS

Participants reported positive experiences and benefits from daily self-weighing and daily activity tracking. Findings suggest that daily self-weighing and daily activity tracking using digital tools are well-received, acceptable, and feasible intervention strategies for AABCS in the context of posttreatment weight management.

Attitudes and Beliefs of Older Female Breast Cancer Survivors and Providers About Exercise in Cancer Care

OBJECTIVES

To understand breast cancer survivors' and providers' attitudes and beliefs regarding exercise counseling and structured exercise programs within cancer care.

SAMPLE & SETTING

61 female breast cancer survivors and 11 breast cancer providers from a university cancer center in the Pacific Northwest.

METHODS & VARIABLES

Survivors completed anonymous self-report surveys, and providers participated in semistructured interviews. Survey data were analyzed using descriptive statistics, and interview transcripts were analyzed using qualitative content analysis.

RESULTS

Breast cancer survivors and providers believed that including exercise counseling within cancer care was important. More than half of the survivors reported that they would attend structured exercise classes; a majority of providers thought cancer centers should offer exercise programs.

IMPLICATIONS FOR NURSING

Nurses could facilitate exercise counseling within cancer care and advocate for clinic-based exercise programs.

"Finding my own motivation" - A Mixed Methods Study of Exercise and Behaviour Change Support During Oncological Treatment

BACKGROUND

Exercising during oncological treatment is beneficial but challenging for persons with cancer and may require strategies to increase motivation. Behaviour change support, including specific behaviour change techniques (BCTs), have been used to facilitate exercise in persons undergoing oncological treatment, but more detailed knowledge from an individual perspective is needed to inform clinical practice. The aims were to explore the motivational experiences of exercise combined with behaviour change support, and to describe how specific BCTs were valued among persons exercising during oncological treatment.

METHODS

A mixed-methods study was conducted using semi-structured interviews (n = 18) and a questionnaire (n = 229). Participants with breast, colorectal or prostate cancer who completed or dropped out of a six-month exercise programme during oncological treatment were included. The interviews were analysed with thematic analysis and the questionnaire with descriptive statistics (median and interquartile range).

RESULTS

The participants underwent a motivational process through the exercise programme. By experiencing 'Health gains and mastery', 'Learning', 'Affinity', 'Commitment', and 'Managing challenges', they found incentives that fostered feelings of autonomy, competence and relatedness, leading to an increased motivation to exercise. Social support from coaches, structuring the physical environment with scheduled sessions, self-monitoring with resistance training log, and feedback based on heart rate monitor and fitness tests were the most valued BCTs.

CONCLUSIONS

The results indicate the importance of finding incentives and creating an environment that fosters autonomy, competence and relatedness to motivate persons to exercise during oncological treatment. Some BCTs appear particularly useful and may be used by health professionals to increase patients' motivation to exercise.

Exploring tensions within young breast cancer survivors' physical activity, nutrition and weight management beliefs and practices

Purpose: Although the benefits of physical activity, healthy eating, and weight management for breast cancer survivors are well established, little is known about how best to promote these practices among women diagnosed before age 40 years. We conducted a qualitative study to explore young breast cancer survivors' beliefs and practices regarding physical activity, nutrition, and weight management.Methods: Semi-structured interviews were conducted with 12 women (M_age=36 years, SD=3.4) who were within 5 years of breast cancer diagnosis. Data were analyzed using thematic analysis.Results: Participants' accounts revealed several tensions between the factors motivating them to engage in physical activity, healthy eating, and weight management and those deterring them. Tensions were captured within three themes: (1) prolonging life with a healthy lifestyle versus enjoying living; (2) perceiving benefits versus barriers, and; (3) seeking social connection versus protecting the self from social threats. Participants also noted preferences, which if considered could help them maintain healthy lifestyle practices.Conclusions: Although young breast cancer survivors value physical activity, healthy eating, and weight management, they are constantly weighing the benefits of these practices against their perceived drawbacks. To facilitate long-term participation among young breast cancer survivors, future programing must address their conflicting beliefs and priorities.Implications for RehabilitationPhysical activity, healthy eating, and weight management can play an important role in the health and wellbeing of breast cancer survivors.Young breast cancer survivors experience a 'tug-of-war' between the factors motivating them to be active and eat healthy and those deterring them.Following treatment for breast cancer, young women would benefit from tailored lifestyle-based programing that addresses their conflicting beliefs and priorities.Tailored programing might involve strategically scheduled program times or flexible programs designed to include the participation of family and friends.

A longitudinal mixed methods study on changes in body weight, body composition, and lifestyle in breast cancer patients during chemotherapy and in a comparison group of women without cancer: study protocol

Background

More than 60% of women diagnosed with early stage breast cancer receive (neo)adjuvant chemotherapy. Breast cancer patients receiving chemotherapy often experience symptoms such as nausea, vomiting and loss of appetite that potentially affect body weight and body composition. Changes in body weight and body composition may detrimentally affect their quality of life, and could potentially increase the risk of disease recurrence, cardiovascular disease and diabetes. To date, from existing single method (quantitative or qualitative) studies is not clear whether changes in body weight and body composition in breast cancer patients are treatment related because previous studies have not included a control group of women without breast cancer.

Methods

We therefore developed the COBRA-study (Change Of Body composition in BReast cancer: All-in Assessment-study) to assess changes in body weight, body composition and related lifestyle factors such as changes in physical activity, dietary intake and other behaviours. Important and unique features of the COBRA-study is that it used I) a “Mixed Methods Design”, in order to quantitatively assess changes in body weight, body composition and lifestyle factors and, to qualitatively assess how perceptions of women may have influenced these measured changes pre-, during and post-chemotherapy, and II) a control group of non-cancer women for comparison. Descriptive statistics on individual quantitative data were combined with results from a thematic analysis on the interviews- and focus group data to understand patients’ experiences before, during and after chemotherapy.

Discussion

The findings of our mixed methods study, on chemotherapy treated cancer patients and a comparison group, can enable healthcare researchers and professionals to develop tailored intervention schemes to help breast cancer patients prevent or handle the physical and mental changes they experience as a result of their chemotherapy. This will ultimately improve their quality of life and could potentially reduce their risk for other co-morbidity health issues such as cardiovascular disease and diabetes.

Promoting Team-Based Exercise Among African American Breast Cancer Survivors

Physical activity benefits the health and well-being of breast cancer survivors (BCS). Yet, many African American survivors do not routinely exercise and have increased risk of poor outcomes. The purpose of this mixed-method study was to identify motivational factors compelling African American BCS to participate in a 14-week team walking program and to intend to continue exercise after the intervention concluded. Focus groups were held with participants ( n = 12) before and after training. Content analysis discovered themes before the intervention: Not wanting to go at it alone, exercise not a life or treatment priority, cancer treatment affected activity, advocates to exercise, and can exercise really help? Four themes postintervention themes included: In the same boat, changed mind-set, improved weight and activity, and overcoming barriers. Physical data verified improvements. Results suggest that a team-based exercise training program may assist in overcoming a sedentary behavior tendency and subsequently improve health among survivors.

Breast cancer survivors' perceptions of participating in a supervised exercise intervention: An exploratory review of the literature

BACKGROUND

Despite the reported beneficial effects of physical activity (PA) during and after cancer diagnosis, current research data suggest that the percentages of breast cancer survivors who adhere to PA recommendations are low. The objective of the present systematic, critical review was to identify, analyze, and provide a summary of qualitative literature findings, which have explored breast cancer survivors' experiences of participating in an exercise/PA intervention after cancer treatment.

METHODS

A systematic search was conducted using CINAHL, PsychINFO, PubMed, and Scopus electronic databases to search for qualitative literature published during 2000-2016. A total of six studies that met the inclusion criteria were reviewed. Thematic synthesis, following Thomas and Harden's methods, were used to analyze the data.

FINDINGS

Seven descriptive themes were developed: control, focus, transitioning phase, regaining a sense of confidence, enhanced spirits, social support, and safe environment. The findings suggested that participation in supervised exercise interventions enhanced the self-confidence and mood of breast cancer survivors. It allowed them to regain control and provide a focus, thereby allowing them to move forward in their lives.

CONCLUSION

The results of this systematic critical review indicated that the supervised exercise was a positive experience for breast cancer survivors.

Physical Activity During and After Adjuvant Treatment for Breast Cancer: An Integrative Review of Women's Experiences

Background: In oncology, physical activity (PA) is recognized to improve psychological and physiological functions. Motivating women with breast cancer to sustain a physically active lifestyle is important for promoting positive health after diagnosis. To review and synthesize what is known about how women with breast cancer experience supervised and unsupervised PA during and after adjuvant treatment. PubMed, PsycINFO, and CINAHL were searched, yielding 994 citations. The final review included 17 articles published between 2004 and 2014 in English. The CASP (Critical Appraisal Skills Programme) instrument was used to appraise quality. Results: Exercise is experienced as a positive element with multiple benefits. However, maintaining a physically active lifestyle during and after chemotherapy is sometimes challenging. Reported benefits of PA include feeling empowered, and improving and reclaiming health. Facilitators to PA comprised exercising with peers and skilled instructors. Barriers included social factors and lack of information. Conclusions: Findings highlight the importance of incorporating PA programs from a patient experience perspective as routine treatment. Health care professionals play a crucial “gateway” role in providing information on implementation and benefits of PA. Providing support and educated advice about how to safely start or continue regular PA to minimize symptoms, reduce morbidity, and increase well-being during or after treatment is vital for women with breast cancer. Implications for Practice: Health care professionals need increased knowledge of the breast cancer patients’ perspectives on facilitators and barriers to PA during and after treatment, in order to provide sufficient support for women to stay physically active during a breast cancer illness.

Breast cancer survivors' experience of making weight, dietary and physical activity changes during participation in a weight loss intervention

PURPOSE

The aim of this study is to explore breast cancer survivors' experience of a weight loss intervention and identify potential facilitators and barriers of initiating and maintaining weight, dietary or physical activity changes.

METHOD

Fourteen women randomised to and completing the 12-month weight loss intervention completed semi-structured interviews 7.5 ± 0.5 months after intervention completion. An inductive thematic analysis was conducted whereby interviews were independently coded and themes identified.

RESULTS

Women were (mean ± SD) 55.6 ± 8.5 years, 30.2 ± 4.6 kg/m² and 17.1 ± 3.4 months post-diagnosis at study baseline. Four themes emerged: (1) perceived motivation to participate in the intervention, (2) facilitators, (3) challenges and (4) maintenance of weight loss and behaviour changes. All women noted the impact of social/family environments, either to facilitate (e.g., support from family members) or impede (e.g., major family event) changes. The structure and support of the intervention, particularly accountability to their coach, was also seen as facilitating. Formation of habitual physical activity facilitated dietary changes. Dietary change strategies most perceived to facilitate weight loss were reducing energy intake by dietary self-monitoring, increasing vegetable intake and portion control. Challenges included breast cancer-specific issues such as post-diagnosis weight gain, treatment-related side effects and psychological issues around readiness to change and self-regulation. Diminished accountability following intervention completion impacted the maintenance of weight loss and behaviour changes, notably dietary self-monitoring.

CONCLUSIONS

Results suggest that formal involvement of a support person (e.g. family member/friend) and referring women to ongoing, community-based services to maintain patient-perceived accountability may be particularly useful strategies for future weight loss intervention trials targeting women with breast cancer.

Military veteran cancer survivors' preferences for a program to address lifestyle change and psychosocial wellness following treatment

This study aimed to understand military veteran cancer survivors' preferences regarding the delivery of post-treatment wellness services. Thirty-three military veteran cancer survivors were interviewed about their perceptions of three models of health service delivery (home-, primary care-, and oncology-based services). Conventional qualitative content analysis revealed strengths and weaknesses of each service delivery model's content and structure (e.g., program location, inclusion of emotional support, access to clinical experts). All service delivery programs had strengths, with clinic-based programs offering the greatest breadth of services deemed important for wellness by cancer survivors.

Effects of physical activity on systemic oxidative/DNA status in breast cancer survivors

Physical activity offers a paradoxical hormetic effect and a health benefit to cancer survivors; however, the biochemical mechanisms have not been entirely elucidated. Despite the well-documented evidence implicating oxidative stress in breast cancer, the association between health benefits and redox status has not been investigated in survivors who participate in dragon boating. The present study investigated the plasmatic systemic oxidative status (SOS) in breast cancer survivors involved in two distinct physical training exercises. A total of 75 breast cancer survivors were allocated to one of three groups: Control (resting), dragon boat racing and walking group; the latter is a type of aerobic conditioning exercise often advised to cancer patients. Various biochemical oxidative stress markers were examined, including oxidant status (hydroperoxide levels, lipid oxidation) and antioxidant status (enzymatic activities of superoxide dismutase and glutathione peroxidase, reduced glutathione levels and antioxidant capability). In addition, the individual DNA fragmentation and DNA repair capability of nucleotide excision repair (NER) systems were examined by comet assays. According to the results, all patients exhibited high levels of oxidative stress. Physical activity maintained this oxidative stress condition but simultaneously had a positive influence on the antioxidant component of the SOS, particularly in the dragon boat racing group. DNA fragmentation, according to the levels of single- and double-strand breaks, were within the normal range in the two survivor groups that were involved in training activities. Radiation-induced damage was not completely recognised or repaired by NER systems in any of the patients, probably leading to radiosensitivity and/or susceptibility of patients to cancer. These findings suggest that physical activity, particularly dragon boat racing, that modulates SOS and DNA repair capability could represent a strategy for enhancing the quality of life and improving the long-term health benefits for breast cancer survivors.

Cardiometabolic Health Among Cancer Survivors: A 13-Week Pilot Study of a Combined Aerobic and Resistance Training Program

PURPOSE/OBJECTIVES

To explore the feasibility of combined aerobic and resistance training (CART) as a safe method of improving cardiometabolic health among cancer survivors.
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DESIGN

Descriptive and longitudinal pilot study for exercise intervention.
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SETTING

University campus in Los Angeles, California.
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SAMPLE

A multiethnic population of cancer survivors (N = 11) was recruited by convenience sampling and physician referral. 
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METHODS

Consenting participants were prescribed CART for one hour per day, three days per week for 13 weeks.
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MAIN RESEARCH VARIABLES

Components of cardiometabolic health were measured, including resting heart rate (HRrest), blood pressure, body mass index, waist circumference, body fat percentage, and android fat percentage at baseline and after 13 weeks of training. Fasting blood glucose, insulin, adiponectin, leptin, tumor necrosis factor alpha, and C-reactive protein (CRP) also were assessed at baseline and after 13 weeks of training.
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FINDINGS

More than half of the participants reported living with at least two other chronic diseases or conditions in addition to a cancer diagnosis. Five of six African American and Hispanic participants reported the presence of at least two risk factors for metabolic syndrome, compared to one of five Caucasian participants. After 13 weeks of training, participants experienced an average decrease in waist circumference. Decrease in waist circumference was associated with a decrease in CRP. A relationship also was suggested between number of exercise sessions attended and improvement in HRrest. 
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CONCLUSIONS

A CART intervention among cancer survivors should continue to be explored in a larger sample to establish efficacy and effectiveness at improving cardiometabolic health. Because of the higher risk of comorbidity among cancer survivors in comparison to cancer-free adults, improving cardiometabolic health is as important as monitoring cancer recurrence. A need exists for increased attention to the post-treatment cardiometabolic health of cancer survivors and also for examining potential cardiometabolic health disparities among non-Caucasian cancer survivors.
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IMPLICATIONS FOR NURSING

CART may be a plausible alternative to reduce the risk of metabolic syndrome and improve cardiometabolic health among cancer survivors. Additional studies that continue to explore the efficacy and effectiveness of CART may provide more information to help nurses and physicians determine whether the cancer survivorship care plan should include an exercise-based alternative to intervene on cardiometabolic health.

A qualitative evaluation of a group phone-based weight loss intervention for rural breast cancer survivors: Themes and mechanisms of success

PURPOSE

Obesity is prevalent in breast cancer survivors and is a significant risk factor for recurrence and mortality. Weight management interventions for survivors have been diverse in design (in-person vs. phone-based, group vs. individual) and yielded varying weight loss results. Given these issues, participants themselves may provide insight into treatment-based factors that contributed to their weight loss outcomes. Here, we report qualitative results from interviews with survivors in a group phone-based weight loss intervention, with the objective of identifying mechanisms that facilitated or hindered adherence and weight loss. We explored interest in paying for continued treatment as an indicator of dissemination potential.

METHODS

Individual interviews were conducted with 186 rural, obese breast cancer survivors upon completion of a 6-month weight loss intervention that produced clinically meaningful weight loss (>5 %) in 91 % of participants. A thematic analysis of the interview data was performed.

RESULTS

Five themes were identified as impacting adherence and success: (1) accountability; (2) importance of the group, with varying levels of connectedness; (3) dietary convenience; (4) difficulty maintaining intervention components that required more effort; and (5) importance of internal motivation to attributions of physical activity success or failure. Most were interested in paying to continue the program if it were extended beyond the study.

CONCLUSIONS

Key intervention components that participants attributed to their success included supportive group processes and convenience. Results highlight the group phone-based approach as a potential venue for disseminating an effective weight loss program for breast cancer survivors.

TRIAL REGISTRATION

NCT01441011.

Exercise and dietary advice intervention for survivors of triple-negative breast cancer: effects on body fat, physical function, quality of life, and adipokine profile

PURPOSE

Regular exercise and healthy eating are routinely recommended for breast cancer survivors, and past studies show benefits in quality of life and decreased inflammation. However, this has not been tested specifically in triple-negative breast cancer survivors. Increasing physical activity and losing body fat are thought to positively affect inflammatory biomarkers that have been associated with breast cancer. Therefore, the primary purpose of this study was to determine if participation in an exercise and dietary counseling program can improve body fat, physical function, and quality of life in survivors of this aggressive breast cancer. Secondarily, we sought to determine if participation in the program had beneficial effects on obesity-related markers of the adipokine profile.

METHODS

Sixty-six survivors of triple-negative breast cancer with BMI >25 were invited to participate. Twenty-eight enrolled and 23 completed the randomized, controlled trial (13 intervention, 10 control). Moderate-intensity aerobic exercise (150 min per week, for 12 weeks) and diet counseling were compared to usual care, education only. The primary outcome of interest was weight loss (body mass, BMI, % fat), and secondary outcomes included physical function (exercise capacity), quality of life (Function After Cancer Therapy-Breast (FACT-B)), cytokines (C-reactive protein (CRP), TNF-α, IL-6), and adipokine profile (leptin, adiponectin, insulin).

RESULTS

Participants in the program lost more body fat (2.4 % loss vs. 0.4 % gain, p < 0.05) than the control group. The intervention group also improved quality of life (FACT-B total score +14 pts) and decreased sedentary time but did not improve peak exercise capacity. The intervention had no effect on serum cytokines and adipokines after 12 weeks in the program. However, serum leptin and adiponectin and their ratio were significantly correlated with BMI in the intervention group (p < 0.05).

CONCLUSIONS

Exercise and dietary counseling led to loss of body fat and improved quality of life in survivors of triple-negative breast cancer. BMI was associated with favorable changes in leptin and adiponectin which may reflect a change in adiposity with intervention. Exercise and healthy eating may be equally effective in this high-risk population as in other breast cancer survivors and should be encouraged as a part of a cancer survivorship program.

Lifestyle changes for prevention of breast cancer

Breast cancer is the second most common cause of death from cancer among women. Lifestyle changes are shown to be important in the prevention of breast cancer. Diet, physical activity, smoking, alcohol use, and vitamin and mineral use are key factors influencing the risk of breast cancer among women. Because these factors are related to each other, it is difficult to assess their individual roles in breast cancer. Some of these factors are alterable, meaning that women can decrease their risk for breast cancer by changing their behavior. Breast cancer is associated with a high rate of mortality and morbidity among women. Therefore, it is logical to try to find ways to decrease the risk of developing breast cancer. Lifestyle changes seem to be an easy, effective, and economical way to help prevention breast cancer. In women with a confirmed breast cancer diagnosis who are under radiotherapy treatment after undergoing a mastectomy, lifestyle changes are still very important. Some factors, such as smoking cessation and prevention of weight gain, may improve the long-term survival chances of these patients. Therefore, ways to increase women’s knowledge about the role of lifestyle changes in the prevention of breast cancer and in the survival of patients with diagnosed breast cancer should be considered and studied.