Effects of tandem cognitive behavioral therapy and healthy lifestyle interventions on health-related outcomes in cancer survivors: a systematic review

Exercise interventions and physical activity in adults living with and beyond blood cancer: a scoping review

PURPOSE

Adults living with and beyond cancer (survivors) often face physical and psychological challenges, including pain, fatigue, sleep disturbances, and depression, which impair quality of life (QOL). While exercise interventions are demonstrated to benefit survivors of solid tumors, their impact on survivors of blood cancer remains underexplored. This review evaluates the evidence regarding exercise interventions in survivors of blood cancer, focusing on intervention types, study participant characteristics, and reported outcomes.

METHODS

A literature search was conducted using Embase (Elsevier), Medline (EBSCO), CINAHL (EBSCO), and Scopus (Elsevier) to identify studies on exercise interventions in survivors of blood cancer published through March 15, 2024. Articles were screened based on inclusion criteria, including adults aged 18 or older who completed cancer treatment and underwent exercise interventions. Exclusion criteria included pediatric populations, active cancer treatment, study protocols, incomplete results, or non-English publications.

RESULTS

Seventeen studies were identified, including nine feasibility studies and eight randomized controlled trials. Participants, predominantly white, had a median age range of 31.5-63.5 years. Interventions, often combining aerobic and resistance exercises, were delivered three times weekly over 8-12 weeks. Feasibility studies reported adherence rates of 66-87% and retention rates of 70-95%, with improvements in QOL and physical function. Randomized controlled trials similarly demonstrated benefits in fatigue, QOL, and physical function.  CONCLUSIONS: Exercise interventions improve QOL for survivors of blood cancer, though long-term effectiveness and adherence require further study.

IMPLICATIONS FOR CANCER SURVIVORS

Future research should focus on diverse populations and long-term outcomes to develop tailored, accessible exercise interventions for survivors of blood cancer.

The moderating effect of family socioeconomic status in the relationship between health-related behaviors and quality of life among the Hakka older adults in Fujian, China

PURPOSE

This study examined the moderating effect of family socioeconomic status (SES) in the relationship between health-related behaviors and quality of life (QOL) among Hakka older adults from three levels: specific behaviors, the number of healthy behaviors, and behavior patterns.

METHODS

A total of 1,262 participants aged 60 years or above were included in this study. The Chinese version of the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD) with six domains was used to measure the QOL. Two-Step Cluster Analysis (TCA) was employed to determine the health-related behaviors patterns. The generalized linear regression models were utilized to reveal the relationship between specific behaviors, the number of healthy behaviors and behavior patterns, and QOL.

RESULTS

Sleep regularity (β = 2.70, 95%CI 1.68, 3.72), physical exercise (β = 5.61, 95%CI 4.50, 6.72) were associated with higher QOL. Moreover, the higher number of healthy behaviors (from 4 to 5) were more likely to experience higher QOL, the β (95%CI) ranges from 5.08 (3.52, 6.64) to 5.82 (4.07, 7.57). Compared with the moderate-health pattern, risk-selective pattern (β = 7.432, t = 2.343, P < 0.05) and family SES (β = 4.691, t = 6.356, P < 0.001) were positively related to QOL. And the family SES exclusively moderated the risk-selective pattern (β = - 2.552, t = - 2.378 P < 0.05) on QOL.

CONCLUSION

Maintaining healthy behaviors is closely related to a better QOL. Potential benefits of the active management of healthy behavior may improve the QOL of Hakka older adults.

Addressing Mental Health Needs in Patients With Cancer: A Recent Systematic Review and Meta-Analysis of the Effectiveness of Nurse-Led Interventions

BACKGROUND

Depression and anxiety are prevalent among patients with cancer, impacting their quality of life and treatment outcomes. Nurse-led interventions are promising but show variable effectiveness.

PURPOSE

This review assessed the effectiveness of nurse-led interventions in reducing depression and anxiety in patients with cancer.

METHODS

A systematic search identified studies evaluating nurse-led approaches for depression and anxiety. Meta-analysis used Cohen's d with a random-effects model, and heterogeneity was assessed using the I2 statistic.

RESULTS

Eighteen studies (n = 2054) showed significant reductions in depression (-1.29, 95% confidence interval [CI]: -1.52 to -1.06) and anxiety (-1.31, 95% CI: -1.55 to -1.07). Effective strategies included self-care education, cognitive-behavioral therapy, and peer support. Moderate to high heterogeneity (I2 = 70%-75%) was partly resolved through sensitivity analyses.

CONCLUSIONS

Nurse-led interventions effectively reduce depression and anxiety in patients with cancer. Integrating these strategies into oncology care and standardizing protocols can further improve outcomes.

Lifestyle modification program (IM Healthy) for cancer survivors: Implementation of a reimbursable telehealth group program during the COVID-19 pandemic

PURPOSE

We designed and pilot-tested a reimbursable lifestyle change program delivered via telehealth that was initiated during the COVID-19 pandemic.

METHODS

The program (IM Healthy) focused on increasing physical activity, improving nutrition, and facilitating stress management and healthy behavior change. Retrospective chart review was used to collect data on IM Healthy participants from the period of Sept 2021 to Aug 2022. The program was offered three days each week with the same topic presented each day. Patients chose which day they attended. Meetings were primarily led by a health psychologist, with intermittent weeks led by a dietitian or physical therapist. Chart review provided demographics, group attendance, ESAS-FS, PROMIS10, weight, and BMI. Patient feedback regarding the telehealth program was collected approximately 6 months following the data collection period.

RESULTS

Patients (N = 50) mostly women (90%) with mean 57.9 years old (SD = 11.2) attended at least one group with an average of 13.1 (SD = 10.8; range = 1-45) attended sessions. Frequency of individual psychology sessions decreased after starting IM Healthy (z = - 2.17, p = 0.03). Overall, patients provided positive feedback including feelings of connectedness and physical and psychological benefit. Patients endorsed moderate to high perceived success in physical activity, nutrition, and stress management.

CONCLUSIONS

We demonstrate that a reimbursable lifestyle change group program can be tailored to telehealth and is well-received and beneficial to cancer survivors.

A Machine Learning Classification Model for Gastrointestinal Health in Cancer Survivors: Roles of Telomere Length and Social Determinants of Health

BACKGROUND

Gastrointestinal (GI) distress is prevalent and often persistent among cancer survivors, impacting their quality of life, nutrition, daily function, and mortality. GI health screening is crucial for preventing and managing this distress. However, accurate classification methods for GI health remain unexplored. We aimed to develop machine learning (ML) models to classify GI health status (better vs. worse) by incorporating biological aging and social determinants of health (SDOH) indicators in cancer survivors.

METHODS

We included 645 adult cancer survivors from the 1999-2002 NHANES survey. Using training and test datasets, we employed six ML models to classify GI health conditions (better vs. worse). These models incorporated leukocyte telomere length (TL), SDOH, and demographic/clinical data.

RESULTS

Among the ML models, the random forest (RF) performed the best, achieving a high area under the curve (AUC = 0.98) in the training dataset. The gradient boosting machine (GBM) demonstrated excellent classification performance with a high AUC (0.80) in the test dataset. TL, several socio-economic factors, cancer risk behaviors (including lifestyle choices), and inflammatory markers were associated with GI health. The most significant input features for better GI health in our ML models were longer TL and an annual household income above the poverty level, followed by routine physical activity, low white blood cell counts, and food security.

CONCLUSIONS

Our findings provide valuable insights into classifying and identifying risk factors related to GI health, including biological aging and SDOH indicators. To enhance model predictability, further longitudinal studies and external clinical validations are necessary.

Effects of psychological intervention on negative emotions and psychological resilience in breast cancer patients after radical mastectomy

Breast cancer (BC)is the most common malignant tumor in women, and the treatment process not only results in physical pain but also significant psychological distress in patients. Psychological intervention (PI) has been recognized as an important approach in treating postoperative psychological disorders in BC patients. It has been proven that PI has a significant therapeutic effect on post-operative psychological disorders, improving patients' negative emotions, enhancing their psychological resilience, and effectively enhancing their quality of life and treatment compliance.

Stress Management Interventions to Facilitate Psychological and Physiological Adaptation and Optimal Health Outcomes in Cancer Patients and Survivors

Cancer diagnosis and treatment constitute profoundly stressful experiences involving unique and common challenges that generate uncertainty, fear, and emotional distress. Individuals with cancer must cope with multiple stressors, from the point of diagnosis through surgical and adjuvant treatments and into survivorship, that require substantial psychological and physiological adaptation. This can take a toll on quality of life and well-being and may also promote cellular and molecular changes that can exacerbate physical symptoms and facilitate tumor growth and metastasis, thereby contributing to negative long-term health outcomes. Since modifying responses tostressors might improve psychological and physiological adaptation, quality of life, and clinical health outcomes, several randomized controlled trials have tested interventions that aim to facilitate stress management. We review evidence for the effects of stress management interventions on psychological and physiological adaptation and health outcomes in cancer patients and survivors and summarize emerging research in the field to address unanswered questions.

Cognitive behavioral therapy for anxiety and depression in cancer survivors: a meta-analysis

This study aimed to investigate the effects of cognitive behavioral therapy (CBT) on anxiety and depression in cancer survivors. The PubMed, Embase, PsycINFO, and Cochrane Library databases were searched. Randomized controlled trials that evaluated the effects of CBT in cancer survivors were included. The standardized mean difference (SMD) was used as an effect size indicator. Fifteen studies were included. For the depression score, the pooled results of the random effects model were as follows: pre-treatment versus post-treatment, SMD (95% confidence interval [CI]) = 0.88 (0.46, 1.29), P < 0.001; pre-treatment versus 3-month follow-up, 0.83 (0.09, 1.76), P = 0.08; pre-treatment versus 6-month follow-up, 0.92 (0.27, 1.58), P = 0.006; and pre-treatment versus 12-month follow-up, 0.21 (- 0.28, 0.70), P = 0.40. For the anxiety score, the pooled results of the random effects model were as follows: pre-treatment versus post-treatment, 0.97 (0.58, 1.36), P < 0.001; pre-treatment versus 3-month follow-up, 1.45 (- 0.82, 3.72), P = 0.21; and pre-treatment versus 6-month follow-up, 1.00 (0.17, 1.83), P = 0.02). The pooled result of the fixed effects model for the comparison between pre-treatment and the 12-month follow-up was 0.10 (- 0.16, 0.35; P = 0.45). The subgroup analysis revealed that the geographical location, treatment time and treatment form were not sources of significant heterogeneity. CBT significantly improved the depression and anxiety scores of the cancer survivors; such improvement was maintained until the 6-month follow-up. These findings support recommendations for the use of CBT in survivors of cancer.

The efficacy of cognitive behavioral therapy for cancer: A scientometric analysis

Cognitive behavioral therapy (CBT) is one of the most recognized psychological interventions to improve the overall quality of life of cancer survivors. To analyze current research trends in the field of the link between CBT and cancer and to provide potential future research directions, we conducted the scientometric analysis. The study was conducted on all documents in this field from 2012 to 2022 retrieved from Web of Science. Then Biblioshiny, VOSviewer software, and CiteSpace software were used for getting the information of article postings and citations, countries, institutions, journals, authors, and keywords. The number of documents about the link between CBT and cancer from 2012 to 19 July 2022, was 619, with 476 of articles and 143 of reviews. The number of annual publications has been fluctuating, with the highest number of publications in 2020. The country with the maximum number of publications and citations was the US. The University of Houston was the organization with the highest quantity of publications and total link strength (TLS). Psycho-Oncology was the most active journal in the field and has the highest h-index. Zvolensky MJ was the author with the highest quantity of publications. The most cited keywords were "Quality-of-life," "Cognitive-behavioral therapy," "Depression," "Cognitive therapy" and "Breast-cancer." And as evidenced by the keyword citations, the focus of this research area has gradually shifted to the mental health of patients and the underlying pathogenesis. The impact of CBT in cancer treatment is now well established and has gradually evolved toward symptom-specific treatment. However, the relationship between CBT and cancer has not been further developed. Future research is needed to be further developed in the identification of a generic formula for CBT in cancer and the exploration of mechanisms of CBT and cancer.

A randomized controlled trial of WeChat-based cognitive behavioral therapy intervention to improve cancer-related symptoms in gynecological cancer survivors: study protocol

Background

Gynecological malignant patients often have significant psychological and physical problems. The feasibility and generalizability of traditional intervention method is low due to the high time and labor cost, large number of gynecological malignant tumor patients in China, as well as shortage of health professionals. Therefore, it is necessary to design an alternative, innovative, and easily accessible intervention method. This study aims to evaluate the effect of WeChat-based intervention on anxiety, depression and disease-related symptoms of patients with gynecological malignant tumors during rehabilitation.

Methods

A single-blinded, randomized, controlled, parallel-group pre-test and repeated post-test design will be conducted. A total of 76 participants will be randomly divided into the intervention group and control group. Anxiety and depression, disease-related symptoms, coping ability, benefit finding and quality of life will be measured at baseline and repeated immediately after the intervention (test 1), 3 months (test 2) and 6 months (test 3) after the intervention.

Discussion

As the first randomized controlled trial with rigorous research design for patients with gynecological malignant tumors in the rehabilitation stage in China, this study will provide evidences for the effectiveness of the WeChat platform during intervention of patients with gynecological malignant tumors in the rehabilitation stage. The results are helpful to further explore the effect of WeChat-based intervention on improving patients' anxiety and depression, disease-related symptoms, and quality of life.

Trial registration

Chinese Clinical Trial Registry: ChiCTR2100053450, Registered 21 November 2021,http://www.chictr.org.cn/searchproj.aspx

Lifestyle and Pain following Cancer: State-of-the-Art and Future Directions

This review discusses chronic pain, multiple modifiable lifestyle factors, such as stress, insomnia, diet, obesity, smoking, alcohol consumption and physical activity, and the relationship between these lifestyle factors and pain after cancer. Chronic pain is known to be a common consequence of cancer treatments, which considerably impacts cancer survivors' quality of life when it remains untreated. Improvements in lifestyle behaviour are known to reduce mortality, comorbid conditions (i.e., cardiovascular diseases, other cancer, and recurrence) and cancer-related side-effects (i.e., fatigue and psychological issues). An inadequate stress response plays an important role in dysregulating the body's autonomic, endocrine, and immune responses, creating a problematic back loop with pain. Next, given the high vulnerability of cancer survivors to insomnia, addressing and treating those sleep problems should be another target in pain management due to its capacity to increase hyperalgesia. Furthermore, adherence to a healthy diet holds great anti-inflammatory potential for relieving pain after cancer. Additionally, a healthy diet might go hand in hand with weight reduction in the case of obesity. Consuming alcohol and smoking have an acute analgesic effect in the short-term, with evidence lacking in the long-term. However, this acute effect is outweighed by other harms on cancer survivors' general health. Last, informing patients about the benefits of an active lifestyle and reducing a sedentary lifestyle after cancer treatment must be emphasised when considering the proven benefits of physical activity in this population. A multimodal approach addressing all relevant lifestyle factors together seems appropriate for managing comorbid conditions, side-effects, and chronic pain after cancer. Further research is needed to evaluate whether modifiable lifestyle factors have a beneficial influence on chronic pain among cancer survivors.

Cognitive behavioral therapy on personality characteristics of cancer patients

BACKGROUND

The main treatment methods for cancer include surgery, radiotherapy, chemotherapy, targeted drug therapy and so on. Patients often feel anger, anxiety, depression, and other negative psychological reactions in the process of treatment.

AIM

To explore the effects of cognitive behavioral therapy on the personality characteristics of cancer patients.

METHODS

According to the matching design requirements, 150 cancer patients were divided into 3 groups based on sex, age, condition, and cultural background. Patients in the control group received conventional treatment. Patients in experimental group 1 received an intervention based on conventional treatment combined with cognitive behavioral therapy. Patients in experimental group 2 received family members' participation in addition to the treatment given in experimental group 1. An Eysenck personality questionnaire was used to investigate all the patients before and after the intervention, and the scores for psychosis, introversion, neuroticism, and concealment degree were analyzed.

RESULTS

Compared with the control group, for experimental group 1 and experimental group 2 before and after the intervention, the four dimensions of mental quality, neuroticism, introversion and concealment degree all decreased, and the difference was statistically significant (P < 0.05). After the intervention, there were no obvious or statistically significant differences (P > 0.05) among the control group, experimental group 1, and experimental group 2 for two personality traits, psychoticism and neuroticism, both inside and outside degree and all four dimensions.

CONCLUSION

Simple cognitive behavioral therapy could not change the personality characteristics of cancer patients quickly, but the patients’ personality characteristics were significantly improved after treatment.

Rationale and Methods for a Randomized Controlled Trial of a Dyadic, Web-Based, Weight Loss Intervention among Cancer Survivors and Partners: The DUET Study

Scalable, effective interventions are needed to address poor diet, insufficient physical activity, and obesity amongst rising numbers of cancer survivors. Interventions targeting survivors and their friends and family may promote both tertiary and primary prevention. The design, rationale, and enrollment of an ongoing randomized controlled trial (RCT) (NCT04132219) to test a web-based lifestyle intervention for cancer survivors and their supportive partners are described, along with the characteristics of the sample recruited. This two-arm, single-blinded RCT randomly assigns 56 dyads (cancer survivor and partner, both with obesity, poor diets, and physical inactivity) to the six-month DUET intervention vs. wait-list control. Intervention delivery and assessment are remotely performed with 0-6 month, between-arm tests comparing body weight status (primary outcome), and secondary outcomes (waist circumference, health indices, and biomarkers of glucose homeostasis, lipid regulation and inflammation). Despite COVID-19, targeted accrual was achieved within 9 months. Not having Internet access was a rare exclusion (<2%). Inability to identify a support partner precluded enrollment of 42% of interested/eligible survivors. The enrolled sample is diverse: ages 23-81 and 38% racial/ethnic minorities. Results support the accessibility and appeal of web-based lifestyle interventions for cancer survivors, though some cancer survivors struggled to enlist support partners and may require alternative strategies.