A Systematic Review of Exercise Systematic Reviews in the Cancer Literature (2005-2017)

Efficacy of supervised exercise on sleep of women who survived breast cancer: a systematic review with meta-analysis

PURPOSE

To analyze the efficacy of supervised exercise (SE) compared with control protocols on sleep parameters of women who survived breast cancer.

METHODS

This systematic review with meta-analysis searched studies using the following electronic databases: PubMed, Scopus, Physiotherapy Evidence Database (PEDro), Cochrane Library, and EMBASE. The PEDro scale assessed the bias risk, and the study protocol was registered in the PROSPERO (no. CRD42023420894).

RESULTS

Of 3,566 identified studies, 13 randomized clinical trials involving 847 women diagnosed with breast cancer were included. Interventions consisted of SE in an outpatient setting (62%) or combined protocols with supervised and home exercises. Most interventions (85%) used multicomponent protocols with aerobic and resistance exercises. Usual care and health education were the most reported controls. SE decreased the sleep disturbance score (- 31.61 [95% confidence interval =  - 39.40 to - 23.83]) of the European Organisation for Research and Treatment of Cancer quality of life questionnaire and daytime dysfunction score (- 0.41 [95% confidence interval =  - 0.73 to - 0.09]) of the Pittsburgh Sleep Quality Index (PSQI). Also, SE presented a tendency to improve the self-reported sleep quality score of the PSQI (p = 0.06).

CONCLUSION

SE increased the subjective sleep quality and immobility time and decreased sleep disturbance and daytime dysfunction symptoms in women who survived breast cancer. Most SE protocols were multicomponent, with aerobic and resistance exercises ranging from moderate to high intensity.

IMPLICATIONS FOR CANCER SURVIVORS

Supervised exercise may improve sleep quality and reduce symptoms of sleep disorders, contributing to survival outcomes.

Why do older patients with advanced cancer decline participation in an exercise-based trial during oncological treatment? - A mixed methods study

BACKGROUND

Exercise is recommended during anti-cancer treatments. However, there is lack of knowledge about existing barriers to participation in exercise-based trials, especially among understudied groups such as older patients and those with advanced cancer.

OBJECTIVE

To explore reasons for refusal of participation in an exercise-based study among older patients with advanced cancer and identify factors associated with higher likelihood of declining.

METHODS

A mixed methods design was applied, using qualitative data from interviews and quantitative data from medical records. We investigated potential differences in characteristics between patients who accepted and declined. Qualitative data underwent thematic analysis, and findings were synthesized to generate meta-inferences.

RESULTS

Among 34 invited patients, 20 (59%) agreed to participate in the interviews, and 261 of 269 (97%) patients were included in quantitative analyses. Meta-inferences identified factors related to refusing exercise participation, including older age, perceptions of being sufficiently active, physical limitations, and awareness of having a poor prognosis.

CONCLUSION

Refusal of participation was particularly related to advanced cancer, physical limitations, and older age. To address these barriers, it is recommended to adopt a holistic and supportive approach and improve the flexibility of recruitment strategies.

Global trends and research hotspots in autophagy and tumor drug resistance: a bibliometric analysis

Autophagy plays a crucial role in tumor drug resistance by enabling cancer cells to survive under stress conditions, including chemotherapy. It helps tumor cells maintain homeostasis, resist cell death, and contribute to therapy failure. This study analyzed the literature related to autophagy and tumor drug resistance based on the Web of Science Core Collection (WoSCC) database. The results revealed that there are 9284 relevant articles published to date, covering 103 countries and regions, with contributions from 5964 institutions and 37,240 researchers. The annual number of publications has steadily increased since 2004, especially after 2019, indicating the growing importance of autophagy in tumor drug resistance research. China leads globally in terms of publication output, accounting for nearly 50% of the total publications. Additionally, international collaboration and cross-country research have become increasingly prominent, particularly collaborations between China and countries like South Korea and Japan. Journal analysis showed that the International Journal of Molecular Sciences and Oncotarget are the most productive journals, while Autophagy stands out with a higher impact factor. Author, citation, and keyword analyses revealed research hotspots and future trends in the field of autophagy and tumor drug resistance, including chemotherapy resistance, cell death mechanisms, and immunotherapy. This study provides a systematic academic perspective for future research in the field of autophagy and tumor drug resistance and emphasizes the importance of strengthening international cooperation.

A Qualitative Descriptive Study to Assess Experiences and Care Needs of Patients With Cancer During the COVID-19 Pandemic

PURPOSE

To explore the experiences and unmet clinical needs of patients with cancer during the COVID-19 pandemic.

PARTICIPANTS & SETTING

The authors recruited patients with cancer who received cancer-directed therapy in March 2020 at a National Cancer Institute-designated comprehensive cancer center. Interviews with patients were conducted between June 2021 and January 2023.

METHODOLOGIC APPROACH

In this deductive-inductive descriptive qualitative investigation, participants completed a one-time 45-minute semistructured telephone interview via Zoom.

FINDINGS

The qualitative analysis revealed (a) a myriad of psychological stressors, (b) bolstered human connectedness, (c) disruptions to daily life, (d) clinical support and education from healthcare teams, and (e) looking ahead to postpandemic life. Participants experienced changes in health behaviors and material hardships but highlighted support from family, friends, and healthcare teams.

IMPLICATIONS FOR NURSING

The cohort of patients experienced significant distress and disruptions to their lives during the COVID-19 pandemic. Interventions implemented during an unanticipated event such as a pandemic need to be developed and tested to support patients with cancer.

Advancing the implementation of quality-assured oncological exercise therapy in Germany: protocol for the IMPLEMENT project

BACKGROUND

Although quality-assured oncological exercise therapy (qOET) has proven effective for cancer patients at any stage of treatment and during aftercare, it is not yet incorporated into standard care in Germany and, to the best of our knowledge, in any other country. A collaboration involving eight German research institutions was initiated to investigate the barriers and facilitators to implementation and promote the wider dissemination of qOET for cancer patients across various settings in Germany.

METHODS

The IMPLEMENT project is designed as an exploratory study with a quasi-experimental design and a mixed-methods approach, combining qualitative and quantitative data collection. Institutions involved in the treatment and/or aftercare of cancer patients will be approached to identify key barriers and facilitators of qOET. Based on these findings, a set of implementation strategies (IPS) will be developed, implemented, and evaluated to facilitate the delivery of qOET for cancer patients. We aim to develop a variety of IPS for different contexts: urban settings (e.g. qualifying local aftercare institutions to provide qOET); rural settings (e.g. a hybrid approach for areas with limited access to local qOET services); adult cancer patients (e.g. focussing on patient education); and children and young cancer patients (e.g. offering consultations with training therapy experts). Additionally, interface management, training concepts, digital support, and economic evaluation will be considered to further promote the wider dissemination of qOET. The impact of the IPS will primarily be measured by the reach of qOET, assessed by comparing the number of cancer patients receiving qOET before and after implementation.

DISCUSSION

The aim of IMPLEMENT is to address key barriers and facilitators for the implementation of qOET in Germany, and to increase the number of cancer patients receiving qOET in the long term. Following the project, successful IPS will be disseminated for broader application. The IMPLEMENT consortium aims to make a significant contribution to the long-term integration of qOET into the standard care of cancer patients in Germany and prospectively for other countries as well.

TRIAL REGISTRATION

Clin.

TRIALS

NCT06496711. German Clinical Trial Register (Deutsches Register Klinischer Studien - DRKS): 00032292. Bavarian Cancer Research Center (Bayerisches Krebsforschungszentrum (BZKF bzw. ZKS): DZ-2024-2165-9.

Kinect-Based Mixed Reality Exercise Program Improves Physical Function and Quality of Life in Breast Cancer Survivors: A Randomized Clinical Trial

PURPOSE

Exercise is an effective non-pharmacological approach for alleviating treatment-related adverse effects and enhancing physical fitness in breast cancer survivors. A Kinect-based mixed reality device (KMR), with real-time feedback and user data collection, is an innovative exercise intervention for breast cancer survivors. This study aimed to investigate the effect of KMR exercise program on quality of life (QOL) and physical function in breast cancer survivors.

MATERIALS AND METHODS

Seventy-seven participants were randomly assigned to either the KMR exercise group or home stretching group with an 8-week intervention. Physical function (shoulder range of motion, body composition, aerobic capacity, and hand grip strength) was evaluated before and after the intervention period. Participants completed questionnaires such as the Disabilities of the Arm, Shoulder, and Hand (DASH), Functional Assessment of Cancer Therapy-Breast, and International Physical Activity Questionnaire (IPAQ) to assess upper extremity disabilities, QOL, and physical activity levels.

RESULTS

Significant group-by-time interaction was found for flexion of the operated arm (154.3±12.5 to 165.8±11.2), and the non-operated arm (158.2±13.8 to 166.5±12.2), abduction of the non-operated arm (154.8±31.6 to 161.1±28.1), and adduction of the operated arm (46.5±9.1 to 52.6±7.2). Significant improvements were also observed in DASH (46.8±9.1 to 40.8±9.3) and IPAQ (1,136.3±612.8 to 1,287±664.1).

CONCLUSION

The KMR exercise program effectively improved the physical function, alleviated edema, reduced upper extremity disability, and enhanced the QOL in breast cancer survivors. Coupled with significant group-by-time interactions for various outcomes, the results emphasize the potential benefits of incorporating the KMR exercise program to improve the QOL in breast cancer survivors.

Analysis of Metabolic and Quality-of-Life Factors in Patients With Cancer for a New Approach to Classifying Walking Habits: Secondary Analysis of a Randomized Controlled Trial

BACKGROUND

As the number of people diagnosed with cancer continues to increase, self-management has become crucial for patients recovering from cancer surgery or undergoing chemotherapy. Technology has emerged as a key tool in supporting self-management, particularly through interventions that promote physical activity, which is important for improving health outcomes and quality of life for patients with cancer. Despite the growing availability of digital tools that facilitate physical activity tracking, high-level evidence of their long-term effectiveness remains limited.

OBJECTIVE

This study aimed to investigate the effect of long-term physical activity on patients with cancer by categorizing them into active and inactive groups based on step count time-series data using the mobile health intervention, the Walkon app (Swallaby Co, Ltd.).

METHODS

Patients with cancer who had previously used the Walkon app in a previous randomized controlled trial were chosen for this study. Walking step count data were acquired from the app users. Biometric measurements, including BMI, waist circumference, blood sugar levels, and body composition, along with quality of life (QOL) questionnaire responses (European Quality of Life 5 Dimensions 5 Level version and Health-related Quality of Life Instrument with 8 Items), were collected during both the baseline and 6-month follow-up at an outpatient clinic. To analyze step count patterns over time, the concept of sample entropy was used for patient clustering, distinguishing between the active walking group (AWG) and the inactive walking group (IWG). Statistical analysis was performed using the Shapiro-Wilk test for normality, with paired t tests for parametric data, Wilcoxon signed-rank tests for nonparametric data, and chi-square tests for categorical variables.

RESULTS

The proposed method effectively categorized the AWG (n=137) and IWG (n=75) based on step count trends, revealing significant differences in daily (4223 vs 5355), weekly (13,887 vs 40,247), and monthly (60,178 vs 174,405) step counts. Higher physical activity levels were observed in patients with breast cancer and younger individuals. In terms of biometric measurements, only waist circumference (P=.01) and visceral fat (P=.002) demonstrated a significant improvement exclusively within the AWG. Regarding QOL measurements, aspects such as energy (P=.01), work (P<.003), depression (P=.02), memory (P=.01), and happiness (P=.05) displayed significant improvements solely in the AWG.

CONCLUSIONS

This study introduces a novel methodology for categorizing patients with cancer based on physical activity using step count data. Although significant improvements were noted in the AWG, particularly in QOL and specific physical metrics, differences in 6-month change between the AWG and IWG were statistically insignificant. These findings highlight the potential of digital interventions in improving outcomes for patients with cancer, contributing valuable insights into cancer care and self-management.

TRIAL REGISTRATION

Clinical Research Information Service by Korea Centers for Diseases Control and Prevention, Republic of Korea KCT0005447; https://tinyurl.com/3zc7zvzz.

The effects of exercise interventions on fatigue, body composition, physical fitness, and biomarkers in breast cancer patients during and after treatment: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Breast cancer is the leading cancer type among women, accounting for 24.5% of female cancer cases worldwide.

OBJECTIVE

The purpose of this study is to systematically review and conduct a meta-analysis to evaluate the effects of exercise interventions on breast cancer patients at different stages of treatment.

METHODS

Databases including PubMed, Cochrane Library, and Embase were searched for English-language randomized controlled trials (RCTs) published since 2000. The study included data from women aged 18 and above with breast cancer, either undergoing treatment or after treatment. Effect sizes were calculated using the standardized mean difference.

RESULTS

Out of 2845 studies, 40 met the inclusion criteria, with 17 studies focusing on patients undergoing treatment and 23 on after treatment patients. Exercise significantly reduced fatigue both undergoing (d =  - 0.20) and after treatment (d =  - 1.11). After treatment exercise interventions resulted in improvements in lean mass (d = 1.27), fat mass (d =  - 1.33), percentage body fat (d =  - 1.22), and waist circumference (d =  - 0.69). Additionally, biomarkers such as IL-6, HDL, LDL, glucose, systolic blood pressure (SBP), and diastolic blood pressure (DBP) showed improvements after treatment.

CONCLUSIONS

Exercise interventions are effective in reducing fatigue and enhancing fitness while undergoing treatment and have positive effects on body composition and biomarkers after treatment. Low-to-moderate intensity exercise is recommended undergoing treatment, while moderate-to-high intensity exercise is beneficial after treatment.

IMPLICATIONS FOR CANCER SURVIVORS

Personalized exercise programs should be incorporated as a standard part of care in clinical settings to alleviate fatigue undergoing treatment and improve body composition and biomarkers following treatment.

Feasibility and effects of the telerehabilitation program during hematopoietic stem cell transplantation

This study aims to identify the feasibility and effects of the telerehabilitation program for patients with hematologic cancer who underwent hematopoietic stem cell transplantation (HSCT). In this single-arm prospective study, a telerehabilitation program was administered to patients who underwent HSCT. The program utilized a camera and video conferencing system, delivering 30-minute exercise sessions based on the Otago exercise. Baseline, immediate follow-up, and 3-month follow-up examinations were performed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30, Beck Depression Inventory-II, fatigue severity scale, body composition, and a 10-item satisfaction survey. Fifteen (9 males and 6 females) completed the program. The mean number of exercise participation was 8.67 ± 1.91, and no adverse events or safety issues were reported. The results showed no significant deterioration in global health status, physical, role, emotional, cognitive, or social functioning as well as depression and fatigue. Physical function was well maintained without significant deterioration. In the satisfaction survey, participants believed that it was physically and mentally beneficial. This study showed that the telerehabilitation program may be helpful for patients undergoing HSCT. Direct communication with a physical therapist helped patients maintain their physical and mental health during isolation.

The feasibility of a multi-site, clinic-supported, and tailored neuro-oncology exercise program

Background

To address the lack of access to supportive cancer care resources, the purpose of this study was to examine the feasibility of a tailored exercise program for neuro-oncology patients.

Methods

Patients with a primary brain tumor diagnosis, >18 years, and able to consent in English were recruited at 2 tertiary cancer centers in Alberta. Recruitment occurred via the electronic medical record as well as self-referral. A 12-week, tailored exercise intervention with health coaching was delivered in both one-on-one and group-based formats, either in-person or online. Measures of feasibility included tracking referral, enrollment, intervention completion and adherence, measurement completion, fidelity, participant satisfaction, and safety. Participant-reported outcomes and functional fitness were assessed at baseline and 12 weeks. Objective physical activity was tracked via a Garmin activity tracker.

Results

Recruitment occurred between April 2021-December 2022. N = 70 patients enrolled in the study and n = 51 completed the intervention. The referral rate was 31%, the enrollment rate was 66%, and intervention completion and adherence rates were 82.3% and 89.7%. At baseline and 12 weeks, measurement completion rates were 100% and 77.4% for patient-reported outcomes, and 98.4% and 75.8% for functional fitness. The average wear-time for the activity tracker was 72.8%. Fidelity of intervention delivery was 100% for exercise sessions and 87.8% for health coaching. Overall participant satisfaction was 86.5%. No major and 4 minor adverse events occurred.

Conclusions

Delivery of a tailored neuro-oncology exercise program with referral included via the electronic medical record is feasible. Future work is needed to optimize tailored programming as well as to address factors critical for implementation into standard cancer care.

Clinical Trials Registration

NCT04831190 (https://clinicaltrials.gov/ct2/show/NCT04831190).

Exercise in cancer patients: assistance levels and referral pathways-a position statement from the Spanish Society of Medical Oncology

There is growing evidence about how physical activity can improve cancer care. Unfortunately, exercise is still not widely prescribed to oncology patients, despite the benefit it brings. For this to occur, it is necessary for a multidisciplinary approach involving different types of healthcare professionals, given that each treatment be tailored for each single case. Besides incorporating appropriate infrastructures and referral pathways, we need to integrate exercise into healthcare practice, which ameliorates patients' quality of life and treatment side effects. From the Spanish Society of Medical Oncology (SEOM), and through the Exercise and Cancer Working Group, we indicate considerations, analyze patient care scenarios, and propose a referral pathway algorithm for exercise prescription, taking in account the patient's needs. In later sections of this paper, we describe how this algorithm could be implemented, and how the exercise programs should be built, including the physical activity contents, the settings, and the delivery mode. We conclude that professionals, infrastructures, and organizations should be available at every assistance level to create programs providing adequate exercise training for cancer patients.

Exploring the use of rehabilitation in individuals with head and neck cancer undergoing treatment: a scoping review

PURPOSE

Explore the use, characteristics, feasibility, and functional outcomes of rehabilitation interventions used for individuals with head and neck cancer (HNC) during treatment.

METHODS

Searches were conducted in four databases from Jan 2011 to Dec 31, 2022. Included studies had to include adults with HNC undergoing treatment, a rehabilitation intervention, an assessment of functional outcome(s) addressed by the International Classification of Functioning Framework (ICF) and be published in English language. Title and abstract screening, full-text review, and data extraction were completed independently, in duplicate. Descriptive statistics and a qualitative synthesis summarized findings.

RESULTS

Twenty-seven studies were included in this review. The majority of studies were randomized controlled trials (70%). Most individuals represented in the included studies were males (92% of all participants) between 50 and 60 years of age. Interventions led by a speech language pathologist (33%) were most commonly described. Sixteen studies (59%) described primary outcomes that fit the ICF "impairment" domain.

CONCLUSIONS

We identified few studies that explored the use, feasibility, and effectiveness of rehabilitation interventions for individuals with HNC during treatment. Future research should assess the effectiveness of rehabilitation interventions on functional outcomes beyond the ICF body function and structure domain.

The Importance of Nutrition in Cancer Care: A Narrative Review

PURPOSE OF REVIEW

Cancer, a complex disease affecting millions globally, presents considerable challenges for both patients and health care providers. Within the broad spectrum of cancer care, nutrition plays a key role in supporting patients throughout their journey. This narrative review examines the role of nutrition in cancer care, exploring its impact on treatment outcomes, nutritional status, current dietary recommendations, physical activity, palliative care, and finally, as a nutritional encouragement for cancer survivors.

RECENT FINDINGS

Evidence indicates that cancer and anticancer treatments frequently cause malnutrition and loss of muscle mass, which can exacerbate symptoms, impair immune function, and hamper recovery. Therefore, adequate nutritional support is crucial for maintaining strength, controlling symptoms, and optimizing treatment tolerance in patients with cancer. Several factors influence nutritional needs and dietary recommendations, including cancer type, treatment, and individual patient characteristics. Nutritional care aims not only to ensure sufficient energy and protein intake, but also to manage specific symptoms such as dysgeusia, nausea, and dysphagia. Registered dietitians play a crucial role in providing personalized nutritional guidance, monitoring nutritional status, and implementing interventions to address emerging challenges in cancer care. Furthermore, recent research has underscored the benefits of dietary interventions in cancer treatment. From targeted nutritional supplements to more invasive nutritional support, interest in how nutrition can affect cancer risk and treatment outcomes is increasing. Overall, this review highlights the critical role of nutritional care in comprehensive cancer treatment. By recognizing and meeting dietary demands throughout the entire cancer journey, health care professionals can improve patients' well-being, response to treatment, and long-term prognosis.

Personalised exercise rehabilitation in cancer survivorship: Findings from a triage and referral feasibility study

PURPOSE

Screening, triage and referral systems are proposed as efficient, needs-based models of cancer rehabilitation. This study aimed to evaluate the feasibility of the PERCS triage and referral system.

METHODS

Utilising a pre-post design, the feasibility of PERCS was evaluated quantitatively in the context of a physiotherapy-led clinic for patients diagnosed with cancer during COVID-19. Assessments at baseline and 12 weeks (T1) included medical, social and physical activity history; patient-reported outcomes and performance-based measures. Following the assessment, the PERCS system allocated participants to one of three exercise pathways.

RESULTS

Sixty-four participants were recruited over 5 months (25.2% recruitment rate; female n = 39; mean age 61.4 (12.4) years). Almost all participants (90.6%) required support to become more physically active. The majority (n = 43, 66%) were referred to community exercise programmes, and n = 15 (23%) required physiotherapy rehabilitation. Five required medical pre-clearance, and one was re-triaged at 1 week. The mean cost per participant for community exercise services was €107.70. At T1, adherence to physical activity guidelines increased for aerobic (44 to 83%) and resistance (13 to 67%) exercise. Improvements were observed in hand grip strength (x̄ 2.59 kg, p = 0.001), 30-s sit-to-stand (x̄ + 3.7 stands, p < 0.001) and 6-min walk test (x̄ + 37.3 m, p = 0.001).

CONCLUSION

PERCS appropriately triaged patients to the right level of exercise and rehabilitation for individual needs. Participants experienced improvements in physical activity and physical functioning metrics.

IMPLICATIONS FOR CANCER SURVIVORS

The PERCS triage and referral system is feasible to complete and may support the effective and patient-centred implementation of exercise into cancer care.

TRIAL REGISTRATION

ClinicalTrials.gov registration: NCT05615285.

Efficacy of Prehabilitation in cancer patients: an Rcts systematic review with meta-analysis

BACKGROUND

Patients with cancer (PwC) who undergo specific treatments reported greater fatigue and reduced functional capacity as predominant outcomes, compromising their QoL during and following the treatment. Prehabilitation intervention, provided after diagnosis and before treatments, is to optimize the physiological reserve and address modifiable risk factors before surgery or chemotherapy to improve post-treatment results. The primary aim of this study is to obtain a common line of efficacy compared with prehabilitation treatment; the secondary endpoint is to assess the methodological quality of the studies eligible in the review.

METHODS

The systematic review was conducted from September to February 2024, in accordance with PRISMA guidelines. Databases consulted were MEDLINE, Scopus, Web of science and CINAHL, RCTs related to Prehabilitation intervention on PwC were included. The methodological quality of the included studies was assessed through the RoB2 Cochrane tool and the PEDro scale. Meta-analysis was performed to estimate relative treatment effects among evaluated outcomes.

RESULTS

Forty-two studies were included in the systematic review, 13 were included in the quantitative analysis. The results of the studies reporting reduced postoperative hospital stay, improved endurance, muscle strength, respiratory function, quality of life, and urinary incontinence. Critical analysis of the articles using the PEDro scale revealed 28 RCTs with a good rating, 9 with a fair rating, and 5 with a poor rating; in contrast, the Cochrane RoB2 tool revealed that all articles were at high risk of bias. Meta-analysis showed statistically significant values for 6MWT (38.53, 95%CI 33.03 - 44.04); HADS-depression (-0.71, 95%CI -0.93 -0.49) and HADS-anxiety (-0.49, 95%CI -0.76 -0.23).

CONCLUSIONS

Prehabilitation represents a specific intervention that aims to improve postoperative outcomes in fragile patients undergoing surgery, increasing their preoperative physiological reserve in anticipation of the stress they will face and facilitating the postoperative recovery of functional capacity. Prehabilitation is a good intervention to use, especially in terms of functional capacity and mental health, the latter being very impactful in terms of reduced levels of anxiety and depression. These data make it possible to justify supportive intervention by physical therapists aimed at improving and restoring health-related QoL especially in the short term.

Embedding Multimodal Rehabilitation Within Routine Cancer Care in Sheffield-The Active Together Service Evaluation Protocol

BACKGROUND

Approximately 3 million people in the United Kingdom are currently living with or beyond cancer. People undergoing treatment for cancer are at risk of complications following treatment. Increasing evidence supports the role of rehabilitation (including prehabilitation) in enhancing psychological and physical well-being in patients with cancer and improving outcomes. Active Together is an evidence-based, multimodal rehabilitation service for patients with cancer, providing support to help patients prepare for and recover from treatment. This paper presents the evaluation protocol for the Active Together service, aiming to determine its impact on patient-reported outcomes and clinical endpoints, as well as understand processes and mechanisms that influence its delivery and outcomes.

METHODS

This evaluation comprises an outcome and process evaluation, with service implementation data integrated into the analysis of outcome measures. The outcome evaluation will assess changes in outcomes of patients that attend the service and compare health care resource use against historical data. The process evaluation will use performance indicators, semistructured interviews, and focus groups to explore mechanisms of action and contextual factors influencing delivery and outcomes. Integrating psychological change mechanisms with outcome data might help to clarify complex causal pathways within the service.

CONCLUSIONS

Evidence to support the role of multimodal rehabilitation before, during, and after cancer treatment is increasing. The translation of that evidence into practice is less advanced. Findings from this evaluation will contribute to our understanding of the real-world impact of cancer rehabilitation and strengthen the case for widespread adoption of rehabilitation into routine care for people with cancer.

Current approaches to the pharmacological management of metastatic breast cancer in older women

INTRODUCTION

A substantial majority of patients diagnosed with metastatic breast cancer consists of individuals 65-year-old or above. Emerging treatment approaches, which utilize genomics-guided therapy and innovative biomarkers, are currently in development. Given the numerous choices in the metastatic context, it is necessary to adopt a personalized approach to decision-making for these patients.

AREAS COVERED

The authors provide a comprehensive analysis of the existing literature on the use of systemic anticancer treatments in older women, specifically those aged 65 and above, who have metastatic breast cancer, focusing on the reported effectiveness and adverse effects of these treatments in this population.

EXPERT OPINION

The evidence to treat older patients with metastatic breast cancer primarily relies on subgroup analyses, whose interpretation should be approached with caution. In several clinical trials subgroup analysis, it has been observed that this population seem to have comparable benefits and toxicities to younger patients, but real-world data have showed older women exhibit worse rates of survival compared to younger women. Multiple factors are likely involved in this, but we postulate this is related to lower rates of guideline concordant, and factors such as comorbidity, lack of social supports, malnutrition, and geriatric factors like frailty and/or vulnerability. This underscores the importance of a broader assessment for patients with a geriatric perspective and involvement of multi-disciplinary team.

Telemedicine Applications for Cancer Rehabilitation: Scoping Review

BACKGROUND

Cancer is a significant public health issue worldwide. Treatments such as surgery, chemotherapy, and radiation therapy often cause psychological and physiological side effects, affecting patients' ability to function and their quality of life (QoL). Physical activity is crucial to cancer rehabilitation, improving physical function and QoL and reducing cancer-related fatigue. However, many patients face barriers to accessing cancer rehabilitation due to socioeconomic factors, transportation issues, and time constraints. Telerehabilitation can potentially overcome these barriers by delivering rehabilitation remotely.

OBJECTIVE

The aim of the study is to identify how telemedicine is used for the rehabilitation of patients with cancer.

METHODS

This scoping review followed recognized frameworks. We conducted an electronic literature search on PubMed for studies published between January 2015 and May 2023. Inclusion criteria were studies reporting physical therapy telerehabilitation interventions for patients with cancer, including randomized and nonrandomized controlled trials, feasibility studies, and usability studies. In total, 21 studies met the criteria and were included in the final review.

RESULTS

Our search yielded 37 papers, with 21 included in the final review. Randomized controlled trials comprised 47% (n=10) of the studies, with feasibility studies at 33% (n=7) and usability studies at 19% (n=4). Sample sizes were typically 50 or fewer participants in 57% (n=12) of the reports. Participants were generally aged 65 years or younger (n=17, 81%), with a balanced gender distribution. Organ-specific cancers were the focus of 66% (n=14) of the papers, while 28% (n=6) included patients who were in the posttreatment period. Web-based systems were the most used technology (n=13, 61%), followed by phone call or SMS text messaging-based systems (n=9, 42%) and mobile apps (n=5, 23%). Exercise programs were mainly home based (n=19, 90%) and included aerobic (n=19, 90%), resistance (n=13, 61%), and flexibility training (n=7, 33%). Outcomes included improvements in functional capacity, cognitive functioning, and QoL (n=10, 47%); reductions in pain and hospital length of stay; and enhancements in fatigue, physical and emotional well-being, and anxiety. Positive effects on feasibility (n=3, 14%), acceptability (n=8, 38%), and cost-effectiveness (n=2, 9%) were also noted. Functional outcomes were frequently assessed (n=19, 71%) with tools like the 6-minute walk test and grip strength tests.

CONCLUSIONS

Telerehabilitation for patients with cancer is beneficial and feasible, with diverse approaches in study design, technologies, exercises, and outcomes. Future research should focus on developing standardized methodologies, incorporating objective measures, and exploring emerging technologies like virtual reality, wearable or noncontact sensors, and artificial intelligence to optimize telerehabilitation interventions. Addressing these areas can enhance clinical practice and improve outcomes for remote rehabilitation with patients.

Perioperative management of sarcopenia in patients undergoing major surgeries in Singapore: a modified Delphi consensus

BACKGROUND

Ageing population is a worldwide phenomenon with correspondingly higher proportion of older patients being treated in the hospital setting. Sarcopenia, which increases with age, has serious negative implications on health, hospitalisation, and overall postoperative recovery. There is no mutual consensus on perioperative management of sarcopenia in surgical patients in Singapore. The purpose of this study is to create greater clarity pertaining to the recognition of sarcopenia, the application of assessment criteria of sarcopenia and perioperative management of surgical patients in Singapore.

METHODS

A modified Delphi consensus consisting of a panel of experts from Singapore forming a multidisciplinary team, including surgeons, geriatricians, anesthesiologists, physiotherapists, and dieticians. Eight recommendations were proposed by the steering committee. Literature search from MEDLINE, Embase, and Scopus for articles up till June 2023 were performed to support recommendation statements. The expert panel voted on agreement to recommendation statements and graded the level of evidence supporting each statement through surveys to achieve consensus, set at 85% a priori.

RESULTS

The panellists underwent two rounds of anonymized, independent voting before reaching consensus for all eight statements. After the first round, seven statements reached consensus, including the corresponding grading for level of evidence. The statement which did not achieve consensus was revised with supporting literature and after the second round of survey, all eight statements and level of evidence reached consensus, completing the Delphi process. These eight statements covered themes to (1) encourage the identification of sarcopenia, (2) guide preoperative, and (3) postoperative management of sarcopenia.

CONCLUSION

With the varying approaches in perioperative management, poor understanding of and identification of sarcopenia can result in suboptimal management of sarcopenia in surgical patients. Given the abundance of evidence linking beneficial impact on recovery and postoperative complications with prudent management of sarcopenia, it is imperative and urgent to achieve awareness and consensus.

Dutch prostate cancer patients' views about exercise and experience with exercise advice: a national survey

PURPOSE

To support the development and implementation of exercise programming for people with prostate cancer (PC), we investigated their views on exercise.

METHODS

Online survey with open recruitment. We collected data on clinical and sociodemographic variables, experiences with exercise advice, outcome expectations, and preferences. We explored determinants of (1) having been counselled about exercise and (2) preferring supervised exercise.

RESULTS

The survey was completed by 171 patients (mean age = 70 years, SD = 6.5) from all PC treatment pathways. Sixty-three percent of the respondents reported never having been informed about the potential benefits of exercise. Forty-nine percent preferred exercise to be supervised. Respondents generally reported a positive attitude towards exercise. Seventy-four percent indicated barriers to exercising, including fatigue and lack of access to specific programmes. Outcome expectations were generally positive but moderately strong. Receiving hormonal therapy and younger age were significantly associated with having received exercise advice. Being insured and having higher fatigue levels contributed significantly to the preference for supervised exercise.

CONCLUSION

Dutch people with PC report receiving insufficient effective exercise counselling. Yet, they are open to exercise and expect exercise to improve their health, although they experience various barriers that limit their ability to exercise.

IMPLICATIONS FOR CANCER SURVIVORS

The moderate outcome expectations for exercise of people with PC and their limited recall of exercise counselling highlight the need for better integration of exercise in clinical pathways. The lack of access to specific programming limits the use of evidence-based exercise programmes for people with PC.

Effect of resistance exercise on physical fitness, quality of life, and fatigue in patients with cancer: a systematic review

OBJECTIVE

The purpose of this study is to conduct a systematic review to assess the effects of different forms of resistance exercises (resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises) on physical fitness, quality of life (QOL), and fatigue of patients with cancer.

METHODS

We conducted a systematic review using the Cochrane Handbook for Systematic Reviews of Interventions guidelines. We searched PubMed, Web of Science, and Scopus databases for the studies from the establishment of the database to September 2023, including randomized controlled trials and clinical trials that evaluated the effects of different resistance exercise on physical fitness, QOL, and fatigue in all patients with cancer. Two reviewers independently assessed the quality of all the included studies using the Cochrane Handbook for Systematic Reviews of Interventions and MINORS scale. We divided the intervention into three types: resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises.

RESULTS

In total, 48 studies (3,843 participants) met the inclusion criteria. The three exercise intervention forms have significant effects on physical fitness and QOL, but the improvement effect on fatigue is not clear. A total of 34 studies reported significant and beneficial effects of resistance exercise on physical fitness across all types of cancer. There were 28 studies that reported significant or borderline improvement effects of resistance on QOL, and only 10 studies reported significant effects of resistance exercise interventions on fatigue improvement in patients with cancer.

CONCLUSIONS

Resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises all have a positive effect on improving fitness and QOL in patients with cancer. Resistance exercise has an advantage in improving muscle strength, while combined resistance exercise has an advantage in improving QOL; however, there are no consistent findings in improving fatigue, although low-intensity resistance exercise is effective.

SYSTEMATIC REVIEW REGISTRATION

www.inplasy.com, identifier INPLASY2023110034.

The experience of live-remote exercise-perspectives after cancer treatment

PURPOSE

Live-remote exercise interventions, supervised by exercise professionals in a home-based setting, could potentially enhance exercise accessibility for cancer survivors, yet research on their perspectives is limited. This study explored cancer survivors' experience of exercise within the context of a live-remote exercise intervention, to understand factors influencing exercise engagement.

METHODS

Four online focus groups with, in total, 22 breast, prostate, and colorectal cancer survivors were conducted between March and June 2023. These individuals had participated in a 12-week live-remote exercise intervention. The semi-structured discussions were transcribed verbatim and analysed using reflexive thematic analysis with an abductive approach. The Capability, Opportunity, Motivation model of Behaviour (COM-B) served as a supportive framework.

RESULTS

Nine themes were identified and mapped onto COM-B domains (capability, opportunity, motivation). Factors influencing cancer survivors' exercise engagement included exercise readiness following cancer treatment, bringing exercise closer, in capable hands, peer support through shared experience, life factors as hurdles or support, exercise as an integral component of cancer treatment, caring for myself and others after me, the positive impact of exercise exceeding expectations, and getting into the habit.

CONCLUSIONS

Identifying factors shaping exercise engagement, these findings emphasise live-remote's potential benefit in overcoming barriers and fostering participation. Supervised by professionals, it offered psychosocial and exercise support, facilitating the integration of exercise into daily life.

IMPLICATIONS FOR CANCER SURVIVORS

Elucidating key factors for exercise engagement within a live-remote context is essential for developing and implementing live-remote exercise interventions to ensure accessible, integrated exercise for optimal post-treatment well-being for cancer survivors.

Combined Mindfulness-Based Stress Reduction and Exercise Intervention for Improving Psychological Well-Being in Patients With Non-Small Cell Lung Cancer

OBJECTIVE

This study aims to assess the clinical effectiveness of combining mindfulness-based stress reduction (MBSR) with exercise intervention in improving anxiety, depression, sleep quality and mood regulation in patients with non-small cell lung cancer (NSCLC).

METHODS

A total of 60 patients with NSCLC who had not received surgical treatment were selected using convenience sampling and divided into an intervention group and control group, with 30 patients in each group. The control group received conventional psychological nursing care, whereas the intervention group received a combination of MBwSR and exercise therapy. Before the intervention, a questionnaire was completed to collect the basic data of the two groups. Further questionnaires were administered at 6 and 8 weeks after treatment to assess anxiety, depression, sleep quality and other items included in the five-item Brief Symptom Rating Scale (BSRS-5).

RESULTS

No significant differences between the intervention and control groups were identified in terms of personal and clinical characteristics (p > 0.05). No significant differences were determined in the BSRS-5, Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) or Pittsburgh Sleep Quality Index (PSQI) scores between the intervention and control groups before the intervention. However, 6 and 8 weeks after the intervention, scores were significantly lower in both groups (p < 0.001). Significant differences in the BSRS-5, SAS, SDS and PSQI scores were identified between the two groups at different time points (p < 0.001).

CONCLUSION

The combination of MBSR and exercise intervention demonstrated improvements in anxiety, depression, sleep quality and BSRS-5 scores in patients with NSCLC.

Adapting an Efficacious Peer-Delivered Physical Activity Program for Survivors of Breast Cancer for Web Platform Delivery: Protocol for a 2-Phase Study

BACKGROUND

Interventions promoting physical activity (PA) among survivors of cancer improve their functioning, reduce fatigue, and offer other benefits in cancer recovery and risk reduction for future cancer. There is a need for interventions that can be implemented on a wider scale than that is possible in research settings. We have previously demonstrated that a 3-month peer-delivered PA program (Moving Forward Together [MFT]) significantly increased the moderate to vigorous PA (MVPA) of survivors of breast cancer.

OBJECTIVE

Our goal is to scale up the MFT program by adapting an existing peer mentoring web platform, Mentor1to1. InquistHealth's web platform (Mentor1to1) has demonstrated efficacy in peer mentoring for chronic disease management. We will partner with InquisitHealth to adapt their web platform for MFT. The adaptation will allow for automating key resource-intensive components such as matching survivors with a coach via the web-based peer mentoring platform and collecting key indexes to prepare for large-scale implementation. The aim is to streamline intervention delivery, assure fidelity, and improve survivor outcomes.

METHODS

In phase 1 of this 2-phase study, we will interview 4 peer mentors or coaches with experience in delivering MFT and use their feedback to create Mentor1to1 web platform adapted for MFT (webMFT). Next, another 4 coaches will participate in rapid, iterative user-centered testing of webMFT. In phase 2, we will conduct a randomized controlled trial by recruiting and training 10 to 12 coaches from cancer organizations to deliver webMFT to 56 survivors of breast cancer, who will be assigned to receive either webMFT or MVPA tracking (control) for 3 months. We will assess effectiveness with survivors' accelerometer-measured MVPA and self-reported psychosocial well-being at baseline and 3 months. We will assess implementation outcomes, including acceptability, feasibility, and program costs from the perspective of survivors, coaches, and collaborating organizations, as guided by the expanded Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.

RESULTS

As of September 2023, phase 1 of the study was completed, and 61 survivors were enrolled in phase 2. Using newer technologies for enhanced intervention delivery, program management, and automated data collection has the exciting promise of facilitating effective implementation by organizations with limited resources. Adapting evidence-based MFT to a customized web platform and collecting data at multiple levels (coaches, survivors, and organizations) along with costs will provide a strong foundation for a robust multisite implementation trial to increase MVPA and its benefits among many more survivors of breast cancer.

CONCLUSIONS

The quantitative and qualitative data collected from survivors of cancer, coaches, and organizations will be analyzed to inform a future larger-scale trial of peer mentoring for PA delivered by cancer care organizations to survivors.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05409664; https://clinicaltrials.gov/study/NCT05409664.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52494.

Cancer survivors maintain health benefits 6 to 12 months after exercise-based rehabilitation: a systematic review and meta-analysis

PURPOSE

To determine if the effects of exercise-based cancer rehabilitation on physical functioning, activity (including physical activity) and participation (including quality of life) are maintained at 6 to 12 months.

METHODS

Electronic databases CINAHL, Embase, MEDLINE, PsycINFO and PubMed were searched from the earliest available time to August 2021. Randomised controlled trials examining the long-term effects (≥ 6 months post-intervention) of exercise-based rehabilitation were eligible for inclusion. Outcome data (e.g. fitness, physical activity, walking capacity, fatigue, depression, quality of life) were extracted and the methodological quality assessed using PEDro. Meta-analyses using standardised mean differences were used to synthesise data and Grades of Recommendation, Assessment, Development and Evaluation criteria were applied.

RESULTS

Nineteen randomised controlled trials including 2974 participants were included. Participants who underwent exercise-based rehabilitation had improved physical activity (SMD 0.30, 95% CI 0.09 to 0.51, I2 = 0%), cardiorespiratory fitness (SMD 2.00 ml/kg/min, 95% CI 0.56 to 3.45, I2 = 0%), walking capacity (SMD 0.62, 95% CI 0.33 to 0.92, I2 = 0%), depression (SMD 0.71, 95% 0.05 to 1.37, I2 = 90%), quality of life (physical functioning component SMD 0.56, 95% CI 0.11 to 1.01, I2 = 62%) and sleep (MD 0.69 points, 95% 0.46 to 0.92, I2 = 0%) at 6 to 12 months follow-up. There was no data available on cancer-related mortality or recurrence.

CONCLUSION

Health outcomes of cancer survivors after exercise-based rehabilitation can be maintained after rehabilitation completion.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors can maintain health benefits achieved through exercise-based rehabilitation.

Exercise Across the Phases of Cancer Survivorship: A Narrative Review

Exercise has long been recognized as an important component of treatment for various diseases. However, the benefits and risks of exercise interventions must be carefully evaluated to ensure the former outweighs the latter. As cancer patients undergo diverse treatment modalities with distinct objectives, a systematic approach partitioning the cancer journey into distinct phases is necessary to inform tailored exercise prescriptions. This narrative review summarizes exercise benefits and mechanisms for cancer patients and survivors across four distinct survivorship periods-before surgery, after surgery and before adjuvant treatment, during nonsurgical treatment (adjuvant and neoadjuvant), and during extended survival. In summary, exercise reduces the risks of complications and declines in physical functioning while improving fatigue, quality of life, and the ability to manage treatment effects. Although additional research is warranted, existing evidence is sufficient to integrate exercise into clinical oncology practice and cancer survivorship programs.

Potential Therapeutic Role of Respiratory Muscle Training in Dyspnea Management of Cancer Survivors: A Narrative Review

Dyspnea is a disabling symptom presented in approximately half of all cancer survivors. From a clinical perspective, despite the availability of pharmacotherapies, evidence-based effective treatments are limited for relieving dyspnea in cancer survivors. Preliminary evidence supports the potential of respiratory muscle training to reduce dyspnea in cancer survivors, although large randomized controlled studies are warranted. The aims of this article were to review the relevant scientific literature on the potential therapeutic role of respiratory muscle training in dyspnea management of cancer survivor, and to identify possible mechanisms, strengths and limitations of the evidence as well as important gaps for future research directions.

Effects of Closed Kinetic Chain Exercises in Chemotherapy-Induced Peripheral Neuropathy: A Case Report

Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse reaction to many first- and second-line chemotherapy medications that can be debilitating, severe, and often dose-limiting. Treatment options for CIPN are limited. We report a case of a 52-year-old female patient with Stage II ovarian cancer who was hospitalised in the chemotherapy ward for a second round of chemotherapy. We describe the effectiveness of closed kinetic chain (CKC) exercises for the management of CIPN symptoms. The patient was advised to take neurophysiotherapy. The patient complained of pain, tingling in both feet, weakness in the lower limbs, and trouble keeping her balance while walking. Thus, three days after the start of the chemotherapy drugs, physical therapy rehabilitation was started. The patient stated total pain reduction and a noticeable improvement in tingling and numbness in both lower extremities following four weeks of physical therapy. Even though CIPN usually disappears gradually over time, it can persist for an extended period. It seems doubtful that this was a spontaneous resolve, given the regularity of her symptoms before starting physiotherapy sessions and their quick recovery with treatment. Further investigation is required to comprehend the role that physiotherapy and non-pharmacologic interventions play in ameliorating CIPN symptoms and to ascertain if improvements in CIPN symptoms are associated with an increase in blood flow directly or indirectly.

The Influence of Exercise on Cancer Risk, the Tumor Microenvironment and the Treatment of Cancer

There are several modifiable factors that can be targeted to prevent and manage the occurrence and progression of cancer, and maintaining adequate exercise is a crucial one. Regular physical exercise has been shown to be a beneficial strategy in preventing cancer, potentially amplifying the effectiveness of established cancer therapies, alleviating certain cancer-related symptoms, and possibly mitigating side effects resulting from treatment. Nevertheless, the exact mechanisms by which exercise affects tumors, especially its impact on the tumor microenvironment (TME), remain uncertain. This review aims to present an overview of the beneficial effects of exercise in the context of cancer management, followed by a summary of the exercise parameters, especially exercise intensity, that need to be considered when prescribing exercise for cancer patients. Finally, we discuss the influence of exercise on the TME, including its effects on crucial immune cells (e.g., T cells, macrophages, neutrophils, natural killer cells, myeloid-derived suppressor cells, B cells), intratumor angiogenesis, and cancer metabolism. This comprehensive review provides up-to-date scientific evidence on the effects of exercise training on cancer and offers guidance to clinicians for the development of safe and feasible exercise training programs for cancer patients in clinical practice.

Effect of a Long-Term Online Home-Based Supervised Exercise Program on Physical Fitness and Adherence in Breast Cancer Patients: A Randomized Clinical Trial

The purpose of the present study was to analyze the effect of a synchronous-supervised online home-based exercise program (HBG) during 24 weeks on body composition, physical fitness and adherence compared to an exercise recommendation group (ERG) without supervision with patients undergoing breast cancer treatment. Fifty-nine female breast cancer patients (31 in HBG and 28 in the ERG) undergoing cancer treatments participated in the present randomized clinical trial. The exercise program consisted of a 60 min combined resistance and aerobic supervised exercise session (6-8 points on Borg Scale CR-10, moderate intensity), twice a week during 24 weeks. The exercise recommendation group only received general recommendations to comply with the current ACSM guidelines. Body composition and physical fitness were assessed at baseline, 12 weeks and 24 weeks of the program. Adherence to the intervention was measured according to the minutes of exercise completed per session during each week. A general linear model of two-way repeated measures showed significant improvements (p < 0.05) in physical fitness that were observed in the home-based exercise group at the baseline, 12-week and 24-week assessments compared to the exercise recommendation group. Adherence was also higher in the home-based exercise group. However, no changes (p > 0.05) in body composition between groups and moments were observed. In this sense, supervised home-based exercise interventions can be an interesting strategy to improve physical fitness and adherence rates in breast cancer patients undergoing treatment.

Exercise oncology clinical trials during treatments: a commentary to address the safety concerns of human subjects regulatory reviewers and committees

Exercise oncology clinical trials contribute to the advancement of our scientific knowledge and to the safety and care of patients diagnosed with cancer. Nevertheless, regulatory reviewers and committees may not be familiar with the well-documented long-term health benefits and safety of the regular practice of physical activity. Moreover, they may not see how the benefits outweigh the risks in the context where patients diagnosed with cancer are typically seen as vulnerable. Therefore, we would like to provide a purpose-built overview of exercise oncology clinical trials for members involved in institutional review committees, including the Scientific Review Committee (SRC), the Institutional Review Board (IRB), and the Data Safety Monitoring Committee (DSMC) to facilitate a greater understanding of the safety and benefits of physical activity during cancer treatments. Communication is key to improve the success of exercise oncology clinical trials, which are vital for patients diagnosed with cancer.

Digital home-based post-treatment exercise interventions for female cancer survivors: A systematic review and meta-analysis

BACKGROUND

Although exercise benefits female cancer survivors, clinical decision-making regarding timing, frequency, duration, and intensity is lacking. Optimizing exercise interventions in this population is necessary. This study aimed to describe existing digital home-based exercises and to assess their effectiveness at improving physical health in female cancer survivors upon completion of therapy.

DESIGN

We conducted a systematic review using articles from Web of Science, Embase and Medline (Ovid). We included intervention studies examining the effects of digital home-based exercise programs on post-treatment recovery in female cancer survivors. Rob2 and ROBIN I were used to assess quality of studies. Quality-of-life, fatigue score, and physical performance were assessed using meta-analysis.

RESULTS

This study involved 1578 female cancer survivors in 21 interventions. Following guidelines and supervised exercise with coaches led to better outcomes than interventions without guidelines, programs without coaches, or lower intensity exercise. Exercise led to significant improvement in some physical performance outcomes. Significant improvements were seen in physical performance outcomes, including the 6-min walk test, metabolic equivalent task, and number of steps per day.

CONCLUSION

Providing cancer survivors with standard guidelines for home-based, coach-supervised, vigorous exercise on digital platforms could improve their physical function, health, and quality-of-life.

Comparing the efficacy of a multi-dimensional breast cancer rehabilitation programme versus a home-based exercise programme during adjuvant cancer treatment

BACKGROUND

Breast cancer is the most common female malignancy worldwide and a major cause of morbidity and mortality. Exercise during adjuvant treatment improves function and relieves symptoms in breast cancer survivors. However, it is unclear if an unsupervised exercise programme may be as effective as a supervised multimodal group. We investigated the feasibility and efficacy of a centre-based multidimensional rehabilitation (MDR) programme for breast cancer survivors undergoing adjuvant treatment and compared it to an unsupervised home-based exercise (HE) programme.

METHODS

Participants were self-allocated to either MDR or HE group. MDR participants underwent 24 supervised exercise classes and 10 education classes over 12 weeks. HE participants were instructed on a home exercise regime. Outcome measures, including the 6-min walk test (6MWT) and Frenchay Activities Index (FAI), FACT-Cognitive Function scale, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, were conducted at baseline (W0), post-intervention (W12) and 6-months post-intervention (M6). Variance between time points and the 2 groups were analysed using a linear mixed model (unstructured covariance matrix) and adjusted with Bonferroni.

RESULT

Twenty-five participants attended at least half of the MDR interventions, while 21 completed the HE interventions. The former showed significant improvement in 6MWT, from 406.88 m (W0) to 443.34 m (W12) to 452.81 m (M6), while the improvement in the HE group was not significant (407.67 m (W0) to 433.14 m (W12) to 430.96 m (M6)). Both groups showed a significant improvement in FAI, with earlier significant improvement noted at W12 in the MDR group (22.71 (W0) to 27.65 (W12) to 28.81 (M6)) compared to the HE group (23.16 (W0) to 26.47 (W12) to 29.85 (M6)). Dropout rate was 16% in the MDR group and 34% in HE group. Overall satisfaction with the MDR programme was high.

CONCLUSION

Both MDR and HE programmes were feasible. MDR was superior in improving endurance and earlier return to instrumental activities for those who completed at least half of the sessions. Future studies could explore use of technology to improve adherence to exercise.

TRIAL REGISTRATION

The study was registered with ClinicalTrial.gov on 01/04/2022 with the registration number NCT05306808.

Designing viable, durable physical activity programs for cancer survivors: reflections from program participants and organizational leaders

PURPOSE

Despite recommendations for cancer survivors to participate in routine physical activity (PA), offering programs that fit both survivors' needs and sponsoring organizations' resources remains a challenge. The purpose of this study is to explore the perspectives of cancer survivors and organizational stakeholders with the intent of developing PA peer-led programs that organizations can implement into their programming.

METHODS

This study explored cancer survivors' (n = 11) and cancer care organizational stakeholders' (n = 27) perspectives on the design and feasibility of PA programs targeted for cancer survivors. Semi-structured interview guides were developed for survivors and stakeholders; interviews lasted approximately 30 min. Two analysts used a thematic analysis approach and independently conducted a line-by-line coding of each transcript. With guidance from a senior analyst, the codes were collapsed into themes and subthemes.

RESULTS

The qualitative analysis of the interview data resulted in seven major themes relating to PA program development and success. Survivor-related themes included the following: (1) developing PA programs based on cancer survivors' characteristics and experiences; (2) perceived value and importance of accessible, face-to-face instruction; (3) ensuring success based on physical abilities and limitations of the survivor; and (4) the value of physician recommendation for PA participation. Organization-related themes included the following: (1) incorporating participant and community input into program offerings; (2) program feasibility and sustainability; (3) incorporating organizational experience when adopting new program initiatives.

CONCLUSION

These findings highlight the challenges of developing viable PA programs for cancer survivors and may guide organizations in future program development and implementation.

Effects of a peer-led physical activity program on psychosocial outcomes among breast cancer survivors

OBJECTIVE

To examine the effects of three programs aimed at maintaining moderate-to-vigorous physical activity (MVPA) on breast cancer survivors' quality of life, physical functioning, fatigue and mood.

METHODS

161 survivors participated in a 12-month randomized controlled study and were assigned to one of three groups: Reach Plus, Reach Plus Message, or Reach Plus Phone. All participants received the same intervention for the first 3 months (weekly calls from peer coach) for MVPA adoption. In Months 4-9, Reach Plus monitored MVPA and received feedback reports. Reach Plus Message monitored MVPA and received weekly text/email messages and feedback reports. Reach Plus Phone participants monitored MVPA and received monthly calls from coaches and feedback reports. Intervention delivery ended at 9 months. Assessments were obtained at baseline, 3, 6, 9, and 12-months. Analyses used a series of longitudinal mixed effects models with subject-specific intercepts.

RESULTS

All groups improved significantly across time on psychosocial measures. At 9 months, Reach Plus Message and Reach Plus Phone reported better physical functioning compared to Reach Plus (b = 8.27, 95% CI: [2.27, 14.27]; b = 4.89, 95% CI: [0.01, 10.53]) respectively). At 12 months, Reach Plus Message reported better physical functioning than Reach Plus (b = 4.52, 95% CI: [0.01, 9.75]. Participants who met national PA guidelines reported significantly lower fatigue and higher physical functioning (at 9 and 12 months), and improved mood (at 12 months).

CONCLUSIONS

MVPA maintenance via weekly messages or monthly coach calls improved physical functioning. Maintaining MVPA at or above national recommendations was associated with improved physical functioning, mood and less fatigue.

Association of self-directed walking with toxicity moderation during chemotherapy for the treatment of early breast cancer

BACKGROUND

In the field of exercise oncology, there is a need to quantify the potential benefits of moderate, self-directed physical activity during active treatment. In a pooled analysis of three identical single-arm intervention studies, we investigate the association of activity tracker steps with patient-reported toxicities during chemotherapy.

METHODS

Women with early breast cancer who were enrolled in the intervention studies reported their symptom severity every 2-3 weeks throughout chemotherapy, and daily steps were documented through a Fitbit activity tracker. Relative risks (RR) and 95% confidence intervals (CI) were calculated using Poisson regression models with robust variance. For outcomes significant in unadjusted models, adjusted RRs were calculated controlling for race, age, and education level. Tracker step cut point (high step, low step) was determined by the means. Cumulative incidence functions of moderate, severe, and very severe (MSVS) symptoms were estimated using the Kaplan-Meier method and compared using a Cox proportional hazard model.

RESULTS

In a sample of 283 women, mean age was 56 years and 76% were White. Mean tracker-documented steps/week were 29,625, with 55% walking below the mean (low step) and 45% above (high step). In multivariable analysis, high step patients had lower risk for fatigue [RR 0.83 (0.70, 0.99)] (p = 0.04), anxiety [RR 0.59 (0.42, 0.84)] (p = 0.003), nausea [RR 0.66 (0.46, 0.96)] (p = 0.03), depression [RR 0.59 (0.37, 0.03)] (p = 0.02), and ≥ 6 MSVS symptoms [RR 0.73 (0.54, 1.00)] (p = 0.05) and had 36% lower risk for dose reductions [RR 0.64 (95% CI 0.43, 0.97)] (p = 0.03).

CONCLUSION

Self-directed walking at a rate of at least 30,000 steps/week may moderate the severity of treatment side effects during chemotherapy for early breast cancer.

TRIAL NUMBERS

NCT02167932, NCT02328313, NCT03761706.

Impact of Exercise Interventions on Sustained Brain Health Outcomes in Frail Older Individuals: A Comprehensive Review of Systematic Reviews

Several systematic review studies highlight exercise's positive impact on brain health outcomes for frail individuals. This study adopts a Comprehensive Review of reviews (CRs) approach to amalgamate data from existing reviews, focusing on exercise's influence on brain health outcomes in older frail and pre-frail adults. The methodology involves a thorough search of Portuguese, Spanish, and English-indexed databases (i.e., Ebsco Health, Scielo, ERIC, LILACS, Medline, Web of Science, SportDiscus) from 1990 to 2022, with the AMSTAR-2 tool assessing evidence robustness. The search terms "physical exercise", "elderly frail", and "systematic review" were employed. Results: Out of 12 systematically reviewed studies, four presented high-quality (with metanalyses), while eight exhibit critically low quality. Positive trends emerge in specific cognitive and neuromotor aspects, yet challenges persist in psychosocial domains, complex cognitive tasks, and ADL outcomes. This study yields reasonable and promising evidence regarding exercise's influence on quality of life and depression in frail older individuals. However, the impact on biochemical markers remains inconclusive, emphasizing the need for standardized methodologies. Conclusions: The findings highlight the importance of acknowledging methodological nuances for clinicians and policymakers when translating these results into impactful interventions for aging populations. This emphasizes the necessity for a comprehensive and customized approach to exercise interventions aimed at fostering the sustainability of overall well-being in older individuals, aligning with United Nations Sustainable Development Goal 3.

Qualitative exploration of the perceptions of exercise in patients with cancer initiated during chemotherapy: a meta-synthesis

OBJECTIVE

To synthesise qualitative literature on (1) the perceptions of patients with cancer of participating in an exercise intervention while undergoing chemotherapy and (2) to inform and guide professionals in oncology and haematology practice.

DESIGN

A qualitative meta-synthesis based on Noblit and Hare's seven-step meta-ethnography.

DATA SOURCES

Six electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, EMBASE, PubMed, SCI-Expanded-SSCI and Scopus (final search June 2022) were used to identify qualitative literature containing individual or focus group interviews. The transparency of reporting for each study was assessed using the Consolidated criteria for Reporting Qualitative research checklist.

RESULTS

The search identified 5002 articles, 107 of which were selected for full-text review. Seventeen articles from five countries with patients undergoing chemotherapy during exercise interventions were included. Eleven articles were included in the meta-synthesis, which comprised 193 patients with various cancer diagnoses, disease stages, sexes and ages. Four main themes were identified: chemotherapy overpowers the body; exercise in battle with side effects; a break from gloomy thoughts; and a question of survivorship.

CONCLUSIONS AND IMPLICATIONS

The meta-synthesis emphasised that patients with cancer undergoing chemotherapy and simultaneously participating in exercise interventions may experience momentary relief from overwhelming side effects, even though full bodily recovery may be perceived as a distant prospect. The synthesis offers a sparse empirical basis for gaining insight into what patients experience existentially following exercise interventions. It is up to patients to independently apply the transfer value of exercise to their own existential circumstances.

Effects of Exercise Rehabilitation on Physical Function in Adults With Hematological Cancer Receiving Active Treatment: A Systematic Review and Meta-Analysis

OBJECTIVE

Evaluate the efficacy of exercise rehabilitation at improving physical function during active treatment for adults diagnosed with a hematological malignancy.

DATA SOURCE

Systematic review with a multilevel meta-analysis of randomized trails was conducted. Four electronic databases, MEDLINE (EBSCOhost), CINAHL, Scopus, and CENTRAL, were searched using key words and medical subject headings. Articles were screened and assessed against the predetermined eligibility criteria. Data extracted were appraised using the Cochrane risk of bias tool for randomized trials and the GRADE guidelines. A meta-analysis examined four key clinical objectives.

CONCLUSION

Twelve studies representing a total of 812 participants were included. Analysis of 36 dependent effect sizes from nine studies revealed structured and prescribed exercise interventions improved physical function (SMD = 0.39; 95% CI 0.21-0.57) compared to usual care or an active control. Exercise interventions with a multimodal design consisting of both aerobic and resistance exercise had a statistically significant effect on physical function (P < .001). Exercise intensity also had a statistically significant effect on physical function when prescribed at a moderate (P = .003) and vigorous (P < .001) intensity during active treatment in patients with leukemia or lymphoma.

IMPLICATIONS FOR NURSING PRACTICE

This review suggests individuals diagnosed with leukemia or lymphoma can optimize physical function during and immediately post-treatment by attending exercise rehabilitation 3-5 times per weeks performing moderate-vigorous aerobic and resistance exercise. While further research is needed to identify optimal prescription guidelines throughout the treatment continuum, this review underscores the importance for hematology nurses to support patient referrals to exercise oncology professionals to gain positive improvements in physical function.

Physical function in older adults with and without a cancer history: Findings from the National Health and Aging Trends Study

BACKGROUND

Previous studies identified physical function limitations in older cancer survivors, but few have included objective measures and most focused on breast and prostate cancer survivors. The current study compared patient-reported and objective physical function measures between older adults with and without a cancer history.

METHODS

Our cross-sectional study used a nationally representative sample of community-dwelling, Medicare beneficiaries from the 2015 National Health and Aging Trends Study (n = 7495). Data collected included patient-reported physical function, including a composite physical capacity score and limitations in strength, mobility, and balance, and objectively measured physical performance metrics, including gait speed, five time sit-to-stand, tandem stand, and grip strength. All analyses were weighted to account for the complex sampling design.

RESULTS

Thirteen percent of participants (n = 829) reported a history of cancer, of which more than half (51%) reported a diagnosis other than breast or prostate cancer. In models adjusted for demographics and health history, older cancer survivors had lower Short Physical Performance Battery scores (unstandardized beta [B] = -0.36; 95% CI: -0.64, -0.08), slower gait speed (B = -0.03; 95% CI: -0.05, -0.01), reduced grip strength (B = -0.86; 95% CI: -1.44, -0.27), worse patient-reported composite physical capacity (B = -0.43; 95% CI: -0.67, -0.18) and patient-reported upper extremity strength (B = 1.27; 95% CI: 1.07, 1.50) compared to older adults without cancer. Additionally, the burden of physical function limitations was greater in women than in men, which may be explained by cancer type.

CONCLUSIONS

Our results extend studies in breast and prostate cancer to show worse objective and patient-reported physical function outcomes in older adults with a range of cancer types compared to those without a cancer history. Moreover, these burdens seem to disproportionately affect older adult women, underscoring the need for interventions to address functional limitations and prevent further health consequences of cancer and its treatment.

Effects of exercise on cancer-related cognitive impairment in breast cancer survivors: a scoping review

BACKGROUND

Cancer-related cognitive impairment (CRCI) is one of the major long-term concerns reported by breast cancer survivors after overcoming the disease. The present study undertakes a scoping review of relevant research publications to explore the effect of increasing physical activity (PA) levels or the use of exercise (EX)-based programs on CRCI in female breast cancer survivors; who have completed neo/adjuvant chemotherapy treatment and are awaiting or receiving hormonal therapy.

METHODS

An electronic search of Pubmed, Embase, Scopus, WOS, and Cochrane databases has been conducted to identify published literature from January 2000 to December 2021.

RESULTS

Of 1129 articles, twenty met the inclusion criteria. The majority of the included observational studies (90%) reported cross-sectional design; meanwhile, 72% of experimental research reported randomized controlled trials (RCTs) or randomized crossover trials. 15 neuropsychological batteries and tests, and 5 self-reported validated questionnaires were employed. Only 27% of the included articles used a combination of the previously mentioned methods. The recorder of moderate-vigorous PA (MVPA), defined as more than 3 METs, or represented as average daily minutes spent (≥ 1952 counts/min) was the most analyzed variable in cross-sectional studies, and EX programs based on aerobic training (AT) were the most proposed by RCTs.

CONCLUSIONS

The exploratory approach of this review demonstrates modest but increasingly promising evidence regarding exercise's potential to improve brain health among breast cancer survivors although these findings highlight the importance of addressing methodological heterogeneity in the same direction with the view of using exercise within the clinic area.

Long-term efficacy of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: A randomized controlled trial

BACKGROUND

Physical activity (PA) can improve the physical and psychological health of prostate and colorectal cancer survivors, but PA behavior change maintenance is necessary for long-term health benefits. OncoActive is a print- and web-based intervention in which prostate and colorectal cancer patients and survivors receive automatically generated, personalized feedback aimed at integrating PA into daily life to increase and maintain PA. We evaluated the long-term outcomes of OncoActive by examining the 12-month follow-up differences between OncoActive and a control group, and we explored whether PA was maintained during a 6-month non-intervention follow-up period.

METHODS

Prostate or colorectal cancer patients were randomly assigned to an OncoActive (n = 249) or a usual care waitlist control group (n = 229). OncoActive participants received PA advice and a pedometer. PA outcomes (i.e., ActiGraph and self-report moderate-to-vigorous intensity PA (MVPA) min/week and days with ≥30 min PA) and health-related outcomes (i.e., fatigue, depression, physical functioning) were assessed at baseline, 6 months, and 12 months. Differences between groups and changes over time were assessed with multilevel linear regressions for the primary outcome (ActiGraph MVPA min/week) and all additional outcomes.

RESULTS

At 12 months, OncoActive participants did not perform better than control group participants at ActiGraph MVPA min/week, self-report MVPA min/week, or ActiGraph days with PA. Only self-report days with PA were significantly higher in OncoActive compared to the control group. For health-related outcomes only long-term fatigue was significantly lower in OncoActive. When exploratively examining PA within OncoActive, the previously found PA effects at the end of the intervention (6 months follow-up) were maintained at 12 months. Furthermore, all PA outcomes improved significantly from baseline to 12 months. The control group showed small but non-significant improvements from 6 months to 12 months (and from baseline to 12 months), resulting in a decline of differences between groups.

CONCLUSION

The majority of previously reported significant between-group differences at 6 months follow-up were no longer present at long-term follow-up, possibly because of natural improvement in the control group. At long-term follow-up, fatigue was significantly lower in OncoActive compared to control group participants. Computer-tailored PA advice may give participants an early start toward recovery and potentially contributes to improving long-term health.

The effect of exercise interventions on quality of life in patients with multiple myeloma: a systematic review and meta-analysis of randomised controlled trials

PURPOSE

To determine the effect of exercise interventions on quality of life in adults with multiple myeloma.

METHODS

A literature search of 10 sources was performed in June 2022 to identify eligible studies for synthesis.

INCLUSION CRITERIA

randomised controlled trials comparing the effect of exercise interventions with usual care in adults with a diagnosis of multiple myeloma. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. Meta-analysis was performed using a random-effects model with inverse variance and 95% confidence intervals. Forest plots were constructed to present pooled data.

RESULTS

Five RCTs, which included a total of 519 participants, were selected for inclusion. Four of the five studies were included in the meta-analysis. The mean participant age ranged from 55 to 67 years old. All studies included an aerobic exercise component. Intervention length ranged from 6 to 30 weeks. Meta-analysis of 118 participants showed that exercise interventions had no impact on global quality of life (MD = 2.15, 95% CI: - 4.67, 8.97, p = 0.54, I2 = 0%). Exercise interventions negatively impacted participant grip strength (MD: - 3.69, 95% CI: - 7.12, -0.26, p = 0.03, I2 = 0%) according to pooled data from 186 participants.

CONCLUSION

Exercise interventions have no positive impact on the quality of life of patients with multiple myeloma. The analysis is limited by a high risk of bias across included studies and low certainty evidence. Further high-quality trials are needed to assess the role of exercise in patients with multiple myeloma.

Comparative effects of different types of exercise on health-related quality of life during and after active cancer treatment: A systematic review and network meta-analysis

BACKGROUND

The positive influence of most types of exercise has been reported repeatedly, but what the most effective exercise approaches are for improving health-related quality of life (HRQoL) in people with cancer remains unknown. The aim of this systematic review and network meta-analysis was to synthesize the evidence from intervention studies to assess the effects of different types of exercise on HRQoL during and after cancer treatment.

METHODS

MEDLINE, SPORTDiscus, the Cochrane Library, Web of Science, and Scopus were searched for randomized controlled trials aimed at testing the effects of exercise interventions meant to improve HRQoL in people with cancer. Separate analyses were conducted for HRQoL as measured by general and cancer-specific questionnaires. We also evaluated whether the effects of exercise were different during and after cancer treatment in both the physical and mental HRQoL domains.

RESULTS

In total, 93 studies involving 7435 people with cancer were included. Network effect size estimates comparing exercise intervention vs. usual care were significant for combined exercise (0.35, 95% confidence interval (95%CI): 0.14-0.56) for HRQoL as measured by general questionnaires, and for combined (0.31, 95%CI: 0.13-0.48), mind-body exercise (0.54, 95%CI: 0.18-0.89), and walking (0.39, 95%CI: 0.04-0.74) for HRQoL as measured by cancer-specific questionnaires.

CONCLUSION

Exercise programs combining aerobic and resistance training can be recommended to improve HRQoL during and after cancer treatment. The scarcity and heterogeneity of these studies prevents us from making recommendations about other exercise modalities due to insufficient evidence.

Incorporation of Palliative Care in Gynecologic Oncology

PURPOSE OF REVIEW

This review serves to provide clarity on the nature, scope, and benefits of early palliative care integration into the management of patients with gynecologic malignancies.

RECENT FINDINGS

There is increased recognition that timely referral to palliative care improves quality of life for patients and their families by providing goal-concordant care that reduces physical and emotional suffering and limits futile and aggressive measures at the end of life. Palliative care services rendered throughout the continuum of illness ultimately increase engagement with hospice services and drive down health expenditures. Despite these myriad benefits, misconceptions remain, and barriers to and disparities in access to these services persist and warrant continued attention. Palliative care should be offered to all patients with advanced gynecologic cancers early in the course of their disease to maximize benefit to patients and their families.

Hula as a physical activity and social support intervention for sustained activity in female breast and gynecologic cancer survivors

Background

Physical activity improves health and psychosocial functioning for people who have been diagnosed with cancer. Native Hawaiians face disparities for some cancers, including breast cancer. Delivering culturally grounded interventions has the potential to improve enjoyment and adherence to the intervention. We sought to test the adherence and impact of a 6 month randomized wait-list controlled trial of hula.

Methods

In this randomized wait-list controlled design people who had been diagnosed with breast or gynecologic cancers were invited to participate with other cancer survivors in a group based setting. Participants were randomized to begin hula immediately or after six months. Attendance was collected and heart-rate measured three times per session. In addition, demographic data, self-report psychosocial data, and biological data (findings will be reported elsewhere) were collected at three time points: baseline, 6 months, and 12 months. The study included six months of hula, twice per week, 60 min each session. In addition, participants committed to practice 60 min per week at home.

Results

Participants in the study (n = 42) attended, on average, 72% of the sessions. Significant increase in moderate physical activity (d = 0.50, p = 0.03) was observed in the intervention versus control group. For the measures of intra-individual changes pre-and post-intervention, an increase in total physical activity were seen in the intervention group (d = 0.69, p = 0.003), daily caloric intake decreased (d = -0.62, p = 0.007), and a reduction in waist circumference (d = -0.89, p = 0.0002) that was sustained six months after completion of the intervention. Psychosocially, cognitive functioning significantly declined from baseline to 12 months (d = -0.50, p = 0.03), with role functioning improving (d = 0.55, p = 0.02), social constraints increasing (d = 0.49, p = 0.03), and financial difficulties improving (d = -0.55, p = 0.02).

Conclusion

Sustainable physical activity is crucial to improve both the survival and quality of life of cancer survivors. Culturally grounded interventions, such as hula have the potential to increase the maintenance of physical activity. In addition, they create a support group where the benefits of people who have all experienced cancer can gather and garner those benefits of social support, too. This study was registered as a clinical trial through the National Cancer Institute (NCT02351479).

Clinical trial registration

Clinicaltrails.gov, NCT02351479.

Impact of interventions on the quality of life of cancer patients: a systematic review and meta-analysis of longitudinal research

The impact of cancer interventions has been conducted in several research due to the significant burden of this non-communicable disease. The interventions that played an important role in the improvement of the patient's quality of life (QoL) and health-related quality of life (HRQL) can be classified into two main groups: pharmaceutical and non-pharmacological methods. However, studies so far often analyze a specific group of interventions for specific types of cancer. Thus, in this systematic review and meta-analysis, we synthesized the overall impact of cancer interventions on patients' quality of life in several cancers.In this research, we followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) to search the longitudinal original research on the Web of Science (WOS) database. After that, the Newcastle-Ottawa Scale (NOS) and Jadad Scale were used to assess the quality of non-randomized control trials and randomized control trials, respectively. Then, the characteristics of the included studies were described in the six main fields table and the random effect model with robust estimation was applied to analyze the impact of interventions on the health utility of patients.From the database, 122 longitudinal original research were included in the meta-regression, with most of them having high or fair quality. The European Organization for the research and treatment of cancer scale for quality of life (EORTC-QLQ) was the most used health utility measurement at 65.15%. In the adjusted effect models, the Visual Analogue Scale (VAS) had significant statistics in all models when we compared it with the EQ-5D Scale (p < 0.05) and several types of cancer such as breast, lung, and prostate cancer had significant statistics when comparing with hematological cancer in the model types of cancer (p < 0.01). Moreover, radiotherapy, screening, and a combination of chemotherapy and best supportive care also had significant statistics (p < 0.01) in the model of interventions when compared with radiotherapy applied only. Our research can suggest a vital combination of both pharmaceutical and non-pharmacological interventions to improve the quality of life of some common types of cancer patients.

A systematic review of exercise protocols applied to athymic mice in tumor-related experiments

Athymic mice are unable to produce T-cells and are then characterized as immunodeficient. This characteristic makes these animals ideal for tumor biology and xenograft research. New non-pharmacological therapeutics are required owing to the exponential increase in global oncology costs over the last 10 years and the high cancer mortality rate. In this sense, physical exercise is regarded as a relevant component of cancer treatment. However, the scientific community lacks information regarding the effect of manipulating training variables on cancer in humans, and experiments with athymic mice. Therefore, this systematic review aimed to address the exercise protocols used in tumor-related experiments using athymic mice. The PubMed, Web of Science, and Scopus databases were searched without restrictions on published data. A combination of key terms such as athymic mice, nude mice, physical activity, physical exercise, and training was used. The database search retrieved 852 studies (PubMed, 245; Web of Science, 390; and Scopus, 217). After title, abstract, and full-text screening, 10 articles were eligible. Based on the included studies, this report highlights the considerable divergences in the training variables adopted for this animal model. No studies have reported the determination of a physiological marker for intensity individualization. Future studies are recommended to explore whether invasive procedures can result in pathogenic infections in athymic mice. Moreover, time-consuming tests cannot be applied to experiments with specific characteristics such as tumor implantation. In summary, non-invasive, low-cost, and time-saving approaches can suppress these limitations and improve the welfare of these animals during experiments.

Mediators of physical activity maintenance during a 12-month randomized controlled trial among breast Cancer survivors

PURPOSE

To explore the theoretical constructs that functioned as mediators of interventions for moderate-to-vigorous physical activity (MVPA) maintenance among breast cancer survivors.

METHOD

161 survivors were randomized into 3 groups: Reach Plus, Reach Plus Message or Reach Plus Phone. All participants received a 3-month theory-based intervention delivered by volunteer coaches. During months 4-9, all participants monitored their MVPA and received feedback reports. Additionally, Reach Plus Message received weekly text/email messages and Reach Plus Phone received monthly calls from their coaches. Assessments of weekly MVPA minutes and theoretical constructs (self-efficacy, social support, physical activity [PA] enjoyment and PA barriers) were obtained at baseline, 3, 6, 9 and 12-months.

ANALYSES

Using a multiple mediator analysis with a product of coefficients approach, we examined mechanisms associated with between-group differences over time in weekly MVPA minutes.

RESULTS

Self-efficacy mediated effects of Reach Plus Message vs. Reach Plus at 6 (ab = 16.99) and 9 M (ab = 27.45); social support mediated effects at 6 (ab = 4.86), 9 (ab = 14.30) and 12 M (ab = 6.18). Self-efficacy mediated effects of Reach Plus Phone vs. Reach Plus at 6 (ab = 18.76), 9 (ab = 28.93) and 12 M (ab = 18.18). Social support mediated effects of Reach Plus Phone vs. Reach Plus Message at 6 (ab=-5.50) and 9 M (ab=-13.20); PA enjoyment mediated effects at 12 M (ab=-3.63).

CONCLUSIONS

PA maintenance efforts should focus on strengthening breast cancer survivors' self-efficacy and obtaining social support.The trial was registered at ClinicalTrials.Gov: NCT02694640 (Feb. 26, 2016).