A comparison of physical activity of posttreatment breast cancer survivors and noncancer controls

Smoking Cessation after a Cancer Diagnosis: A Cross-Sectional Analysis in the Setting of a Developing Country

Since smoking accounts for around 30% of all cancer deaths, public health campaigns often focus on smoking cessation as a means of primary prevention. However, smoking after cancer diagnosis is also associated with a higher symptom burden and lower survival rate. As data regarding smoking cessation vary dramatically between different populations, we aimed to analyze smoking prevalence in cancer patients, smoking cessation after cancer diagnosis, and the factors associated with smoking cessation in the setting of a developing country. We performed a cross-sectional survey on 695 patients in two clinical hospital centers. After cancer diagnosis, 15.6% of cancer patients stopped smoking. Male gender, younger age, and smoking-related cancer were the main factors associated with greater smoking cessation (p < 0.05). A total of 96% of breast cancer patients continued to smoke after cancer diagnosis and, compared to lung and colorectal cancer patients, exhibited a lower reduction in the number of cigarettes smoked (p = 0.023). An alarming rate of smoking prevalence was recorded in younger patients (45.6% at the time of cancer diagnosis) suggesting a future rise in smoking-related cancers and complications. These results should guide anti-smoking public health campaigns in transitional countries with a critical focus on younger and breast cancer patients.

Distinct trajectories of moderate to vigorous physical activity and sedentary behavior following a breast cancer diagnosis: the Pathways Study

PURPOSE

To identify distinct trajectories of total moderate-to-vigorous physical activity (MVPA) and sedentary behavior following a breast cancer diagnosis and their correlates.

METHODS

The analysis examined 3000 female breast cancer survivors within Kaiser Permanente Northern California between 2006 and 2013. Self-reported time spent on total MVPA and sedentary behaviors were assessed at baseline (mean = 1.8 months post-diagnosis) and at 6 and 24 months follow up. Trajectory groups were identified using group-based trajectory modeling and K-means for longitudinal data analysis. Trajectory groups were named by baseline activity level (high, medium, or low) and direction of change (increaser, decreaser, or maintainer).

RESULTS

Trajectory analyses identified three MVPA trajectories [high decreaser (7%), medium decreaser (35%), low maintainer (58%)] and four sedentary behavior trajectories [high maintainer (18%), high decreaser (27%), low increaser (24%), and low maintainer (31%)]. Women with higher education (ORs: 1.63-4.37), income (OR: 1.37), dispositional optimism (ORs: 1.60-1.86), and social support (OR: 1.33) were more likely to be high or medium decreasers of MVPA (all P < 0.05). High maintainers and high decreasers of sedentary behavior were more likely to have higher education (OR: 1.84) and social support (ORs: 1.42-1.86), but lower income (OR: 0.66; all P < 0.05).

CONCLUSIONS

In the 24 months following breast cancer diagnosis, 42% of survivors decreased MVPA and 73% maintained or increased time on sedentary behavior. Socioeconomic status and stress coping at diagnosis predicted subsequent PA trajectory.

IMPLICATIONS FOR CANCER SURVIVORS

It is important to prioritize exercise intervention and counseling during early stage of breast cancer survivorship, especially in survivors who are at high risk of becoming physically inactive post-diagnosis.

The difference is more than floating: factors affecting breast cancer survivors' decisions to join and maintain participation in dragon boat teams and support groups

Purpose: Peer support can be helpful in rehabilitation from breast cancer, but participation in peer support groups is low. Groups that provide support opportunities in physical activity contexts are an attractive alternative for some survivors. This study examined survivors' reasons for joining and maintaining participation on a dragon boat team, along with perceptions of barriers and attractions to traditional peer support groups. Materials and methods: Seventeen breast cancer survivors were interviewed on five occasions over their first two seasons of a newly formed dragon boating team to explore their perceptions of peer support groups and dragon boating. Data were inductively analyzed using thematic analysis. Results: Categories surrounding physical, psychological, social and community features were identified with several themes emerging within each. Advantages of dragon boating included opportunities to get a combination of physical, psychosocial and community benefits; health improvement and behavior change; and obtaining social support without the focus being on cancer. Peer support groups were identified as having advantages for forming relationships and avoiding barriers associated with physical activity. Conclusions: While neither type of program meets all needs, practical considerations are identified for incorporating advantages of both programs to improve participation. Implications for rehabilitation Further understanding of perceptions, and attractions and challenges to taking part in group programs will inform development of accessible programs that target multiple rehabilitation needs. Physical activity can provide a positive, alternative focus that takes the emphasis off of cancer, which is more accessible to some survivors. Physical activity also provides opportunities to build relationships around a common, positive goal, which can be a foundation for providing support for coping with cancer.

The Attributable Proportion of Specific Leisure-Time Physical Activities to Total Leisure Activity Volume Among US Adults, National Health and Nutrition Examination Survey 1999-2006

BACKGROUND

Previous studies have examined participation in specific leisure-time physical activities (PA) among US adults. The purpose of this study was to identify specific activities that contribute substantially to total volume of leisure-time PA in US adults.

METHODS

Proportion of total volume of leisure-time PA moderate-equivalent minutes attributable to 9 specific types of activities was estimated using self-reported data from 21,685 adult participants (≥ 18 years) in the National Health and Nutrition Examination Survey 1999-2006.

RESULTS

Overall, walking (28%), sports (22%), and dancing (9%) contributed most to PA volume. Attributable proportion was higher among men than women for sports (30% vs. 11%) and higher among women than men for walking (36% vs. 23%), dancing (16% vs. 4%), and conditioning exercises (10% vs. 5%). The proportion was lower for walking, but higher for sports, among active adults than those insufficiently active and increased with age for walking. Compared with other racial/ethnic groups, the proportion was lower for sports among non-Hispanic white men and for dancing among non-Hispanic white women.

CONCLUSIONS

Walking, sports, and dance account for the most activity time among US adults overall, yet some demographic variations exist. Strategies for PA promotion should be tailored to differences across population subgroups.

Need for Weight Management among Postmenopausal Early Breast Cancer Patients Receiving Adjuvant Endocrine Therapy

Increasingly effective adjuvant therapies mean that the prognosis for postmenopausal women with breast cancer has never been better. Weight problems are common among breast cancer patients and worsen due to the impact of diagnosis and treatment. Recent studies have linked excess weight with the risk of recurrence of breast cancer among premenopausal women. While general obesity (body mass index) does not appear to influence the already much improved prognosis for postmenopausal women, there is some evidence that limiting central obesity and improving insulin resistance may improve survival. The focus of attention for postmenopausal breast cancer survivors is also shifting to consider the mortality and morbidity from other weight-related cancers and noncancer causes, such as cardiovascular disease, making weight control a potentially important adjunct to endocrine therapy. This paper outlines the rationale and optimal design for effective weight management strategies among postmenopausal breast cancer patients receiving endocrine therapy.

U.S. Adults' Participation in Specific Activities: Behavioral Risk Factor Surveillance System--2011

BACKGROUND

There is little information on national estimates for participation in types of aerobic activities among U.S. adults. Current estimates are important to develop appropriate and effective interventions to promote physical activity and interpret bias for some activities measured with devices.

METHODS

The percentage of adults participating in specific aerobic activities was estimated overall and by demographic subgroups. The 2011 Behavioral Risk Factor Surveillance System respondents (N = 446,216) reported up to 2 aerobic activities they spent the most time doing during the past month.

RESULTS

Overall, walking (47%) was the most common activity reported and was reported more by women (54%) than men (41%). Participation in most activities declined with increasing age (P < .006). There were a number of differences in participation between race/ethnic subgroups. Participation increased with more education (P for trend < 0.006) for all activities. Participation in most activities was different (P < .002) across BMI subgroups.

CONCLUSIONS

Walking is the most common activity, overall and among most subgroups. Other activity profiles differ by demographic subgroup. Physical activity promotion strategies that focus on identifying and addressing personal and environmental barriers and understanding demographic subgroup differences could lead to more tailored interventions and public health programs.

Participation in Types of Physical Activities Among US Adults--National Health and Nutrition Examination Survey 1999-2006

BACKGROUND

Information on specific types of physical activities in which US adults participate is important for community and program development to promote physical activity.

METHODS

Prevalence of participation and average time spent for 33 leisure-time aerobic activities and 10 activity categories were calculated using self-reported data from 22,545 participants aged ≥ 18 years in the National Health and Nutrition Examination Survey 1999-2006.

RESULTS

Overall, 38% of US adults reported no leisure-time physical activities, and 43% reported 1 or 2 activities in the past 30 days. Walking was the most frequently reported activity for both men (29%) and women (38%). Among walkers, the average time spent walking was 198 minutes/week for men and 152 minutes/week for women. The most reported activities for men after walking were bicycling and yard work, and for women were aerobics and dance. For most activity categories, participation was lower among adults aged ≥ 65 years than among younger adults, and among Mexican Americans and non-Hispanic blacks than among non-Hispanic whites. Participation in most categories increased with increasing educational attainment.

CONCLUSIONS

Participation in physical activity differs by types of activities and demographic characteristics. Physical activity promotion programs should take these differences into account when developing intervention strategies.

Physical Activity in Breast Cancer Patients during Medical Treatment and in the Aftercare - a Review

Most scientific studies regarding physical activity in cancer patients involve breast cancer patients. It is apparent that physical activity during medical treatment and aftercare is not only feasible and safe but also effective. Current studies clearly show that regular and specific endurance and/or resistance training can reduce a number of side effects caused by medical treatment. Among others, improvements in physical performance, body composition, and quality of life as well as a reduction in fatigue, have been observed. Since inactivity appears to exacerbate lymphedema, patients with lymphedema are also encouraged to exercise. Few studies have been carried out regarding physical exercise in metastatic patients. However, experts in the field also recommend regular physical activity for patients with advanced-stage breast cancer.

Walking, bicycling, and sports in postmenopausal breast cancer survivors--results from a German patient cohort study

OBJECTIVES

Physical activity (PA) is increasingly discussed as a means to achieve both physical and psychological benefits for breast cancer patients and survivors. However, little is known about activity-specific PA behavior following diagnosis. Our objectives were to describe sports and active transportation in the course of breast cancer and to identify factors associated with these activities.

METHODS

We used data from a German cohort study including 1067 postmenopausal breast cancer survivors aged 50-75 years. Data were collected about walking and bicycling for transportation purposes and sports before diagnosis, during therapy, and 1 year after surgery. Associations between these activities and clinical, behavioral, and social characteristics were analyzed with logistic regression.

RESULTS

The proportions of physically active women decreased significantly during therapy compared with before diagnosis (walking: 75.1% vs. 89.7%; bicycling: 19.3% vs. 56.5%; sports: 14.8% vs. 64.5%; all p < 0.001). Calisthenics, swimming, and walking for exercise were the most frequent types of sport. Chemotherapy/radiotherapy was negatively associated with sports (odds ratio [OR]: 0.35 [0.17-0.73]) but positively associated with walking during therapy (OR: 2.08 [1.04-4.15]). Although sociodemographic factors showed weak associations with PA, participation in rehabilitation increased the likelihood for bicycling (OR: 1.48 [1.06-2.09]) and sports (OR: 1.88 [1.38-2.58]) 1 year after surgery.

CONCLUSIONS

The majority of women stopped exercising and bicycling during breast cancer therapy. Interventions promoting in particular moderate activities after breast cancer diagnosis are required for this population. Increasing participation in rehabilitation might help to increase the proportion of women who bicycle and engage in sports after breast cancer diagnosis.

Adherence to Physical Activity Guidelines in Breast Cancer Survivors

Physical activity in breast cancer survivors has been shown to improve outcomes. This study evaluated breast cancer patients’ adherence to physical activity guidelines in a population-based study. Data from the 2007 National Health Interview Survey were used to compare adherence to physical activity guidelines in patients with breast cancer with the general population. Statistical analyses were performed using SUDAAN software. In 2007, 327 breast cancer survivors and 23,030 others from the general population were surveyed. Breast cancer survivors were significantly older than the general population (mean age 64.9 vs 45.6 years, P < 0.001) and tended to be female (99.4 vs 51.2%, P < 0.001). Despite being significantly more likely to have interacted with a healthcare professional within the past year (96.7 vs 82.1%, P < 0.001), fewer breast cancer survivors reported following physical activity guidelines than nonbreast cancer survivors (4.64 vs 12.0%, P < 0.001). Controlling for age, gender, and interaction with healthcare providers, breast cancer survivors were no more likely to follow physical activity guidelines than the general population (OR: 0.73; 95% CI: 0.41-1.30, P = 0.282). Despite more interaction with healthcare providers, breast cancer survivors are no more likely to adhere to activity guidelines than the general population.

Level of physical activity and characteristics associated with change following breast cancer diagnosis and treatment

OBJECTIVE

While the physical and psychosocial benefits of participating in physical activity (PA) during and following breast cancer treatment are well understood, less is known about rates and uptake of PA following diagnosis. This paper explores the levels and patterns of PA among women recently diagnosed with breast cancer and the factors associated with change in activity levels.

METHODS

Using a population-based recruitment approach, PA levels of 287 breast cancer patients were assessed at 6, 12 and 18 months post-diagnosis using the Behavioral Risk Factor Surveillance System, and then converted to MET (metabolic equivalent task)-hours/week. Regression analyses were used to explore the correlates associated with change between 6 and 18 months post-diagnosis.

RESULTS

Although more than 80% of women participated in PA at each testing phases, more than 50% were considered insufficiently active or sedentary according to national recommendations and less than one-third reported engagement in vigorous or strength activities. Mean change in total MET-hours/week between 6 and 18 months post-diagnosis was minor (mean=0.10, median=0.0), however individual changes were substantial (ranging from -100 to +174 MET-hours/week). Results are more encouraging for the lower threshold of 3+ MET-hours/week, which may be most relevant specifically for breast cancer outcomes.

CONCLUSIONS

Since the majority of women report insufficient levels of PA, there is a clear need for exercise interventions during and following breast cancer treatment. Few characteristics predict declines or improvements in PA levels, hence for optimal benefit, interventions should target the entire breast cancer population.

Race/ethnicity, physical activity, and quality of life in breast cancer survivors

PURPOSE

To examine associations between recreational physical activity and quality of life (QOL) in a multiethnic cohort of breast cancer survivors, specifically testing whether associations are consistent across racial/ethnic groups after accounting for relevant medical and demographic factors that might explain disparities in QOL outcomes.

METHODS

Data were collected from a population-based cohort of non-Hispanic White (n = 448), Black (n = 197), and Hispanic (n = 84) breast cancer survivors (stage 0-IIIa) in the Health, Eating, Activity, and Lifestyle Study. Physical activity was assessed approximately 2.5 years after breast cancer diagnosis, with QOL assessed on average 6 to 12 months later. We used structural equation modeling to examine relationships between meeting recommended levels of physical activity and QOL, stratifying by race/ethnicity and adjusting for other demographic, comorbidity, and treatment effects.

RESULTS

Structural equation modeling indicated that meeting recommended levels of physical activity had significant positive associations with QOL for Black and non-Hispanic White women (P < 0.05). Fewer Black women reported meeting recommended physical activity levels (P < 0.001), but meeting recommendations was associated with better QOL. Post hoc tests showed that meeting physical activity recommendations was specifically associated with better vitality, social functioning, emotional roles, and global QOL (P < 0.05 for all).

CONCLUSIONS

These results suggest that meeting recommended levels of physical activity is associated with better QOL in non-Hispanic White and Black breast cancer survivors. Findings may help support future interventions among breast cancer survivors and promote supportive care that includes physical activity, although more research is needed to determine these relationships among Hispanic and other ethnic minority women.

Lifestyle behaviors, obesity, and perceived health among men with and without a diagnosis of prostate cancer: a population-based, cross-sectional study

Background

A better understanding of how prostate cancer survivors differ from men without prostate cancer and whether these potential differences vary across demographic subgroups will help to focus and prioritize future public health interventions for improving the health and well-being of prostate cancer survivors. Therefore, our study aims were to compare lifestyle behaviors, body mass index (BMI), and perceived health in men with and without a diagnosis of prostate cancer in a national, population-based sample and to explore whether these comparisons differ for demographic subgroups.

Methods

In a cross-sectional study, men aged ≥ 40 were identified from the Behavioral Risk Factor Surveillance System (BRFSS) 2002 data (n = 63,662). Respondents reporting history of prostate cancer (n = 2,524) were compared with non prostate cancer controls (n = 61,138) with regard to daily fruit and vegetable servings (FVPD), smoking, alcohol, sedentary behavior, BMI, and perceived health. Multivariable logistic regression calculated adjusted odds ratios (OR) and 95% confidence intervals (CI) for the entire sample and for age, race, education, and urbanicity subgroups.

Results

Men with prostate cancer did not differ from men without prostate cancer with regard to smoking, alcohol, sedentary behavior, and obesity but were more likely to consume ≥ 5 FVPD (OR, 95% CI: 1.30, 1.09–1.56) and report poor or fair health (OR, 95% CI: 1.62, 1.33–1.97). Subgroup analyses demonstrated attenuation of the higher likelihood of ≥ 5 FVPD among prostate cancer survivors in rural respondents (OR, 95% CI: 0.98, 0.72–1.33). Poorer perceived health was greatest if ≤ 65 years of age (OR, 95% CI: 2.54, 1.79–3.60) and nonsignificant if black (OR, 95% CI: 1.41, 0.70–2.82). Smoking and alcohol which were not significant for the sample as a whole, demonstrated significant associations in certain subgroups.

Conclusion

Although efforts to enhance perceived health and healthy lifestyle behaviors among prostate cancer survivors are warranted, demographic subgroups such as prostate cancer survivors ≤ 65 and rural populations may require more aggressive interventions.

Physical activity in Hodgkin's lymphoma survivors with and without chronic fatigue compared with the general population - a cross-sectional study

Background

Hodgkin's lymphoma survivors (HLSs) commonly report chronic fatigue, defined as high levels of fatigue for 6 months or more. Underlying mechanisms are poorly understood. Based upon knowledge from other populations, lifestyle parameters may be related to this increased and persistent fatigue. The primary objective of the present study was to assess self-reported levels of physical activity, smoking habits and sleep patterns in HLSs with and without chronic fatigue. The secondary objective was to compare these results with data from age and gender adjusted data from the general population (Gen-Pop).

Methods

The Fatigue Questionnaire (FQ) and questions about daily smoking, sleep patterns and level of physical activity were completed by 476 HLSs treated at Rikshospitalet-Radiumhospitalet Trust (RR). The Gen-Pop data was derived from 56.999 inhabitants in a Norwegian county responding to a mail survey. Fischer's exact test, chi square test and t-tests were used to compare groups. P-values < .05 were considered statistically significant. A logistic regression analysis was performed in comparing the Gen-Pop with the HLSs.

Results

Level of physical activity, smoking habits and sleep patterns did not differ significantly between HLSs with and without chronic fatigue. The multivariate logistic regression analysis adjusting for different covariates, showed significantly more physically active men among HLSs compared with the Gen-Pop (OR = 1.50, CI 1.04 – 2.17), p = .031. No significant difference was found among females (OR = 1.20, CI = 0.83 – 1.74), p = .33.

Conclusion

Lifestyle parameters did not seem to be related to increased and persistent fatigue among HLSs. The results may indicate that the experience of Hodgkin's lymphoma increases the level of physical activity among male HLSs.

Associations between exercise and quality of life in bladder cancer survivors: a population-based study

BACKGROUND

Exercise has been shown to improve quality of life (QoL) in some cancer survivor groups, but it is unknown if the unique QoL issues faced by bladder cancer survivors are also amenable to an exercise intervention. This study provides the first data examining the association between exercise and QoL in bladder cancer survivors.

METHODS

Bladder cancer survivors identified through a provincial cancer registry were mailed a survey that included the Godin Leisure Time Exercise Questionnaire, the Functional Assessment of Cancer Therapy-Bladder (FACT-Bl) scale, and the Fatigue Symptom Inventory.

RESULTS

Of the 525 bladder cancer survivors (51% response rate) that completed the survey, 22.3% were meeting public health exercise guidelines in the past month, 16.0% were insufficiently active (i.e., some exercise but less than the guidelines), and 61.7% were completely sedentary. ANOVA indicated a general linear association between meeting guidelines and QoL, with those meeting guidelines reporting more favorable scores than completely sedentary survivors on the FACT-Bl (mean difference, 7.6; 95% confidence interval, 3.6-11.7; P < 0.001), the FACT (P = 0.001), the trial outcome index (P < 0.001), functional well-being (P < 0.001), additional concerns (P = 0.001), sexual functioning (P < 0.001), erectile function (P < 0.001), body image (P < 0.001), and various fatigue indicators (P < 0.05). Adjusting for key medical and demographic factors slightly attenuated the magnitude of the associations but did not alter the substantive conclusions.

CONCLUSIONS

Exercise is positively associated with QoL in bladder cancer survivors, although few are meeting public health exercise guidelines. Studies testing the causal effects of exercise on QoL issues unique to this population are warranted.

A review of the benefits of whole body exercise during and after treatment for breast cancer

AIM

A current critical review of the literature was deemed necessary to evaluate the strength of evidence to inform clinical practice.

BACKGROUND

Recently, there has been a noticeable increase in empirical literature surrounding the benefits of exercise for breast cancer patients.

METHODS

A systematic search strategy was used to identify relevant literature. Twenty-nine articles were retained for critical review, appraised for quality and synthesized.

RESULTS

Many early studies had limited internal and external validity. Recent studies were considerably more rigorous and robust. Consistent support for all types of aerobic exercise was most evident in studies of patients during adjuvant cancer treatments (chemotherapy and radiotherapy), compared with post-treatment studies. The evidence which suggested that aerobic exercise limits cancer-related fatigue was particularly strong. For other patient concerns, the empirical support was less robust, however, the potential for beneficial and measurable patient outcomes was indicated for cardiopulmonary function, overall quality of life, global health, strength, sleep, self-esteem and reduced weight gain, depression, anxiety and tiredness.

CONCLUSIONS

Additional studies with higher methodological quality are required in this clinically relevant area to substantiate current indications particularly for patient subgroups (e.g. older people, those with advanced cancer and the disadvantaged).

RELEVANCE TO CLINICAL PRACTICE

It is important for all healthcare professionals involved in the care of individuals affected by breast cancer to be aware of the evidence surrounding the benefits of exercise and to encourage patients to increase physical activity and improve their overall health and well-being.

Modifiable Risk Factors for Breast Cancer Recurrence: What Can We Tell Survivors?

The potential for recurrence causes considerable distress for breast cancer survivors. Major information sources for survivors and providers offer few clear recommendations for postdiagnosis lifestyle change related to recurrence. To design interventions to improve long-term survivors' care and quality of life, we must know what survivors are doing to prevent recurrence in the absence of solid evidence, whether survivors' perceptions and behaviors correspond to hypothesized modifiable risk factors for recurrence, and whether survivors are adopting behaviors that could otherwise be harmful to their health. Our review first addresses the general lack of consensus on the impact of specific lifestyle factors on breast cancer recurrence and the resulting equivocal lifestyle recommendations for survivors. Second, we describe inadequacies of the studies of survivors' lifestyle changes related to recurrence. Because much of the existing knowledge about modifiable risk factors for recurrence comes from studies of survivors whose participation and behavior change were potentially influenced by their concern about recurrence, we need large, population-based observational studies of randomly selected breast cancer survivors, adequately representing the target population. Critical are data on lifestyle change from prediagnosis to postdiagnosis and changes over time after diagnosis, extensive data on conventional and nonconventional treatments, and the temporal relationship between behaviors and treatments, and inclusion of the full complement of potential lifestyle risk factors for recurrence. Understanding in detail the current status of survivors' perceptions and behaviors related to modifiable risk factors for recurrence can provide considerable practical information to inform future interventions and communication strategies for breast cancer survivors.

Health-related goals in female cancer survivors after treatment

Researchers often have studied cancer treatments and psychosocial aspects of dealing with cancer, but seldom have they evaluated cancer survivors at the end of their treatments or survivors' health-related goals. The purpose of the study was to identify the health-related goals of female cancer survivors at this phase of survivorship. Participants (N = 51) were women who were aged 34 to 77 years and had finished radiation and/or chemotherapy for primary breast or gynecologic cancers. Using a longitudinal design, interviews were conducted within 4 weeks and 3 to 4 months after treatment. Participants answered open-ended questions about their health-related goals. Content analyses were performed on participants' responses. Across interviews, the most common goals were improving physical activity (54-56% in first and second interviews, respectively), performing meaningful activities (26-27%), losing weight (21-22%), and eating a better diet (16-22%). Clinicians can assess for such common goals and address them, as needed, among women with breast or gynecologic cancer. Researchers could design and test the effect of interventions designed to address patients' goals on behavioral and health outcomes among similar cancer survivors.

Health behaviors of cancer survivors: examining opportunities for cancer control intervention

PURPOSE

A population-based investigation was conducted to examine the prevalence of health behaviors (smoking, alcohol use, physical activity, and cancer screening) of cancer survivors by age, time since diagnosis, and cancer site. Understanding health behaviors of survivors is imperative, as many survivors are living longer and are at risk for cancer recurrence, second cancers, and complications from treatment.

METHODS

Using the National Health Interview Survey, this study examined the prevalence of smoking and alcohol use as well as whether cancer survivors (n = 7,384) are meeting current recommendations for physical activity and cancer screening compared with noncancer controls (n = 121,347).

RESULTS

Cancer survivors are similar to controls with respect to smoking status and alcohol consumption after adjusting for group differences. However, younger survivors (18 to 40 years) are at greater risk for continued smoking than controls. Survivors are 9% more likely to meet physical activity recommendations compared with controls. chi2 tests indicate no significant differences in smoking, alcohol consumption, and physical activity by time since diagnosis, but differences by cancer site exist. Female cancer survivors are 34% and 36% more likely to meet mammogram and Papanicolaou smear screening recommendations, respectively, compared with controls. Similar screening patterns were found for prostate-specific antigen screening in men.

CONCLUSION

This study provides benchmark approximations of the prevalence of risky health behaviors of survivors by time since diagnosis and cancer site. As part of the collective effort to reduce late effects of cancer treatment, oncologists may be in the best position to offer initial guidance for promoting healthy lifestyle behaviors among cancer survivors.

Life After Cancer Epidemiology (LACE) Study: a cohort of early stage breast cancer survivors (United States)

The Life After Cancer Epidemiology (LACE) Study, a cohort of 2321 early stage breast cancer survivors, was established in 2000 to examine how modifiable behavioral risk factors affect quality of life and long-term survival. Women were recruited primarily from the Kaiser Permanente Northern California Cancer Registry (KPNCAL) and the Utah cancer registry (UCR), United States. Baseline data were collected, on average, at two years post-diagnosis through self-administered questionnaires that included information on demographics, medical history, anthropometry, diet, supplements, physical activity and quality of life. The purpose of this paper is to describe the creation and baseline characteristics of the cohort. Forty-six percent of women to whom questionnaires were mailed agreed to participate. The cohort which is 80% white, was diagnosed predominantly with Stage I and II breast cancer (93%), and will have been followed for 5.6 years post-diagnosis, on average, by the end of 2004. Women reported slightly over four daily servings of fruit and vegetables, well below the suggested 5-A-Day national guidelines. Compared to women free of cancer, physical activity patterns were similar, while weight gain, especially in younger women, was higher than is typical. These data suggest that in the early years post-diagnosis, breast cancer survivors exhibit similar patterns to the general population in many health behaviors.

Pilot study of a home-based aerobic exercise program for sedentary cancer survivors treated with hematopoietic stem cell transplantation

We report a pilot study of a home-based aerobic exercise program in a group of 17 adult hematopoietic stem cell transplant (HSCT) recipients. Participants had received no cancer treatment for at least 6 months and reported leisure time physical activity less than 20 min per day and fewer than three times a week during the previous month. Following baseline assessments of aerobic fitness, fatigue symptoms, and quality of life, participants were placed on home-based aerobic exercise programs consisting of 20-40 min of activity in the target heart rate zone (40-60% predicted heart rate reserve) delivered in three to five sessions per week for 12 weeks. Subjects were supplied with electronic heart rate monitors and we encouraged program adherence using weekly telephone contacts and exercise diaries. In all, 32 of the 42 qualified candidates consented (acceptance=76%). Of these, 17 kept appointments for baseline assessments, four did not complete the study (attrition=46%), and no exercise-related adverse events were reported. Scores on measures of aerobic fitness, fatigue severity, and physical well-being improved (signed ranks test; P<0.05) during program participation. Our findings suggest that individually prescribed, home-based aerobic exercise is an acceptable, safe, and potentially effective intervention for improving physical functioning and fatigue in sedentary HSCT recipients.

Associations among exercise, body weight, and quality of life in a population-based sample of endometrial cancer survivors

OBJECTIVES

Lack of exercise and excess body weight may exacerbate treatment-related declines in quality of life (QoL) in endometrial cancer survivors. The primary purpose of this study was to examine the associations among exercise, body weight, and QoL in a population-based sample of endometrial cancer survivors.

METHODS

Participants were 386 endometrial cancer survivors residing in Alberta, Canada who completed a mailed survey that assessed self-reported exercise, height, and weight to calculate body mass index (BMI) and QoL using the Functional Assessment of Cancer Therapy-Anemia (FACT-An) scale.

RESULTS

Descriptive data indicated that 70% of the sample were not meeting public health exercise guidelines and 72% were overweight or obese. Multivariate analyses of variance demonstrated that endometrial cancer survivors meeting public health guidelines for exercise and body weight reported significantly better QoL than survivors not meeting guidelines. The differences in QoL between the groups were clinically meaningful and were not altered when controlling for important demographic and medical variables. There were no interactions between exercise, BMI, age, or time since diagnosis. Lastly, multiple regression analysis identified that both exercise (beta = .21; P < .001) and BMI (beta = -.17; P < .001) were independently associated with QoL.

CONCLUSIONS

These results suggest that exercise and body weight are important independent correlates of QoL in endometrial cancer survivors. Randomized controlled trials designed to test the causal effects of exercise and/or weight loss on QoL in endometrial cancer survivors are warranted.

Association between exercise and quality of life in multiple myeloma cancer survivors

GOALS OF THE WORK

The goal of this study was to examine the association between exercise and quality of life (QOL) in multiple myeloma cancer survivors.

PATIENTS AND METHODS

Using a retrospective design, 156 multiple myeloma cancer survivors were mailed a questionnaire that assessed self-reported exercise behavior over three periods (prediagnosis, active treatment, and off-treatment) and QOL.

MAIN RESULTS

The response rate was 56% (88/ 156). Descriptive analyses indicated that 6.8% and 20.4% of survivors met national exercise guidelines during active and off-treatment periods, respectively. Exercise during active treatment and off-treatment were positively associated with overall QOL and all subdomains of QOL (all P<0.05) except physical wellbeing.

CONCLUSIONS

A low percentage of multiple myeloma cancer survivors are exercising regularly either during active or off-treatment periods. Survivors who report more exercise during these periods also report higher QOL. These findings suggest that a randomized controlled trial is warranted.