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Cristian A, Rubens M, Cristian C, Wang G, Mendez J. Characterization of Physical Function and Cancer-Related Physical Impairments in Hispanic Women With Breast Cancer: A Descriptive Study. HISPANIC HEALTH CARE INTERNATIONAL 2023; 21:195-202. [PMID: 37340714 DOI: 10.1177/15404153231183447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Introduction: This study reports characteristics of Hispanic women with breast cancer with respect to physical function, body mass index (BMI), and depression. Methods: This retrospective study included 322 Hispanic women with breast cancer. Physical function and fatigue were assessed using the Patient Reported Outcomes Measurement System-Physical Function (PROMIS-PF) short form and PROMIS-Fatigue (PROMISE-F) short form. In addition, Timed Up and Go (TUG) test, sit to stand in 30 s (STS30) test, four-stage balance test (4SB), and grip strength (GS) were measured. Depression was identified using Patient Health Questionnaire (PHQ)-2 and extracted from medical chart. Results: Nearly 40.8% were obese, and 20.8% had depression. Compared to normal BMI patients, mean PROMIS-F score was significantly higher among overweight and obese patients. The mean STS30 score was significantly lower in obese patients, compared to normal BMI patients. Regression analysis showed that the odds of depression were higher with increasing TUG and lower PROMIS-F, STS30, and GS. Conclusion: Hispanic women with breast cancer have substantial loss of physical function, and this is exaggerated if they are obese, overweight, or depressed. Clinicians caring for this population should screen them for the presence of loss of physical function, BMI, and depression.
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Affiliation(s)
| | - Muni Rubens
- Miami Cancer Institute, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Universidad Espíritu Santo, Samborondón, Ecuador
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Biskup M, Macek P, Terek-Derszniak M, Zak M, Krol H, Falana K, Gozdz S. Agreement between Accelerometer-Assessed and Self-Reported Physical Activity and Sedentary Behavior in Female Breast Cancer Survivors. Diagnostics (Basel) 2023; 13:3447. [PMID: 37998583 PMCID: PMC10670656 DOI: 10.3390/diagnostics13223447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/25/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
An accurate quantitative assessment of physical activity and sedentary lifestyles enables a better understanding of their relationship with the health records of cancer survivors. The objective of this study was to compare the subjective and objective methods of physical activity measurement in female breast cancer survivors. Materials and methods: In total, 135 female breast cancer survivors at the Holycross Cancer Center, Kielce, Poland, were included in this study. A shortened version of the International Physical Activity Questionnaire (IPAQ) was used to subjectively assess the participants' physical activity (PA), and an ActiGraph GT3X-BT accelerometer was used for an objective assessment. In total, 75% of the studied women did not report any vigorous PA, irrespective of the measurement method. The average values of moderate PA and moderate-to-vigorous PA (MVPA) measured with IPAQ compared with the accelerometer were sevenfold and tenfold higher, respectively. Conversely, the sedentary behavior values measured with the accelerometer were almost three times higher than those measured with IPAQ. The PA and sedentary behavior measurements were significantly different. Irrespective of PA intensity, the accelerometer-based measurements produced significantly lower results than IPAQ, while higher results were observed for sedentary behavior. The measurement differences between these two methods increased as the average differences grew. Regardless of the measurement method, a negative association was observed between moderate PA with general adiposity and adipose tissue distribution, whereas sedentary behavior demonstrated an opposite trend. This indicates the detrimental role of obesity in limiting PA.
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Affiliation(s)
- Malgorzata Biskup
- Collegium Medicum, Jan Kochanowski University, Avenue IX Centuries Kielc 19A, 25-516 Kielce, Poland; (P.M.); (M.Z.); (H.K.); (S.G.)
- Department of Rehabilitation, Holycross Cancer Center, Artwinskiego 3 Street, 25-734 Kielce, Poland;
| | - Pawel Macek
- Collegium Medicum, Jan Kochanowski University, Avenue IX Centuries Kielc 19A, 25-516 Kielce, Poland; (P.M.); (M.Z.); (H.K.); (S.G.)
- Department of Epidemiology and Cancer Control, Holycross Cancer Center, Artwinskiego 3 Street, 25-734 Kielce, Poland
| | | | - Marek Zak
- Collegium Medicum, Jan Kochanowski University, Avenue IX Centuries Kielc 19A, 25-516 Kielce, Poland; (P.M.); (M.Z.); (H.K.); (S.G.)
| | - Halina Krol
- Collegium Medicum, Jan Kochanowski University, Avenue IX Centuries Kielc 19A, 25-516 Kielce, Poland; (P.M.); (M.Z.); (H.K.); (S.G.)
- Department of Research and Education, Holycross Cancer Center, Artwinskiego 3 Street, 25-734 Kielce, Poland
| | - Krzysztof Falana
- Faculty of Law and Social Sciences, Jan Kochanowski University, Uniwersytecka Street 15, 25-406 Kielce, Poland;
| | - Stanislaw Gozdz
- Collegium Medicum, Jan Kochanowski University, Avenue IX Centuries Kielc 19A, 25-516 Kielce, Poland; (P.M.); (M.Z.); (H.K.); (S.G.)
- Department of Clinical Oncology, Holycross Cancer Center, Artwinskiego 3 Street, 25-734 Kielce, Poland
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Akyol M, Tuğral A, Arıbaş Z, Bakar Y. Assessment of the cardiorespiratory fitness and the quality of life of patients with breast cancer undergoing chemotherapy: a prospective study. Breast Cancer 2023:10.1007/s12282-023-01453-6. [PMID: 36952220 DOI: 10.1007/s12282-023-01453-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Diminished cardiorespiratory fitness is a well-known side effect of chemotherapy as well as a risk factor for potential cardiovascular diseases among cancer patients. This study aimed to assess the potential effects of systemic adjuvant (ACT) or neoadjuvant (NACT) chemotherapy on cardiorespiratory fitness and quality of life (QoL) among breast cancer (BC) patients. METHODS Demographic data, cardiorespiratory fitness, health-related QoL domains were assessed with simple data form, six-minute walk test (6MWT), European Organization for Research and Treatment of Cancer quality of life module (EORTC-C30), and Functional Assessment of Cancer Therapy (FACT-B+), respectively. Time1 (T1, prior to chemotherapy), Time2 (T2; interim assessment), and Time3 (T3, final assessment) were set as assessment points. RESULTS A total of 42 patients (32 ACT vs 10 ACT) completed all assessments. There were no significant differences of main effect of time and time*group interaction on total walked distance (TWD) after controlling for age and BMI (F(2,28) = 1.309, p = 0.286; F(2,28) = 1.444, p = 0.253). EORTC symptoms subscale was found to be correlated with EORTC and FACT-B+ physical function (PF) subscales (r = - 861, p < 0.001; r = - 0.877, p < 0.001) in T3. The EORTC PF subscale was found to be correlated with the TWD in the baseline (r = 0.411, p = 0.024). CONCLUSIONS This study showed that the effect of chemotherapy on diminished PF and remarkably increased symptom burden among BC patients. Yet, the type of chemotherapy had no effect on TWD regarding cardiorespiratory fitness. Monitoring potential functional decline regarding cardiorespiratory fitness can be performed via simple field tests such as 6MWT.
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Affiliation(s)
- Murat Akyol
- Department of Medical Oncology, Faculty of Medicine, Izmir Bakırçay University, Izmir, Turkey
| | - Alper Tuğral
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakırçay University, Izmir, Turkey.
| | - Zeynep Arıbaş
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakırçay University, Izmir, Turkey
| | - Yeşim Bakar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakırçay University, Izmir, Turkey
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Rubio MA, Mejía-Arbeláez CM, Wilches-Mogollon MA, Moreno S, Finck C, Rosas LG, Romero SA, Guevara P, Cabas S, Rubiano O, Flórez-Pregonero A, León JG, Alarcón LF, Haile R, Sarmiento OL, King AC. "My Body, My Rhythm, My Voice": a community dance pilot intervention engaging breast cancer survivors in physical activity in a middle-income country. Pilot Feasibility Stud 2023; 9:30. [PMID: 36855214 PMCID: PMC9971676 DOI: 10.1186/s40814-023-01253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 01/28/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Interventions to promote physical activity among women breast cancer survivors (BCS) in low- to middle-income countries are limited. We assessed the acceptability and preliminary effectiveness of a theory-driven, group-based dance intervention for BCS delivered in Bogotá, Colombia. METHODS We conducted a quasi-experimental study employing a mixed-methods approach to assess the 8-week, 3 times/week group dance intervention. The effect of the intervention on participants' physical activity levels (measured by accelerometry), motivation to engage in physical activity, and quality of life were evaluated using generalized estimating equation analysis. The qualitative method included semi-structured interviews thematically analyzed to evaluate program acceptability. RESULTS Sixty-four BCS were allocated to the intervention (n = 31) or the control groups (n = 33). In the intervention arm, 84% attended ≥ 60% of sessions. We found increases on average minutes of moderate-to-vigorous physical activity per day (intervention: +8.99 vs control: -3.7 min), and in ratings of motivation (intervention change score = 0.45, vs. control change score= -0.05). BCS reported improvements in perceived behavioral capabilities to be active, captured through the interviews. CONCLUSIONS The high attendance, behavioral changes, and successful delivery indicate the potential effectiveness, feasibility, and scalability of the intervention for BCS in Colombia. TRIAL REGISTRATION ClinicalTrial.gov NCT05252780, registered on Dec 7th, 2021-retrospectively registered unique protocol ID: P20CA217199-9492018.
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Affiliation(s)
- María Alejandra Rubio
- grid.7247.60000000419370714School of Medicine, Universidad de los Andes, Carrera 1, #18ª-12, Bogotá, Colombia
| | - Carlos M. Mejía-Arbeláez
- grid.7247.60000000419370714School of Medicine, Universidad de los Andes, Carrera 1, #18ª-12, Bogotá, Colombia
| | - Maria A. Wilches-Mogollon
- grid.7247.60000000419370714School of Engineering, Universidad de los Andes, Carrera 1 #18ª-12, Bogotá, Colombia
| | - Sergio Moreno
- grid.7247.60000000419370714School of Medicine, Universidad de los Andes, Carrera 1, #18ª-12, Bogotá, Colombia
| | - Carolyn Finck
- grid.7247.60000000419370714Department of Psychology, Universidad de los Andes, Carrera 1 #18ª-12, Bogotá, Colombia
| | - Lisa G. Rosas
- grid.168010.e0000000419368956Department of Epidemiology and Population Health, Stanford University School Medicine, Stanford, CA 94305 USA ,grid.168010.e0000000419368956Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Sol A. Romero
- grid.442177.30000 0004 0486 1713Faculty of Health Sciences, Universidad Manuela Beltrán, Bogotá, Colombia
| | - Paula Guevara
- grid.7247.60000000419370714School of Medicine, Universidad de los Andes, Carrera 1, #18ª-12, Bogotá, Colombia
| | - Santiago Cabas
- grid.7247.60000000419370714School of Medicine, Universidad de los Andes, Carrera 1, #18ª-12, Bogotá, Colombia
| | - Oscar Rubiano
- grid.442175.10000 0001 2106 7261Research Department, Universidad Libre, Bogotá, Colombia
| | - Alberto Flórez-Pregonero
- grid.41312.350000 0001 1033 6040School of Education, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - José G. León
- Sports Medicine Service, Hospital de San José, Bogotá, Colombia
| | - Luis Fernando Alarcón
- grid.7247.60000000419370714School of Medicine, Universidad de los Andes, Carrera 1, #18ª-12, Bogotá, Colombia
| | | | - Olga L. Sarmiento
- grid.7247.60000000419370714School of Medicine, Universidad de los Andes, Carrera 1, #18ª-12, Bogotá, Colombia
| | - Abby C. King
- grid.168010.e0000000419368956Department of Epidemiology and Population Health, Stanford University School Medicine, Stanford, CA 94305 USA ,grid.168010.e0000000419368956Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305 USA
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Dewi EU, Nursalam, Mahmudah, Yunitasari E. The effect of peer support psychoeducation based on experiential learning on self-care demands among breast cancer patients with post-chemotherapy. J Public Health Res 2023; 12:22799036221146901. [PMID: 36643605 PMCID: PMC9834624 DOI: 10.1177/22799036221146901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 12/05/2022] [Indexed: 01/11/2023] Open
Abstract
Background Breast cancer patients with post-chemotherapy had self-care deficit problems. The patient is unable to perform activities of daily living which can decrease the quality of life. One of the factors that affected self-care deficit among breast cancer patients was inadequate information. This study aimed to determine the effects of peer support psychoeducation based on experiential learning on the self-care demand. Design and methods This study used a quasi-experimental design with pretest and posttest. The independent variable of the study was the application of peer support psychoeducation based on experiential learning and the dependent variable was the self-care demand. The inclusion criteria in this study were breast cancer patients with post-chemotherapy. The exclusion criteria in this study were patients who were unconscious. We selected the experimental and control group randomly. The total sample in this study was 60 people, 30 respondents for the experiment group and 30 respondents for the control group. Peer support psychoeducation based on experiential learning was developed from Wauchope's psychoeducational theory, Orem's self-care, and David Kolb's experiential learning. We used a self-report questionnaire to measure self-care demand. Data were analyzed using Wilcoxon signed rank and Mann-Whitney U tests. Results Peer support psychoeducation based on experiential learning has a significant effect on self-care demand, namely ADL (p = 0.002), pain management (p = 0.002), nutritional management (p = 0.000), and rest and sleep (p = 0.000). Conclusion Psychoeducation based on experiential learning was recommended for nursing care or physician to increase self-care demand.
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Affiliation(s)
- Erika Untari Dewi
- Faculty of Public Health, Universitas
Airlangga, Surabaya, Indonesia,William Booth Health Science College in
Surabaya, East Java, Indonesia
| | - Nursalam
- Faculty of Nursing, Universitas
Airlangga, Surabaya, Indonesia,Nursalam, Faculty of Nursing, Universitas
Airlangga, Surabaya, 60115, Indonesia.
| | - Mahmudah
- Faculty of Public Health, Universitas
Airlangga, Surabaya, Indonesia
| | - Esti Yunitasari
- Faculty of Nursing, Universitas
Airlangga, Surabaya, Indonesia
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Chan A, Chan D, Lee H, Chin Ng C, Hui Ling Yeo A. Reporting adherence, validity and physical activity measures of wearable activity trackers in medical research: A systematic review. Int J Med Inform 2022; 160:104696. [DOI: 10.1016/j.ijmedinf.2022.104696] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/19/2021] [Accepted: 01/16/2022] [Indexed: 01/18/2023]
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Effectiveness of a Home-Based Exercise Intervention in the Fitness Profile of Hispanic Survivors of Breast Cancer. REHABILITATION ONCOLOGY 2021; 39:175-183. [PMID: 34712520 DOI: 10.1097/01.reo.0000000000000253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Home-based exercise interventions might be a desirable long-term option for breast cancer survivors to enhance compliance and long-term health benefits. Purpose To assess the effectiveness of a home-based intervention aimed at helping survivors of breast cancer meet the physical activity guidelines of the American College of Sports Medicine. Methods Eighty-nine women (age: 55.4 ± 10 years; BMI: 31 ± 6.5 kg/m2) from two cancer centers serving Hispanic women participated in this study. Women performed a baseline assessment of cardiorespiratory fitness, muscle endurance and strength, flexibility, range of motion, and extremity disability. After baseline measures, women were randomized into a control (C) or exercise (E) group. The exercise intervention consisted of a walking program, elastic band strengthening, and flexibility exercises performed at home. The outcome measures were reassessed 16 weeks after baseline measures. Results The intervention showed a strong effect of time on muscle strength and shoulder range of motion, and time and group for self-reported disability. There were no differences in sedentary behavior, physical fitness, and disability measures across intervention groups, including both exercise groups combined and changes over time between intervention groups. Conclusion It appears that a home-based intervention affects only upper body strength and related disability, indicating that other components might need closer monitoring for significant changes to occur across time.
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Dibble KE, Baumgartner RN, Boone SD, Baumgartner KB, Connor AE. Physical activity, ethnicity, and quality of life among breast cancer survivors and population-based controls: the long-term quality of life follow-up study. Breast Cancer Res Treat 2021; 189:247-256. [PMID: 34052975 DOI: 10.1007/s10549-021-06261-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/12/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore the relationship between physical activity (PA) and quality of life (QOL) among Hispanic and non-Hispanic white breast cancer (BC) cases and population-based controls from the New Mexico 'Long-Term Quality of Life Study'. METHODS Self-reported PA (low, moderate, vigorous MET hours/week) at baseline and follow-up interviews (12-15 years) were available for 391 cases and controls and modeled using multiple linear regressions with SF-36 mean composite scores for physical and mental health. The change in PA from baseline to follow-up and interactions with ethnicity were also examined. Models were adjusted for age at diagnosis/baseline interview, education, comorbidities, body mass index, and change in PA. RESULTS PA intensities at each timepoint did not differ by case/control status; however, the change in vigorous PA was lower among cases (p = 0.03). At follow-up, low intensity PA increased mental health QOL scores among cases; however, the interaction between low intensity PA and ethnicity was statistically significant among controls indicating decreased mental health among Hispanics (p = 0.02). Change in moderate PA was associated with increased physical and mental health among cases (physical: β = 0.186, p = 0.008; mental: β = 0.225, p = 0.001) and controls (physical: β = 0.220, p < 0.0001; mental: β = 0.193, p = 0.002), when controlling for confounders. CONCLUSION Our results demonstrate that all levels of PA are important for mental health among BC cases, while activities of higher intensity are important for physical health among women overall. The statistical interaction observed between ethnicity and low intensity PA among controls for mental health warrants further research to provide a meaningful interpretation.
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Affiliation(s)
- Kate E Dibble
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Office E6133, Baltimore, MD, USA.
| | - Richard N Baumgartner
- Department of Epidemiology & Population Health, School of Public Health & Information Sciences, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Stephanie D Boone
- Department of Epidemiology & Population Health, School of Public Health & Information Sciences, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Kathy B Baumgartner
- Department of Epidemiology & Population Health, School of Public Health & Information Sciences, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Avonne E Connor
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Office E6133, Baltimore, MD, USA
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Congruence and trajectories of device-measured and self-reported physical activity during therapy for early breast cancer. Breast Cancer Res Treat 2021; 188:351-359. [PMID: 33788134 PMCID: PMC8260526 DOI: 10.1007/s10549-021-06195-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/13/2021] [Indexed: 11/12/2022]
Abstract
Purpose This study examines congruence between self-reported and device-measured physical activity data in women with early breast cancer and compares trajectories under different treatments. Methods Women with non-metastatic breast cancer were recruited before primary therapy. In four weeks distributed over six months after treatment start, patients reported time spent on work, transport, chores and sports via diary and wore Garmin® vivofit 3 accelerometers to assess steps taken. Associations between these measures and agreement regarding guideline adherence were tested with Spearman’s Correlation Coefficient and Weighted Kappa statistic. Effects of time and treatment were evaluated using mixed analyses of variance. Results Ninety-nine participants (median age = 50) were treated with adjuvant (N= 23), neoadjuvant (N= 21) or without chemotherapy (N= 55). Coherence between self-report and device data was strong (r = 0.566). Agreement about reaching recommendations was only “fair” (kappa coefficient = 0.321 and 0.249, resp.). Neither treatment or week nor their interaction had effects on step counts (all p > 0.05). Self-reported activity time was lower for patients with chemotherapy than for those without (adjuvant: ∆ = 69min, p= 0.006, neoadjuvant: ∆ = 45min, p= 0.038) and lower in week 18 than in week 3 (∆ = 43min, p= 0.010). Conclusion Results show that consumer-grade activity monitors and self-reports correlate but show different perspectives on physical activity in breast cancer patients. In general, patients perceive some decline regardless of primary treatment regimen. Those affected should be offered assistance to gain the benefits of activity. Accelerometers may help professionals to identify these individuals and patients to verify appraisal of their activity levels. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-021-06195-7.
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But-Hadzic J, Dervisevic M, Karpljuk D, Videmsek M, Dervisevic E, Paravlic A, Hadzic V, Tomazin K. Six-Minute Walk Distance in Breast Cancer Survivors-A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052591. [PMID: 33807611 PMCID: PMC7967367 DOI: 10.3390/ijerph18052591] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/25/2021] [Accepted: 02/27/2021] [Indexed: 12/17/2022]
Abstract
The six-minute walk test (6MWT) is a widely used test for the indirect measurement of cardiorespiratory fitness in various cancer populations. Although the 6MWT is a simple test, there are no normative values for breast cancer survivors (BCS) or comparisons of results with healthy counterparts. A systematic review with a meta-analysis was carried out, which included studies from 2007 to 2020. Ninety-one studies were found, 21 of which were included in the quantitative synthesis. Among them were 9 randomized controlled trials (RCT), 8 prospective cohort studies and 4 cross-sectional studies. A total of 1084 BCS were included. Our results revealed that healthy subjects (n = 878) covered a significantly greater distance than BCS during the 6MWT (589.9 m vs. 477.4 m, p < 0.001), and the results of the meta-regression analysis showed that the 6MWD was predicted by the participants’ BMI (p < 0.001), but not by their age (p = 0.070). After adjustment for BMI, the healthy subjects also covered greater distances than the BCS (103 m; p < 0.001). The normative values of 6MWT were presented for BCS. Besides, 6MWT distances distinguish between their healthy counterparts, therefore, the 6MWT distance is a relevant parameter for the assessment and monitoring of cardiorespiratory fitness in medical and exercise interventions for BCS.
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Affiliation(s)
- Jasna But-Hadzic
- Department of Radiation Oncology, Institute of Oncology, 1000 Ljubljana, Slovenia;
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Mirza Dervisevic
- Faculty of Sport, University of Ljubljana, 1000 Ljubljana, Slovenia; (M.D.); (D.K.); (M.V.); (E.D.); (A.P.); (V.H.)
| | - Damir Karpljuk
- Faculty of Sport, University of Ljubljana, 1000 Ljubljana, Slovenia; (M.D.); (D.K.); (M.V.); (E.D.); (A.P.); (V.H.)
| | - Mateja Videmsek
- Faculty of Sport, University of Ljubljana, 1000 Ljubljana, Slovenia; (M.D.); (D.K.); (M.V.); (E.D.); (A.P.); (V.H.)
| | - Edvin Dervisevic
- Faculty of Sport, University of Ljubljana, 1000 Ljubljana, Slovenia; (M.D.); (D.K.); (M.V.); (E.D.); (A.P.); (V.H.)
| | - Armin Paravlic
- Faculty of Sport, University of Ljubljana, 1000 Ljubljana, Slovenia; (M.D.); (D.K.); (M.V.); (E.D.); (A.P.); (V.H.)
- Science and Research Centre, Institute of Kinesiology Research, 6000 Koper, Slovenia
| | - Vedran Hadzic
- Faculty of Sport, University of Ljubljana, 1000 Ljubljana, Slovenia; (M.D.); (D.K.); (M.V.); (E.D.); (A.P.); (V.H.)
| | - Katja Tomazin
- Faculty of Sport, University of Ljubljana, 1000 Ljubljana, Slovenia; (M.D.); (D.K.); (M.V.); (E.D.); (A.P.); (V.H.)
- Correspondence:
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Lang AE, Kim SY, Dickerson CR, Milosavljevic S. Measurement of objective shoulder function following breast cancer surgery: a scoping review. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1851439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Angelica E. Lang
- School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Soo Y. Kim
- School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Canada
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Buscemi J, Oswald LB, Baik SH, Buitrago D, Iacobelli F, Phillips SM, Perez-Tamayo A, Guitelman J, Penedo FJ, Yanez B. My health smartphone intervention decreases daily fat sources among Latina breast cancer survivors. J Behav Med 2020; 43:732-742. [PMID: 31970652 PMCID: PMC7374026 DOI: 10.1007/s10865-020-00136-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/17/2020] [Indexed: 12/15/2022]
Abstract
Breast cancer is the most common cancer among Latina women, and Latina women are at higher risk for breast cancer mortality than white women. Lifestyle factors, such as consuming a nutritious diet and engaging in regular physical activity, promote health and are protective against heart disease, type 2 diabetes, and breast cancer recurrence. Previous studies have developed and tested interventions for Latina breast cancer survivors to improve diet and increase physical activity, however, no studies to date have developed a smartphone delivered intervention. The purpose of the current study was to compare two Smartphone delivered interventions, My Health, which focused on diet and physical activity, and My Guide, which focused on psychosocial functioning, on dietary and physical activity outcomes, post-intervention, and at a 2-week follow-up assessment. Overall, participants receiving the My Health intervention reported a greater reduction in daily fat sources than the My Guide group over time. However, daily sources of fat did not differ between conditions. Walking, measured by estimated weekly metabolic equivalents, increased across time points in both groups. These preliminary findings suggest that eHealth interventions aimed at improving lifestyle factors may favorably impact nutritional intake and physical activity. Future research should utilize more comprehensive and objective measures of diet and physical activity, and incorporate more behavioral lifestyle components into the intervention in larger samples with a longer follow-up period.
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Affiliation(s)
- Joanna Buscemi
- Department of Psychology, DePaul University, 2219 N Kenmore Ave, Chicago, IL, 60614, USA.
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA.
| | - Laura B Oswald
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Sharon H Baik
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diana Buitrago
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Francisco Iacobelli
- Department of Computer Science, Northeastern Illinois University, Chicago, IL, USA
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Judy Guitelman
- ALAS-WINGS, Latina Association for Breast Cancer, Chicago, IL, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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13
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Clemens KS, Tull MT, Murray AB, Boardley D, Tipton J, Geers AL. Examination of the relationship between affect, values, and physical activity among cancer survivors. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Dieli-Conwright CM, Fox FS, Tripathy D, Sami N, Van Fleet J, Buchanan TA, Spicer D, Lee K, Mortimer J, Bernstein L, Demark-Wahnefried W, Courneya KS. Hispanic ethnicity as a moderator of the effects of aerobic and resistance exercise on physical fitness and quality-of-life in breast cancer survivors. J Cancer Surviv 2020; 15:127-139. [PMID: 32681303 DOI: 10.1007/s11764-020-00918-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/10/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Exercise can profoundly affect physical fitness and quality of life in breast cancer survivors; however, few studies have focused on minorities. This secondary analysis examines Hispanic ethnicity as a moderator of the effects of a 16-week aerobic and resistance exercise intervention on physical fitness and quality of life in breast cancer survivors. METHODS Eligible breast cancer survivors (n = 100) were randomized to exercise (n = 50) or usual care (n = 50). The exercise intervention consisted of supervised moderate-vigorous aerobic and resistance exercise thrice weekly for 16 weeks. Physical fitness and quality of life were measured at baseline, post-intervention, and 28-week follow-up (exercise only). Linear mixed-models adjusted for baseline value of the outcome, age, disease stage, adjuvant treatment, and recent physical activity were used to evaluate effect modification by ethnicity. RESULTS The study sample included 57% Hispanic and 43% non-Hispanic breast cancer survivors. Hispanic breast cancer survivors were younger, less fit, and diagnosed with more advanced cancers compared with non-Hispanic breast cancer survivors (p < 0.001). Ethnicity was found to moderate the effects of exercise training on all physical fitness and quality-of-life measures including VO2max (8.4 mL/kg/min; 95% confidence interval (95% CI) 3.2 to 13.4), physical well-being (12.3; 95% CI 4.2 to 18.4), and emotional well-being (11.4; 95% CI 5.9 to 15.5). In all cases, Hispanics experienced larger benefits than non-Hispanics. CONCLUSIONS Hispanic breast cancer survivors have poorer cardiorespiratory fitness, muscle strength, and quality-of-life and therefore may derive larger benefits from exercise than non-Hispanic breast cancer survivors. Clinical exercise interventions may attenuate existing health disparities among minority breast cancer survivors. IMPLICATION OF CANCER SURVIVORS Here we report psychosocial and fitness-related disparities among Hispanic breast cancer survivors when compared with their non-Hispanic counterparts. Our exercise intervention highlights the importance of exercise for minority cancer survivors and the need for distinct, culturally tailored exercise intervention approaches to reduce psychosocial and fitness-related disparities among this understudied population of cancer survivors.
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Affiliation(s)
- Christina M Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 375 Longwood Ave., Boston, MA, 02215, USA.
| | - Frank S Fox
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California (USC), Los Angeles, CA, 90033, USA
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Nathalie Sami
- Department of Medicine, Keck School of Medicine, USC, Los Angeles, CA, 90033, USA
| | - Jessica Van Fleet
- Department of Medicine, Keck School of Medicine, USC, Los Angeles, CA, 90033, USA
| | - Thomas A Buchanan
- Division of Endocrinology and Diabetes, Keck School of Medicine, USC, Los Angeles, CA, 90033, USA
| | - Darcy Spicer
- Department of Medicine, Keck School of Medicine, USC, Los Angeles, CA, 90033, USA
| | - Kyuwan Lee
- Department of Population Sciences, Beckman Research Institute, City of Hope (COH), Duarte, CA, 91010, USA
| | - Joanne Mortimer
- Division of Medical Oncology and Experimental Therapeutics, COH, Duarte, CA, 91010, USA
| | - Leslie Bernstein
- Division of Biomarkers of Early Detection and Prevention, Beckman Research Institute, COH, Duarte, CA, 91010, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, T6G 2H9, Canada
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15
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Cuesta-Vargas AI, Pajares B, Trinidad-Fernandez M, Alba E, Roldan-Jiménez C. Inertial Sensors Embedded in Smartphones as a Tool for Fatigue Assessment Based on Acceleration in Survivors of Breast Cancer. Phys Ther 2020; 100:447-456. [PMID: 32031221 DOI: 10.1093/ptj/pzz173] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/05/2019] [Accepted: 09/23/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cancer-related fatigue is a symptom commonly reported in survivors of breast cancer and is the most variable symptom. Besides questionnaires like PIPER to assess cancer-related fatigue, there is a need to objectively measure fatigue. OBJECTIVE The aim of this study was to assess the physiological dimension of fatigue based on acceleration during a 30-second maximal sit-to-stand test. DESIGN This was a cross-sectional study. METHODS Linear acceleration from a smartphone placed on the sternum was recorded in 70 survivors of breast cancer. Fourth-degree polynomial adjustment from the acceleration signal to the vertical and anterior-posterior axis was calculated. The fatigue temporal cut-off point was detected as a change in the curve slope of the first maximum point of acceleration. RESULTS Women were aged 51.8 (8.9) years with a body mass index of 25.4 (5.1) Kg/m2. They performed 23.6 (6.57) number of repetitions. The mean fatigue cut-off point from the total sample was 10.2 (3.1) seconds. LIMITATIONS Further research should employ time-prolonged tests to study acceleration behavior beyond 30 seconds as well as include a physiological criterion that justifies the nonlinear saturation of the acceleration-based criterion. CONCLUSIONS This study assessed fatigue through a low-cost and easy-to-use methodology during a functional and widely used test such as 30-second maximal sit-to-stand. This would allow clinicians to assess fatigue in a short-effort exercise to individualize exercise prescription dose, measure changes during intervention, and track fatigue objectively throughout survivorship.
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Affiliation(s)
- Antonio Ignacio Cuesta-Vargas
- Physical Therapy Department, Health Sciences Faculty, University of Málaga, Av/Arquitecto Penalosa s/n (Treatinos Campus Expansion), Málaga 29071 Spain; The Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; and School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbane, Queensland, Australia
| | - Bella Pajares
- The Institute of Biomedical Research in Malaga (IBIMA)
| | | | - Emilio Alba
- University of Málaga, Andalucia Tech, and The Institute of Biomedical Research in Malaga (IBIMA), Oncology
| | - Cristina Roldan-Jiménez
- Physical Therapy Department, Health Sciences Faculty, University of Málaga, Andalucía Tech, Málaga, Spain, and The Institute of Biomedical Research in Malaga (IBIMA)
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16
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Larsen RF, Jarden M, Minet LR, Frølund UC, Möller S, Abildgaard N. Physical function in patients newly diagnosed with multiple myeloma; a Danish cohort study. BMC Cancer 2020; 20:169. [PMID: 32126972 PMCID: PMC7055017 DOI: 10.1186/s12885-020-6637-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/17/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Multiple myeloma is a cancer in the bone marrow causing bone destruction. Patients experience various symptoms related to the disease and/or treatment, such as pain and fatigue, leading to poorer quality of life. The symptom burden might affect physical function and physical activity levels, posing a risk of physical deterioration. The aim was to investigate whether physical function in newly diagnosed patients with multiple myeloma differs from the reference values of the normal population and other cancer patients. METHODS The study is a cross sectional descriptive analysis of a prospective cohort of 100 patients newly diagnosed with multiple myeloma. Four physical function tests were carried out; Six-Minute-Walk-Test, Sit-to-Stand-Test, grip strength and knee extension strength. Age and gender specific results of physical function from the multiple myeloma population were compared to normative data and to data from other cancer populations. RESULTS Of the 100 patients included, 73% had bone disease and 55% received pain relieving medicine. Mean age was 67.7 years (SD 10.3). Patients with multiple myeloma had significantly poorer physical function compared to normative data, both regarding aerobic capacity and muscle strength, although not grip strength. No differences in physical function were found between patients with multiple myeloma and other cancer populations. CONCLUSIONS Physical function in newly diagnosed Danish patients with multiple myeloma is lower than in the normal population. Exercise intervention studies are warranted to explore the value of physical exercise on physical function. TRIAL REGISTRATION ClinicalTrials.gov, ID NCT02439112, registered 8 May 2015.
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Affiliation(s)
- Rikke Faebo Larsen
- Department of Physiotherapy and Occupational Therapy, Zealand University Hospital, Roskilde, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
| | - Mary Jarden
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lisbeth Rosenbek Minet
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Rehabilitation, Odense University Hospital, Odense, Denmark.,Health Science Research Centre, UCL University College, Odense, Denmark
| | | | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Niels Abildgaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Haematology, Odense University Hospital, Odense, Denmark.,The Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
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17
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Benton MJ, Schlairet MC, Graham HL. Physical activity-related quality of life in breast cancer survivors compared to healthy women. Eur J Cancer Care (Engl) 2019; 28:e13142. [PMID: 31465139 DOI: 10.1111/ecc.13142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/26/2019] [Accepted: 08/01/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate physical activity-related quality of life (PAQOL) in breast cancer survivors compared to healthy women. METHODS Physical activity level was measured as not active, somewhat active, active or very active. Intensity was reported as hours per week of light, moderate and vigorous activity. Physical activity-related quality of life was measured with the Vitality Plus Scale, a self-report instrument developed and validated to measure exercise-related health benefits. RESULTS Compared to healthy women (n = 23), breast cancer survivors (n = 23) were older (57.0 ± 2.3 vs. 49.0 ± 1.1 years; p < .01) and reported more light activity (4.1 ± 0.6 vs. 2.4 ± 0.5 hr/week; p < .05), but no differences in PAQOL. However, when grouped by physical activity level there were no differences in age, but inactive women (n = 30) had higher body mass index (29.3 ± 1.0 vs. 25.1 ± 1.1 kg/m2 ; p < .05) and reported less moderate (1.3 ± 0.4 vs. 3.6 ± 0.8 hr/week; p < .05) and vigorous (0.2 ± 0.1 vs. 1.9 ± 0.5 hr/week; p < .01) activity than active women (n = 16). Furthermore, active women reported higher overall PAQOL, greater energy levels and quicker sleep onset than inactive women (p < .05). CONCLUSIONS In these women, moderate and vigorous physical activity and PAQOL were not influenced by breast cancer survivorship. Despite diagnosis, active women who engaged in greater amounts of moderate and vigorous activity reported better PAQOL than inactive women.
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Affiliation(s)
| | - Maura C Schlairet
- Georgia Baptist College of Nursing, Mercer University, Atlanta, Georgia
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18
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Cancer-related fatigue stratification system based on patient-reported outcomes and objective outcomes: A cancer-related fatigue ambulatory index. PLoS One 2019; 14:e0215662. [PMID: 31009501 PMCID: PMC6476532 DOI: 10.1371/journal.pone.0215662] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/05/2019] [Indexed: 12/16/2022] Open
Abstract
Although breast cancer mortality is decreasing, morbidity following treatment remains a significant issue, as patients face symptoms such as cancer-related fatigue (CRF). The aim of the present study is to develop a classification system that monitors fatigue via integration of an objective clinical assessment with patient self-report. Forty-three women participated in this research. Participants were post-treatment breast cancer survivors who had been surgically treated for their primary tumour with no evidence of neoplastic disease at the time of recruitment. Self-perceived fatigue was assessed with the Spanish version of the Piper Fatigue Scale-Revised (R-PFS). Objective fatigue was assessed by the 30 second Sit-to-Stand (30-STS) test. Confirmatory factor analysis was done with Maximum Likelihood Extraction (MLE). Internal consistency was obtained by Cronbach's α coefficients. Bivariate correlation showed that 30-STS performance was negatively-inversely associated with R-PFS. The MANOVA model explained 54.3% of 30-STS performance variance. Using normalized scores from the MLE, a classification system was developed based on the quartiles. This study integrated objective and subjective measures of fatigue to better allow classification of patient CRF experience. Results allowed development of a classification index to classify CRF severity in breast cancer survivors using the relationship between 30-STS and R-PFS scores. Future research must consider the patient-perceived and clinically measurable components of CRF to better understand this multidimensional issue.
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19
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Gunathilake MN, Lee J, Jang A, Choi IJ, Kim YI, Kim J. Physical Activity and Gastric Cancer Risk in Patients with and without Helicobacter pylori Infection in A Korean Population: A Hospital-Based Case-Control Study. Cancers (Basel) 2018; 10:E369. [PMID: 30279385 PMCID: PMC6210303 DOI: 10.3390/cancers10100369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/24/2022] Open
Abstract
Although physical activity (PA) is beneficial for prolonging lifespan, evidence for the protective role of PA against the development of gastric cancer (GC) is not yet well established. This study assessed the association between PA and GC risk in patients with and without Helicobacter pylori (H. pylori) infection in a Korean population. In total, 415 GC patients and 830 controls were enrolled at the National Cancer Center, Korea. The International Physical Activity Questionnaire-Short Form was used to collect PA data. The odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression models. In the H. pylori-positive group, subjects who engaged in regular exercise showed a significantly reduced risk of GC in the entire population (OR = 0.52, 95% CI = 0.38⁻0.70) and in females (OR = 0.60, 95% CI = 0.21⁻0.64). Subjects who engaged in a high level of total PA showed a significantly reduced risk of GC relative to subjects in the lowest tertile in the fully adjusted model (OR = 0.46, 95% CI = 0.32⁻0.65, p-trend < 0.001). There was an inverse association between PA and GC risk in the entire population, and in the H. pylori-positive subgroup. Our data indicate the need for the promotion of all domains of PA, especially for Korean populations.
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Affiliation(s)
- Madhawa Neranjan Gunathilake
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, Goyang-si 10408, Gyeonggi-do, Korea.
| | - Jeonghee Lee
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, Goyang-si 10408, Gyeonggi-do, Korea.
| | - Aelee Jang
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, Goyang-si 10408, Gyeonggi-do, Korea.
| | - Il Ju Choi
- Center for Gastric Cancer, National Cancer Center Hospital, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea.
| | - Young-Il Kim
- Center for Gastric Cancer, National Cancer Center Hospital, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea.
| | - Jeongseon Kim
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, Goyang-si 10408, Gyeonggi-do, Korea.
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