1
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Vasilopoulou M, Asimakopoulou Z, Velissari J, Vicha A, Rizogianni M, Pusa S, Stöven S, Ficarra S, Bianco Α, Jiménez-Pavón D, Ponce Gonzalez Jesus G, Tavares Paula C, Gomes B, Bayer D, Silva S, Nogueira C, Papakonstantinou S, Musa K, Glorioso F, Vantarakis A. Interventions about physical activity and diet and their impact on adolescent and young adult cancer survivors: a Prisma systematic review. Support Care Cancer 2024; 32:342. [PMID: 38739198 PMCID: PMC11090968 DOI: 10.1007/s00520-024-08516-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/20/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Over the past few decades, the incidence of cancer among adolescents and young adults (AYA) has been increasing. The impact of behaviors, such as physical activity (PA) and nutrition, on disease progression, prognosis, and overall health and quality of life for AYA cancer survivors is of significant importance. This systematic review aims to evaluate the effectiveness of PA and diet interventions for AYA cancer survivors and to critically evaluate existing literature, gaps, and limitations. METHODS A search of literature was conducted in PubMed, Science Direct, Scopus, and Google Scholar following the PRISMA guidelines. Twenty-two studies were included from online databases from 2012 to 2022, 13 of which were randomized controlled trials. RESULTS Most interventions were related to PA, with only four studies including nutrition or Diet interventions. The interventions were generally feasible and acceptable to AYA cancer survivors, and digitally based PA interventions were commonly used. PA interventions mainly comprised aerobic and resistance training and were individualized. Overall, this review found various PA and diet interventions for AYA cancer survivors that were feasible and well-accepted, but gaps in knowledge and design still exist. CONCLUSIONS This systematic review underscores the importance of conducting more research on diet interventions for YCS. PROSPERO REGISTRATION: https://www.crd.york.ac.uk/prospero/#aboutregpage.
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Affiliation(s)
- M Vasilopoulou
- Department of Public Health, Medical School, University of Patras, Patras, Greece
| | - Z Asimakopoulou
- Department of Public Health, Medical School, University of Patras, Patras, Greece
| | - J Velissari
- Department of Public Health, Medical School, University of Patras, Patras, Greece
- Oncology Unit, University General Hospital of Patras, Patras, Greece
| | - A Vicha
- Oncology Unit, University General Hospital of Patras, Patras, Greece
| | - M Rizogianni
- Department of Public Health, Medical School, University of Patras, Patras, Greece
| | - S Pusa
- Department of Nursing, Umeå University, Campus Örnsköldsvik, Box 843, S 891 18, Örnsköldsvik, Sweden
| | - S Stöven
- European CBRNE Center, Umeå University, KBC-Huset, Linnaeus Väg 6, 90187, Umeå, Sweden
| | - S Ficarra
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144, Palermo, Italy
| | - Α Bianco
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144, Palermo, Italy
| | - D Jiménez-Pavón
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Puerto Real, Spain
- Biomedical Research and Innovation Institute of Cádiz, University of Cádiz, Cádiz, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - G Ponce Gonzalez Jesus
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Puerto Real, Spain
- Biomedical Research and Innovation Institute of Cádiz, University of Cádiz, Cádiz, Spain
| | - C Tavares Paula
- Faculty of Sport Sciences and Physical Education and *CIDAF (Uid/Dtp/042143/2020), University of Coimbra, Coimbra, Portugal
| | - B Gomes
- Faculty of Sport Sciences and Physical Education and *CIDAF (Uid/Dtp/042143/2020), University of Coimbra, Coimbra, Portugal
| | - D Bayer
- Department of Health Consulting, Research and Science, Outdoor Against Cancer, Munich, Germany
| | - S Silva
- Psycho-Oncology Unit, Portuguese Cancer League-Centre Branch, Lisbon, Portugal
| | - C Nogueira
- Innovation & Development Unit, Coimbra Hospital and University Centre (CHUC), Coimbra, Portugal
| | | | - K Musa
- CEIPES ETS, Palermo, Italy
| | - F Glorioso
- Lega Italiana Per La Lotta Contro I Tumori (LILT Palermo), Palermo, Italy
| | - A Vantarakis
- Department of Public Health, Medical School, University of Patras, Patras, Greece.
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2
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Kesting S, Gaser D, Queisser J, Götte M, von Luettichau I, Peters C, Oberhoffer-Fritz R, Gauß G. Availability and adaption of exercise programs in pediatric oncology during the COVID-19 pandemic and beyond: a nationwide follow-up survey of providers in Germany. Front Pediatr 2024; 12:1372261. [PMID: 38586153 PMCID: PMC10995395 DOI: 10.3389/fped.2024.1372261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Background The COVID-19 pandemic has presented major challenges to clinical practice and delivery of care programs throughout all health care systems. Exercise programs, that are implemented in most centers for pediatric oncology in Germany, are a relatively new care program however with high clinical impact and health benefits. Objective The impact and consequences of the pandemic on the delivery and availability of exercise programs in Germany for pediatric cancer patients and survivors are unknown. A national survey analyzed restrictions, challenges and novel approaches of exercise program delivery and scientific research. Method A two-stage online survey was distributed to providers of exercise programs (acute clinics, non-clinical institutions, rehabilitation facilities) via the established Network ActiveOncoKids. Data was collected during the pandemic in 2022 and 2023 using a combination of open and closed questions. Results In total, n = 27 (response rate: 82%) and n = 17 (response rate: 63%) providers participated in the first and second survey, respectively. Findings pointed out restrictions in 85% of all exercise programs in 2020 and 2021, with slight reductions in 2022. During pandemic, restrictions with major impact arose within exercise offers during follow-up and declined gradually. Whereas restrictions within the setting of acute therapy had medium or minor impact but persisted beyond. Delivery of provided exercise programs necessitated adaptions, including digital methods, supervised interventions from a distance and change of locations. Discussion The findings highlight the adaptability, the demand and the potential of exercise programs in pediatric oncology. We assume that exercise professionals have used the pandemic-related challenges to review and modify existing concepts and made adaptations according to local conditions and novel tools for the provision of exercise programs. Nevertheless, a conspicuous lack of exercise-related care has become evident in certain patients and survivors. Further expansion of programs is imperative to address and accommodate all pertinent needs.
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Affiliation(s)
- Sabine Kesting
- Department of Pediatrics and Children's Cancer Research Centre, Kinderklinik München Schwabing, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department Health and Sport Sciences, Institute of Preventive Pediatrics, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Children’s Oncology Network Bavaria, KioNet, Erlangen, Germany
| | - Dominik Gaser
- Department of Pediatrics and Children's Cancer Research Centre, Kinderklinik München Schwabing, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department Health and Sport Sciences, Institute of Preventive Pediatrics, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Children’s Oncology Network Bavaria, KioNet, Erlangen, Germany
| | - Jennifer Queisser
- Department of Pediatrics and Children's Cancer Research Centre, Kinderklinik München Schwabing, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department Health and Sport Sciences, Institute of Preventive Pediatrics, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Miriam Götte
- Clinic of Pediatrics III, Hematology and Oncology, University Hospital Essen, Essen, Germany
- West German Cancer Center Essen, University Hospital Essen, Essen, Germany
| | - Irene von Luettichau
- Department of Pediatrics and Children's Cancer Research Centre, Kinderklinik München Schwabing, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Children’s Oncology Network Bavaria, KioNet, Erlangen, Germany
| | - Christiane Peters
- Department Health and Sport Sciences, Institute of Preventive Pediatrics, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Renate Oberhoffer-Fritz
- Department Health and Sport Sciences, Institute of Preventive Pediatrics, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Gabriele Gauß
- Clinic of Pediatrics III, Hematology and Oncology, University Hospital Essen, Essen, Germany
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3
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Hawn R, Stevens J, Basha M, Kwekkeboom K. A Systematic Review of the Characteristics and Effects of Physical Activity Interventions on Physical Activity Engagement, Long-Term and Late Effects, and Quality of Life in Adolescent and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2024. [PMID: 38324011 DOI: 10.1089/jayao.2023.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Physical activity (PA) may minimize long-term and late effects experienced by cancer survivors. However, the efficacy of PA interventions in increasing PA engagement among adolescent and young adult (AYA) cancer survivors diagnosed between 15 and 39 is not well understood. This systematic review aimed to examine the effects of moderate- to high-intensity or strength training PA interventions on PA engagement in AYA cancer survivors. Secondary aims included describing intervention components unique to efficacious interventions, identifying symptom management in PA interventions, and evaluating intervention effects on quality of life (QoL), and long-term or late effects of cancer. We searched PubMed, CINAHL, PsycINFO, SportDiscus, Cochrane Library, and Scopus databases from inception to August 2022 and identified 12 articles, including 8 randomized controlled trials and 4 quasi-experimental studies. The effect of PA interventions on PA engagement was mixed, with four studies reporting increases in PA engagement ranging from 18.4 to 113.8 min/week postintervention. There was great diversity in PA intervention components. Motivational interviewing, supervised and unsupervised PA sessions together, moderate-intensity PA only, and mindful meditation were components unique to efficacious interventions. No intervention incorporated symptom management components. Studies provided some evidence of PA interventions on potential long-term effects of cancer, with positive impact on fatigue, and some evidence of improved anxiety, sleep, and QoL. Given limited research with AYA cancer survivors, additional research is needed to identify effective intervention components, integrate symptom management strategies into PA interventions, and track effects of PA interventions on late and long-term effects of cancer in this population.
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Affiliation(s)
- Rachel Hawn
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jen Stevens
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Mays Basha
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
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4
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Hoover RL, Xu J, Conklin JL, Nichols HB, Smitherman A, Valle CG, Schwartz T, Mayer DK, Hirschey R. Physical Activity Intervention Characteristics and Effects on Behavioral and Health-Related Outcomes Among Adolescents and Young Adults Living with and Beyond Cancer: A Systematic Review. J Adolesc Young Adult Oncol 2024; 13:55-79. [PMID: 37682344 PMCID: PMC10877394 DOI: 10.1089/jayao.2023.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
Participation in physical activity (PA) during and after cancer treatment is safe and beneficial in the adolescent and young adult (AYA) cancer population. PA can positively impact health-related outcomes; however, participation remains low. This systematic review aims to describe PA intervention characteristics and outcomes in AYA survivors of cancer (AYASCa). This review followed Preferred Reporting Index for Systematic Reviews and Meta Analyses (PRISMA) guidelines and was registered with Prospero (CRD42022365661). PubMed, CINAHL, and Scopus databases were searched for randomized control trials (RCTs) and pre/post-test studies without a control group through December 31, 2022. Data included: participant demographics, PA intervention characteristics, and health-related outcomes. Studies were assessed using the National Institute of Health Critical Appraisal Tools, and findings were synthesized to identify common characteristics of PA interventions and outcomes. Twenty-three studies were included: 15 RCTs and 8 pre/post-test studies. Heterogeneity existed across design, sample demographics, intervention timing, and observed outcomes. The most common characteristics of PA interventions were supervision of PA, wearable device use, tailored/individualized PA prescriptions, and goal setting. PA interventions positively affected health-related outcomes, with 21 studies reporting statistically significant findings. Implementing personalized PA prescriptions, utilizing wearable devices, and incorporating goal setting as characteristics in PA interventions hold potential benefits for AYASCa, leading to improved outcomes. Still, additional research is needed to explore interventions that utilize these PA characteristics and determine which ones are most effective for AYASCa. By further investigating and identifying optimal PA characteristics, interventions can be better tailored to meet this population's specific needs and preferences, ultimately enhancing their overall well-being and recovery.
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Affiliation(s)
- Rebecca L. Hoover
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jingle Xu
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jamie L. Conklin
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hazel B. Nichols
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Andrew Smitherman
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
- Department of Pediatric Hematology/Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Carmina G. Valle
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
- Department of Nutrition, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Todd Schwartz
- Department of Biostatistics, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Deborah K. Mayer
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rachel Hirschey
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
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5
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Aagesen M, la Cour K, Møller JJK, Stapelfeldt CM, Hauken MA, Pilegaard MS. Rehabilitation interventions for young adult cancer survivors: A scoping review. Clin Rehabil 2023; 37:1347-1374. [PMID: 37083478 DOI: 10.1177/02692155231168720] [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: 04/22/2023]
Abstract
OBJECTIVE To map existing research concerning rehabilitation interventions for young adult cancer survivors (YACS) that address at least one factor from the biopsychosocial health model. DESIGN Scoping review. DATA SOURCES Searches were performed in EMBASE, MEDLINE, PsycINFO, CINAHL and Cochrane in January 2022 and updated in March 2023, and grey literature between February and April 2022. METHODS The review followed Joanna Briggs Institute's methodology for scoping reviews. Quantitative, qualitative and mixed methods studies evaluating interventions for YACS of any cancer who had completed primary treatment and were between 18 and 39 years old at diagnosis were included. Two authors independently screened studies for eligibility, and standardised forms were used for data extraction. Descriptive statistics, narrative summaries and thematic analysis were used to analyse the data. RESULTS The search revealed 5706 records, of which 70 were full-text screened. The 20 included studies represented a heterogeneous group of 444 young adults with different cancer types, mean age above 25, and an overrepresentation of females. Most studies were feasibility and pilot studies. The 20 studies consisted of 14 unique interventions focusing primarily on one dimension of the biopsychosocial health model like biological or psychological factors. In the 14 interventions, the most frequent intervention element was peer-to-peer support (n = 12). The interventions were often delivered online (n = 9), lasting 3-12 months (n = 8). A wide variety of theories, providers and outcome measures were used. CONCLUSION The results show that current research on multicomponent, biopsychosocial and age-specific rehabilitation for YACS remains at an early stage.
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Affiliation(s)
- Maria Aagesen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- The Research Unit for User Perspectives and Community-Based Interventions, The Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen la Cour
- The Research Unit for User Perspectives and Community-Based Interventions, The Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens-Jakob Kjer Møller
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christina M Stapelfeldt
- The Danish Clinical Quality Program - National Clinical Registries (RKKP), Aarhus N, Denmark
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - May Aasebø Hauken
- Faculty of Psychology, Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Marc Sampedro Pilegaard
- Central Region Denmark, DEFACTUM, Aarhus, Denmark
- Department of Social Medicine and Rehabilitation, Regional Hospital Gødstrup, Herning, Denmark
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6
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Caru M, Wurz A, Brunet J, Barb ED, Adams SC, Roth ME, Winters-Stone K, Fidler-Benaoudia MM, Dandekar S, Ness KK, Culos-Reed SN, Schulte F, Rao P, Mizrahi D, Swartz MC, Smith M, Valle CG, Kadan-Lottick NS, Dieli-Conwright CM, Schmitz KH. Physical activity and physical fitness assessments in adolescents and young adults diagnosed with cancer: a scoping review. Support Care Cancer 2023; 31:569. [PMID: 37695526 DOI: 10.1007/s00520-023-08008-7] [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] [Received: 05/25/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE This scoping review describes the assessment methodologies for physical activity (PA) and physical fitness assessments used in studies focusing on adolescents and young adults (AYAs) diagnosed with cancer. METHODS A search of the literature was conducted in PubMed, CINAHL, Web of Science, and Cochrane Library following the PRISMA-ScR statement. A total of 34 studies were included in this review. RESULTS PA was primarily assessed via self-reported questionnaires (30/34) either completed in-person (n = 17) or online (n = 13) at different time points and different stages along the cancer trajectory (i.e., from diagnosis onward). A total of 9 studies conducted a physical fitness assessment. CONCLUSIONS PA and physical fitness measurements are key when trying to describe outcomes, assess for associations, track changes, measure intervention adherence, and test intervention efficacy and effectiveness. Considerable heterogeneity across studies was reported limiting the generation of formal recommendations or guidance for researchers, healthcare providers, and policy makers.
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Affiliation(s)
- Maxime Caru
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA.
| | - Amanda Wurz
- School of Kinesiology, University of the Fraser Valley, Chilliwack, BC, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Jennifer Brunet
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Emily D Barb
- School of Kinesiology, Pennsylvania State University-Harrisburg, Middletown, PA, USA
| | - Scott C Adams
- Department of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Michael E Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kerri Winters-Stone
- Oregon Health and Science University, Knight Cancer Institute, Portland, OR, USA
| | - Miranda M Fidler-Benaoudia
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Cancer Care Alberta, Calgary, AB, Canada
| | - Smita Dandekar
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Fiona Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Pooja Rao
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA
| | - David Mizrahi
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Maria Chang Swartz
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marlie Smith
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Carmina G Valle
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nina S Kadan-Lottick
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Christina M Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kathryn H Schmitz
- Department of Medicine, Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA
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7
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Cavestro GM, Mannucci A, Balaguer F, Hampel H, Kupfer SS, Repici A, Sartore-Bianchi A, Seppälä TT, Valentini V, Boland CR, Brand RE, Buffart TE, Burke CA, Caccialanza R, Cannizzaro R, Cascinu S, Cercek A, Crosbie EJ, Danese S, Dekker E, Daca-Alvarez M, Deni F, Dominguez-Valentin M, Eng C, Goel A, Guillem JG, Houwen BBSL, Kahi C, Kalady MF, Kastrinos F, Kühn F, Laghi L, Latchford A, Liska D, Lynch P, Malesci A, Mauri G, Meldolesi E, Møller P, Monahan KJ, Möslein G, Murphy CC, Nass K, Ng K, Oliani C, Papaleo E, Patel SG, Puzzono M, Remo A, Ricciardiello L, Ripamonti CI, Siena S, Singh SK, Stadler ZK, Stanich PP, Syngal S, Turi S, Urso ED, Valle L, Vanni VS, Vilar E, Vitellaro M, You YQN, Yurgelun MB, Zuppardo RA, Stoffel EM. Delphi Initiative for Early-Onset Colorectal Cancer (DIRECt) International Management Guidelines. Clin Gastroenterol Hepatol 2023; 21:581-603.e33. [PMID: 36549470 DOI: 10.1016/j.cgh.2022.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Patients with early-onset colorectal cancer (eoCRC) are managed according to guidelines that are not age-specific. A multidisciplinary international group (DIRECt), composed of 69 experts, was convened to develop the first evidence-based consensus recommendations for eoCRC. METHODS After reviewing the published literature, a Delphi methodology was used to draft and respond to clinically relevant questions. Each statement underwent 3 rounds of voting and reached a consensus level of agreement of ≥80%. RESULTS The DIRECt group produced 31 statements in 7 areas of interest: diagnosis, risk factors, genetics, pathology-oncology, endoscopy, therapy, and supportive care. There was strong consensus that all individuals younger than 50 should undergo CRC risk stratification and prompt symptom assessment. All newly diagnosed eoCRC patients should receive germline genetic testing, ideally before surgery. On the basis of current evidence, endoscopic, surgical, and oncologic treatment of eoCRC should not differ from later-onset CRC, except for individuals with pathogenic or likely pathogenic germline variants. The evidence on chemotherapy is not sufficient to recommend changes to established therapeutic protocols. Fertility preservation and sexual health are important to address in eoCRC survivors. The DIRECt group highlighted areas with knowledge gaps that should be prioritized in future research efforts, including age at first screening for the general population, use of fecal immunochemical tests, chemotherapy, endoscopic therapy, and post-treatment surveillance for eoCRC patients. CONCLUSIONS The DIRECt group produced the first consensus recommendations on eoCRC. All statements should be considered together with the accompanying comments and literature reviews. We highlighted areas where research should be prioritized. These guidelines represent a useful tool for clinicians caring for patients with eoCRC.
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Affiliation(s)
- Giulia Martina Cavestro
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Alessandro Mannucci
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesc Balaguer
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Heather Hampel
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center, Duarte, California
| | - Sonia S Kupfer
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, Illinois
| | - Alessandro Repici
- Gastrointestinal Endoscopy Unit, Humanitas University, Humanitas Research Hospital, Rozzano, Italy
| | - Andrea Sartore-Bianchi
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, and Department of Hematology Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Toni T Seppälä
- Faculty of Medicine and Medical Technology, University of Tampere and TAYS Cancer Centre, Arvo Ylpön katu, Tampere, Finland; Unit of Gastroenterological Surgery, Tampere University Hospital, Elämänaukio, Tampere, Finland; Applied Tumor Genomics Research Program and Department of Surgery, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Vincenzo Valentini
- Department of Radiology, Radiation Oncology and Hematology, Università Cattolica del Sacro Cuore di Roma, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Clement Richard Boland
- Department of Medicine, Division of Gastroenterology, University of California San Diego, San Diego, California
| | - Randall E Brand
- Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tineke E Buffart
- Department of Medical Oncology. Amsterdam UMC, Location de Boelelaan, Amsterdam, The Netherlands
| | - Carol A Burke
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Renato Cannizzaro
- SOC Gastroenterologia Oncologica e Sperimentale Centro di Riferimento Oncologico di Aviano (CRO) IRCCS 33081, Aviano, Italy
| | - Stefano Cascinu
- Oncology Department, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Emma J Crosbie
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, United Kingdom; Division of Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Silvio Danese
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Maria Daca-Alvarez
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesco Deni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mev Dominguez-Valentin
- Department of Tumor Biology, Institute of Cancer Research, The Norwegian Radium Hospital, Oslo, Norway
| | - Cathy Eng
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Ajay Goel
- Department of Molecular Diagnostics & Experimental Therapeutics, Beckman Research Institute of City of Hope Comprehensive Cancer Center, Duarte, California
| | - Josè G Guillem
- Department of Surgery and Lineberger Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Britt B S L Houwen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Charles Kahi
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Matthew F Kalady
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Fay Kastrinos
- Division of Digestive and Liver Diseases, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center and the Vagelos College of Physicians and Surgeons, New York, New York
| | - Florian Kühn
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Luigi Laghi
- Department of Medicine and Surgery, University of Parma, Parma, and Laboratory of Molecular Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Andrew Latchford
- Lynch Syndrome Clinic, Centre for Familial Intestinal Cancer, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, United Kingdom
| | - David Liska
- Department of Colorectal Surgery and Edward J. DeBartolo Jr Family Center for Young-Onset Colorectal Cancer, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Patrick Lynch
- Department of Gastroenterology, M. D. Anderson Cancer Center, Houston, Texas
| | - Alberto Malesci
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gianluca Mauri
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, and Department of Hematology Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy; IFOM ETS - The AIRC Institute of Molecular Oncology, Milan, Italy
| | - Elisa Meldolesi
- Department of Radiology, Radiation Oncology and Hematology, Università Cattolica del Sacro Cuore di Roma, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Pål Møller
- Department of Tumor Biology, Institute of Cancer Research, The Norwegian Radium Hospital, Oslo, Norway
| | - Kevin J Monahan
- Lynch Syndrome Clinic, Centre for Familial Intestinal Cancer, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, United Kingdom; Faculty of Medicine, Department of Surgery & Cancer, Imperial College, London, United Kingdom
| | - Gabriela Möslein
- Surgical Center for Hereditary Tumors, Ev. BETHESDA Khs. Duisburg, Academic Hospital University of Düsseldorf, Düsseldorf, Germany
| | - Caitlin C Murphy
- School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
| | - Karlijn Nass
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Kimmie Ng
- Young-Onset Colorectal Cancer Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Cristina Oliani
- Medical Oncology, AULSS 5 Polesana, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Enrico Papaleo
- Centro Scienze della Natalità, Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Swati G Patel
- University of Colorado Anschutz Medical Center and Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Marta Puzzono
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Remo
- Pathology Unit, Mater Salutis Hospital, ULSS9, Legnago, Verona, Italy
| | - Luigi Ricciardiello
- Department of Medical and Surgical Sciences, Universita degli Studi di Bologna, Bologna, Italy
| | - Carla Ida Ripamonti
- Department of Onco-Haematology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Siena
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, and Department of Hematology Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Satish K Singh
- Department of Medicine, Section of Gastroenterology, VA Boston Healthcare System and Boston University, Boston, Massachusetts
| | - Zsofia K Stadler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter P Stanich
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sapna Syngal
- Brigham and Women's Hospital, Harvard Medical School, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Stefano Turi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emanuele Damiano Urso
- Chirurgia Generale 3, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University Hospital of Padova, Padova, Italy
| | - Laura Valle
- Hereditary Cancer Program, Catalan Institute of Oncology, Oncobell Program, Bellvitge Biomedical Research Center (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Madrid, Spain
| | - Valeria Stella Vanni
- Centro Scienze della Natalità, Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Eduardo Vilar
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marco Vitellaro
- Unit of Hereditary Digestive Tract Tumours, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Yi-Qian Nancy You
- Department of Colon & Rectal Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew B Yurgelun
- Brigham and Women's Hospital, Harvard Medical School, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Raffaella Alessia Zuppardo
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena M Stoffel
- Division of Gastroenterology and Hepatology, Department of Internal Medicine and Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan
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Safety, Feasibility and Efficacy of Lokomat ® and Armeo ®Spring Training in Deconditioned Paediatric, Adolescent and Young Adult Cancer Patients. Cancers (Basel) 2023; 15:cancers15041250. [PMID: 36831593 PMCID: PMC9954270 DOI: 10.3390/cancers15041250] [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: 12/21/2022] [Revised: 02/08/2023] [Accepted: 02/11/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Rehabilitation robotics is a field of study which aims to understand and augment rehabilitation through the use of robotics devices. OBJECTIVE This proof of concept study aimed to test the safety (no. adverse events, incidence of infection), feasibility (program demand, adherence, participant satisfaction) and efficacy (Peak Oxygen uptake (VO2peak), 6-min walk test, gait speeds, Canadian Occupational Performance Measure, quality of life) of Lokomat® and Armeo®Spring training in children and adolescents and young adults (AYAs) during or soon after cancer treatment. METHOD This was a 6-week single arm pre-post study. Cancer patients with significant musculoskeletal, neurological, gait and/or upper limb deficiency aged 5 to 25 years were recruited. The rehabilitation program included access to two robotic orthoses: the Lokomat® and/or Armeo®Spring. Robotic devices utilised real-time biofeedback and computer games to engage and guide participants through a repetitive functional range of movement aimed at improving functional deficiencies. Progressive increases in exercise intensity and duration were encouraged. RESULTS Twentey-eight participants were approached for study; twenty-one consented. Seventy-six percent completed the six-week intervention with an overall adherence of 83%. The mean participant satisfaction score was 8.8/10. Forty-nine adverse events were recorded throughout the course of the study, forty-five grade 1, three grade 2 and one grade 3. No adverse events led to withdrawal from the study. Preliminary efficacy results indicate large beneficial effects on VO2peak (r = 0.63), 10 m comfortable pace walk (r = 0.51) and maximal pace walk (r = 0.60), 6-min walk test (r = 0.60), maximal back and leg strength (r = 0.71), trunk flexibility (r = 0.60), The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30) (r = 0.61), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT F) r = 0.53 and the Canadian Occupational Performance Measure, satisfaction (r = 0.88) and performance scores (r = 0.83), and moderate beneficial effects on Leisure Score Index (LSI) (r = 0.30). CONCLUSION Our results suggest that Lokomat® and Armeo®Spring training is safe and feasible for use in children and AYAs who are currently undergoing or have recently completed cancer therapy. A larger controlled trial investigating the efficacy of robotics rehabilitation in this cohort is warranted.
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Langworthy E, Gokal K, Kettle VE, Daley AJ. Effects of physical activity interventions on physical activity and health outcomes in young people during treatment for cancer: a systematic review and meta-analysis of randomised controlled trials. BMJ Open Sport Exerc Med 2023; 9:e001466. [PMID: 36704714 PMCID: PMC9872472 DOI: 10.1136/bmjsem-2022-001466] [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] [Accepted: 01/05/2023] [Indexed: 01/25/2023] Open
Abstract
Objective Physical activity may improve health and reduce the adverse effects of cancer and/or its treatment in young people, therefore, interventions that promote physical activity are important. This systematic review and meta-analysis aims to synthesise evidence from randomised controlled trials (RCTs) that have assessed the effectiveness of physical activity interventions on health outcomes in young people undergoing cancer treatment. Design Systematic review with meta-analyses. Data sources Embase, PubMed, Medline, PsycINFO, PsychArticles, SPORTDiscus, Scopus, Web of Science and The Cochrane Library were searched from inception to January 2022. Eligibility criteria for selecting studies Studies were eligible for inclusion if they were RCTs, recruited young patients with cancer receiving cancer treatment and tested an aerobic physical activity intervention. Title/abstract reports were screened against the review eligibility criteria. Results Searches revealed seven eligible trials that had recruited 317 participants. No differences were found in minutes per day of participation in moderate to vigorous intensity physical activity (MD 2.61, 95% CI -3.67 to 8.89, p=0.42), total physical activity (standardised mean difference, SMD 0.35, 95% CI -0.39 to 1.09, p=0.35) or fatigue (SMD -0.50, 95% CI -1.03 to 0.02, p=0.06). Sensitivity analyses where trials with a high risk of bias were excluded, revealed significant effects for total physical activity (SMD 0.87, 95% CI 0.17 to 1.57, p=0.02) and fatigue (SMD 0.74, 95% CI -1.13 to -0.35), p=0.0002). Conclusion Evidence regarding the effects of physical activity interventions on the health of young people undergoing treatment for cancer is limited and mixed, where results from high-quality trials showed some promise.
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Affiliation(s)
- Ellie Langworthy
- Centre for Lifestyle Medicine and Behaviour, Loughborough University, Loughborough, UK
| | - Kajal Gokal
- Centre for Lifestyle Medicine and Behaviour, Loughborough University, Loughborough, UK
| | - Victoria E Kettle
- Centre for Lifestyle Medicine and Behaviour, Loughborough University, Loughborough, UK
| | - Amanda J Daley
- Centre for Lifestyle Medicine and Behaviour, Loughborough University, Loughborough, UK
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10
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Voland A, Krell V, Götte M, Niels T, Köppel M, Wiskemann J. Exercise Preferences in Young Adults with Cancer-The YOUEX Study. Curr Oncol 2023; 30:1473-1487. [PMID: 36826074 PMCID: PMC9955702 DOI: 10.3390/curroncol30020113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
(1) Background: Strong evidence supports the persuasive positive effects of exercise for cancer patients and survivors. Different approaches of exercise programs have been established; however, the special interests of young adults (YAs) with cancer have rarely been considered in exercise interventions. Therefore, the study YOUng EXercisers (YOUEX) aimed to investigate exercise preferences in YAs. (2) Methods: YOUEX was a three-arm, patient preference-based non-randomized, longitudinal, pre-post exercise intervention, offering three different exercise modules to YAs during or after acute therapy (Module 1: online supervised group-based (M1); Module 2: online unsupervised (M2); Module 3: in-person supervised (M3)). The intervention period was 12 weeks with another 12-week follow-up period, the modules could be changed or amended after 6 and 12 weeks. (3) Results: 92 YAs were allocated to the study. At baseline, 50 YAs (54%) chose M2, 32 YAs (35%) M1 and 10 YAs (11%) M3. The analysis revealed high acceptability and feasibility of the online exercise programs (M1, M2). There was a high impact of the COVID-19 pandemic on the execution of M3. YAs showed diverse preferences in module selection due to differences in, e.g., cancer therapy status or favored level of supervision. (4) Conclusions: YAs need personalized exercise programs that consider their individual interests and needs. Online exercise programs can be a promising addition to existing exercise opportunities. They are an effective way to increase physical activity levels in YAs.
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Affiliation(s)
- Annelie Voland
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Verena Krell
- Department of Sports Medicine, Charité—Universitätsmedizin Berlin, 10115 Berlin, Germany
- Department of Sports Medicine, Humboldt—Universität zu Berlin, 10115 Berlin, Germany
| | - Miriam Götte
- West German Cancer Center, University Hospital Essen, 45122 Essen, Germany
| | - Timo Niels
- Department I of Internal Medicine, Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf, University Hospital of Cologne, 50937 Cologne, Germany
| | - Maximilian Köppel
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Joachim Wiskemann
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Correspondence:
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The physicAl aCtivity Counselling for young adult cancEr SurvivorS (ACCESS) trial: A protocol for a parallel, two-arm pilot randomized controlled trial. PLoS One 2022; 17:e0273045. [PMID: 36584027 PMCID: PMC9803096 DOI: 10.1371/journal.pone.0273045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Young adults aged 18-39 years commonly experience persistent side effects following cancer treatment that can impair their quality of life. Physical activity (PA) holds promise as a behavioral intervention to mitigate persistent side effects and improve quality of life. Yet, few young adults are active enough to incur these benefits and efforts to promote PA after cancer treatment ends are lacking. Therefore, we developed a novel theory-driven behavior change intervention to promote PA via videoconferencing technology in young adults who have completed cancer treatment, and are undertaking a pilot randomized controlled trial (RCT) to gather evidence to inform the design of a large, full-scale RCT. The specific aims of this parallel, two-arm pilot RCT are to: (1) assess intervention and trial protocol feasibility and acceptability; and (2) generate data on PA behavior. To promote transparency, improve reproducibility, and serve as a reference for forthcoming publication of results, we present the study protocol for this pilot RCT (version 7) within this paper. METHODS Young adults who have completed cancer treatment are being recruited from across Canada. After informed consent is obtained and baseline assessments are completed, participants are randomized to the intervention group (i.e., a 12-week behavior change intervention delivered via videoconferencing technology by trained PA counsellors) or usual care group (i.e., no intervention). Several feasibility outcomes covering enrollment, allocation, follow-up, and analysis are tracked by study staff. Acceptability is assessed through interviews exploring participants' experiences, thoughts, and perspectives of the trial protocol (i.e., intervention and usual care groups), as well as participants' views of the intervention and its mode of delivery (i.e., intervention group only) and PA counsellors' experiences delivering the intervention. PA behavior is measured using accelerometers at baseline (pre-randomization), post-intervention, and at follow-up (24 weeks post-baseline). DISCUSSION There are growing calls to develop interventions to support young adults' motivation to engage in PA and adopt an active lifestyle to improve their quality of life after cancer treatment ends. Real-time videoconferencing shows promise for disseminating behavior change interventions to young adults and addressing participation barriers. Considering the importance of establishing intervention and trial protocol feasibility and acceptability prior to evaluating intervention efficacy (or effectiveness), this pilot RCT is critical to understand how participants embrace, engage with, and complete the intervention and trial protocol. Indeed, these data will help to determine which refinements, if any, are required to the intervention and trial protocol (e.g., implementation approach, evaluation methods) prior to a large, full-scale RCT aiming to test the effects of the intervention on PA behavior. Additionally, the PA behavior data collected will be useful to inform the sample size calculation for a large, full-scale RCT. TRIAL REGISTRATION The trial was registered with the ClinicalTrials.gov database (ID: NCT04163042) on November 14, 2019, prior to the start of the trial in February, 2021.
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Moraitis AM, Seven M, Sirard J, Walker RR. Clinical Relevance and Implementation Considerations of Physical Activity in Young Adult Cancer Survivorship: An Expert Consensus Study. J Adolesc Young Adult Oncol 2022. [PMID: 36269579 DOI: 10.1089/jayao.2022.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Significance: Elevated survival rates in young adult cancer survivors (YACS) are accompanied by high morbidity levels resulting in an array of unmet needs limiting full life potential. Physical activity (PA) improves physical, psychological, and social aspects of health after a cancer diagnosis. There are no standardized PA guidelines tailored to YACS. Therefore, there is a critical need to understand areas of clinical relevance/agreement on PA use and implementation in young adult (YA) survivorship care. Aim: To identify expert consensus areas on the assessment, prescription, and implementation of PA in YA survivorship care; identify areas of clinical relevance and endorsement of PA as a health optimization strategy in YA survivorship care. Methods: A four-round modified Delphi study of international multidisciplinary experts (Round I/II n = 18; Round III n = 57, Round IV n = 45) in exercise oncology, symptom management, survivorship care, youth cancer care was conducted. Qualitative content analysis, descriptive statistics (% agreement, standard deviation, mean), and inter-rater reliability (Kappa) were calculated. Results: Experts reached a consensus on clinical providers needed to assess, refer, and provide PA interventions, the need for guidelines, and essential care delivery system components to foster the integration of PA integration in YA survivorship care as a health optimization activity. Conclusions/Implications: Cancer care integration models should optimize the unique preferences, strengths, and developmental stage of YA affected by cancer. The study adds to the existing literature on multidisciplinary teams needed to provide clinical expertise and organizational support to foster PA integration into YA survivorship care.
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Affiliation(s)
| | - Memnun Seven
- Elaine Marieb College of Nursing, University of Massachusetts, Amherst, Massachusetts, Amherst, USA
| | - John Sirard
- Department of Kinesiology and Commonwealth Honors College, University of Massachusetts, Amherst, Massachusetts, Amherst, USA
| | - Rachel Rae Walker
- Elaine Marieb College of Nursing, University of Massachusetts, Amherst, Massachusetts, Amherst, USA
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Munsie C, Ebert J, Joske D, Ackland T. A randomised controlled trial investigating the ability for supervised exercise to reduce treatment-related decline in adolescent and young adult cancer patients. Support Care Cancer 2022; 30:8159-8171. [PMID: 35792926 PMCID: PMC9257117 DOI: 10.1007/s00520-022-07217-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 06/09/2022] [Indexed: 11/23/2022]
Abstract
Introduction Exercise is recognised as integral in mitigating a myriad negative consequences of cancer treatment. However, its benefit within adolescent and young adult (AYA) cancer cohorts remains relatively under researched, and caution should be taken in extrapolating outcomes from adult and paediatric populations given AYA distinctly different physiological and psychosocial contexts. This study sought to evaluate the impact of an exercise intervention on mitigating the expected decline in fitness, strength, physical functioning, and quality of life (QOL) in AYA undergoing cancer treatment. Methods This prospective, randomised controlled trial (FiGHTINGF!T) allocated 43 participants (63% male, mean age 21.1 years) to a 10-week, multimodal, bi-weekly exercise intervention (EG) or control group (CG) undergoing usual care. Pre- and post-intervention assessments included cardiopulmonary exercise tests, one-repetition maximum (1RM) strength, functional tests, and QOL patient-reported outcome measures. Data were analysed via linear mixed models and regression. Results While no significant group differences (p > 0.05) were observed, neither group significantly declined (p > 0.05) in any outcome measure over the 10-week period. No significant (p˃0.05) strength or functional improvements were observed in the CG, though the EG demonstrated significant improvements in their 1RM leg press (p = 0.004) and chest press (p = 0.032), maximal push ups (p = 0.032), and global QOL (p = 0.011). The EG reported a significant increase in fatigue (p = 0.014), while the CG reported significant positive changes in anxiety measures (p = 0.005). Conclusion The exercise intervention produced superior improvements in strength and global QOL, compared with the CG. Regardless of group allocation, enrolment in the exercise study appeared to mitigate the treatment-related decline expected in AYA undergoing cancer treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07217-w.
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Affiliation(s)
- Claire Munsie
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, WA, Australia. .,WA Youth Cancer Service, Locked Bag 2012, Nedlands, WA, 6009, Australia. .,Sir Charles Gairdner Hospital, Perth, WA, Australia.
| | - Jay Ebert
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, WA, Australia
| | - David Joske
- Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Medicine, The University of Western Australia, Perth, WA, Australia
| | - Timothy Ackland
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, WA, Australia
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14
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Liu Y, Wang R, Qiao S, Liu F, Wang L, Su Y. How dignity-related distress interact with quality of life in young adult patients with cancer during the active treatment stage: A network analysis. Psychooncology 2022; 31:1564-1571. [PMID: 35793432 DOI: 10.1002/pon.5998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/25/2022] [Accepted: 07/03/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Young adult patients with cancer are a growing concern. By means of network analysis, this study aimed to explore the interplay between dignity-related distress and quality of life (QoL) in young adult patients with cancer when they undergo active treatments. METHODS In this cross-sectional study, 309 young adults aged 18-39 and diagnosed with malignant tumors were recruited from an oncology center in China between September 2020 and August 2021. Participants completed the Patient Dignity Inventory and SF-36 questionnaires. Network analysis was applied to examine the network structure. RESULTS Overall, the core facets of dignity-related distress were negatively related to QoL and its corresponding domains, either directly or indirectly. Developmental distress played a central role among estimated networks and strongly interplayed with most QoL domains, especially the mental domains. Symptom distress was the only facet consistently interplayed with the physical domains of QoL (i.e., physical function and bodily pain). The social aspects were also revealed in the association between limited social support and vitality. CONCLUSIONS Early attention must be paid to guarantee the need of preserving dignity and enhancing QoL for young adult patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yuqi Liu
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Rui Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Shiman Qiao
- Department of Radiotherapy, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Fuyan Liu
- Department of Radiotherapy, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Lanzhong Wang
- School of Foreign Languages and Literature, Shandong University, Jinan, Shandong, China
| | - Yonggang Su
- School of Foreign Languages and Literature, Shandong University, Jinan, Shandong, China.,School of Basic Medical Sciences, Shandong University, Jinan, Shandong, China.,Shandong Provincial Key Laboratory of Mental Disorders, School of Basic Medical Sciences, Shandong University, Jinan, Shandong, China
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15
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A Scoping Review to Map the Evidence of Physical Activity Interventions in Post-Treatment Adolescent and Young Adult Cancer Survivors. Crit Rev Oncol Hematol 2022; 171:103620. [DOI: 10.1016/j.critrevonc.2022.103620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 02/03/2023] Open
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16
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Guimarães JAC, Guerra PH, Ueno DT, Spósito LAC, Sebastião E, Nakamura PM. Barriers to physical activity among cancer pediatric cancer patients and survivors: a scoping review. MOTRIZ: REVISTA DE EDUCACAO FISICA 2022. [DOI: 10.1590/s1980-657420220005621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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17
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Ketterl TG, Ballard S, Bradford MC, Chow EJ, Jenssen K, Myers S, Rosenberg AR, Doren MV, Scott Baker K. Feasibility and acceptability of a home-based resistance training intervention in adolescent and young adult hematopoietic cell transplant survivors. Pediatr Blood Cancer 2021; 68:e29206. [PMID: 34260139 PMCID: PMC8463478 DOI: 10.1002/pbc.29206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adolescent and young adult (AYA) hematopoietic cell transplantation (HCT) survivors are at increased risk of metabolic syndrome and lean body mass (LBM) deficits. Resistance training (RT) is a potential intervention to improve LBM, metabolic fitness, and reduce risk of cardiovascular disease. PROCEDURE Eligible participants ages 13-39 years, 80-120 days post-HCT, transfusion independent, and prednisone dose ≤1 mg/kg/day were approached. Baseline assessments of body composition (DXA), anthropometrics, and strength testing were completed and participants were taught a 12-week, home-based RT intervention with weekly remote coaching. Follow-up assessments were at day +200 (FU1) and +365 post-HCT (FU2). Feasibility targets were (a) 60% enrollment of approached patients, (b) 80% completion of weekly phone calls, and (c) 80% completion of the RT intervention and FU1 assessments. Acceptability was based on positive responses in qualitative interviews. RESULTS Twenty of 31 (65%) eligible AYAs enrolled. Three participants failed to complete baseline measurements (2 = scheduling barriers, 1 = passive refusal) and four participants who completed baseline assessments did not receive the intervention (1 = medical reasons, 2 = no longer interested). Of those who completed baseline assessments, 13 received the intervention, completed 88.5% of coaching calls, and 11 (65%) completed FU1. LBM (kg) increased or remained unchanged in nine of nine participants with complete body composition data at FU1 (mean 1.1 kg; 95%CI: 0.4, 1.9). All participants who completed FU1 reported they would recommend the intervention to an AYA HCT survivor. CONCLUSIONS A home-based RT intervention in AYA HCT survivors early post HCT is both feasible and acceptable and may maintain or increase LBM.
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Affiliation(s)
- Tyler G. Ketterl
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, WA,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Washington, Seattle, WA,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Sheri Ballard
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Miranda C. Bradford
- Core for Biostatistics Epidemiology and Analytics in Research, Seattle Children’s Research Institute, Seattle, WA
| | - Eric J. Chow
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, WA,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Washington, Seattle, WA,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kari Jenssen
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Sam Myers
- Exercise Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Abby R. Rosenberg
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, WA,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Washington, Seattle, WA,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Matt Van Doren
- Exercise Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - K. Scott Baker
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, WA,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Washington, Seattle, WA,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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18
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Munsie C, Ebert J, Collins J, Plaster M, Joske D, Ackland T. A supervised exercise intervention during cancer treatment for adolescents and young adults-FiGHTING F!T: study protocol of a randomised controlled trial. Trials 2021; 22:676. [PMID: 34602065 PMCID: PMC8489079 DOI: 10.1186/s13063-021-05616-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 09/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND High-quality evidence supports the integration of exercise to mitigate treatment-related side effects in a wide range of paediatric and adult cancer cohorts. However, the implementation of exercise in adolescent and young adult (AYA) cancer patients is yet to be explored in depth. FiGHTINGF!T is a randomised controlled cross over trial designed to determine if a supervised, structured, and progressive exercise programme can reduce the decline in physical fitness (V02peak) associated with cancer treatment in AYAs from diagnosis. METHODS/DESIGN A total of 40 AYAs recently diagnosed and due to commence systemic treatment (± 2 weeks) for a primary haematological malignancy or solid tumour will be recruited and randomised to either an immediate exercise intervention or usual care (delayed exercise) for 10 weeks. This randomised controlled crossover trial will see both groups engage in a supervised exercise intervention from either diagnosis (baseline assessment) for 10 weeks (0-10 weeks) or following an interim assessment to 20 weeks (10-20 weeks). The bi-weekly tailored exercise programme will combine aerobic and resistance exercises and be supervised by an Accredited Exercise Physiologist. Participants will complete a range of assessments at 0, 10, and 20 weeks including cardiopulmonary exercise tests, 1 repetition maximum strength measures, physical functioning, and self-reported quality of life measurements. Patient-reported treatment-related toxicities will be recorded on a weekly basis. DISCUSSION The FiGHTINGF!T trial will provide insight into the potential benefits of a supervised exercise programme in AYAs undergoing cancer treatment. This trial will contribute to the evidence supporting the necessary integration of exercise during cancer treatment, specifically in the under-reported AYA cohort. TRIAL REGISTRATION This trial was registered retrospectively with the Australia New Zealand Clinical Trial registry ( ACTRN12620000663954 ). Registered on 10 June 2020.
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Affiliation(s)
- Claire Munsie
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia Australia
- Western Australian Youth Cancer Service, Perth, Western Australia Australia
- Sir Charles Gairdner Hospital, Perth, Western Australia Australia
| | - Jay Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia Australia
| | - Joanne Collins
- Western Australian Youth Cancer Service, Perth, Western Australia Australia
- Sir Charles Gairdner Hospital, Perth, Western Australia Australia
| | - Megan Plaster
- Western Australian Youth Cancer Service, Perth, Western Australia Australia
- Sir Charles Gairdner Hospital, Perth, Western Australia Australia
| | - David Joske
- Sir Charles Gairdner Hospital, Perth, Western Australia Australia
- School of Medicine, University of Western Australia, Western Australia Perth, Australia
| | - Timothy Ackland
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia Australia
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19
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Murnane A, Kiss N, Fraser SF, Lewin J. Health-related quality of life, fatigue and health behaviours in Australian adolescent and young adult cancer survivors. Pediatr Blood Cancer 2021; 68:e29243. [PMID: 34309171 DOI: 10.1002/pbc.29243] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Current knowledge of the long-term health behaviours and well-being of adolescent and yong adult (AYA) cancer survivors is limited. The aim of this study was to evaluate the health behaviours of AYA cancer survivors compared to Australian normative data and describe their health-related quality of life (HR-QoL) and levels of fatigue. METHOD A cross-sectional online survey of participants aged 15-25 years at diagnosis and 2-7 years post treatment completion was conducted at a comprehensive cancer centre. Validated questionnaires assessed health behaviours and functioning including current physical activity (PA) levels, diet quality, fatigue (FACIT-F) and HR-QoL (AQoL-6D, Short Form 36v2 [SF-36v2]) were compared to Australian normative data. RESULTS Ninety individuals completed the survey (26% response rate) with a mean age of 25.4 years and median time post treatment of 61 months (24-85 months). Compared to normative data, a higher proportion of AYA cancer survivors was consuming the recommended daily serves of fruit and vegetables (16.7% vs. 3.9%, p < .0001), had a lower presence of overweight or obesity (46.7% vs. 57.7%, p = .04) and lower percentage of current smokers (2.2% vs. 16.7%, p < .0001). However, AYA cancer survivors reported increased fatigue (t[df = 596] = -4.1, p < .0001) and reduced HR-QoL compared to normative data (t[df = 533] = 9.2, p < .0001) along with a higher proportion suffering from one or more chronic health conditions (65% vs. 40%, p < .0001). CONCLUSION AYA cancer survivors from a single Australian institution, who were on average 5 years post treatment, exhibited better health behaviours compared to Australian normative data, but still below recommended guidelines. However, they continue to experience issues with fatigue and reduced HR-QoL, especially in those not meeting the PA guidelines.
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Affiliation(s)
- Andrew Murnane
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia.,Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
| | - Jeremy Lewin
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
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20
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Marec-Bérard P, Delrieu L, Febvey-Combes O, Mongondry R, Pérol O, Moumjid-Ferdjaoui N, Boyle H, Fervers B, Carretier J. Implementation of a Prevention Program Based on Adapted Physical Activity and Recommendations for Adolescents and Young Adults with Cancer: PREVAPAJA Study. J Adolesc Young Adult Oncol 2021; 11:189-201. [PMID: 34255553 DOI: 10.1089/jayao.2021.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: In Europe, 20,000 Adolescent and Young Adults (AYAs) aged 15-25 years are diagnosed with cancer annually. Although prognosis is good, AYA cancer survivors are at greater risk of second primary cancers, cardiovascular disease, and various long-term effects. Benefits of physical activity (PA) in AYAs reported in current studies remain difficult to generalize; none has been performed in France. This single-arm intervention study tested the feasibility of combining hospital-based supervised and home-based unsupervised physical activity sessions (PAS) and providing cancer prevention recommendations for AYAs. Methods: The AYAs attended PAS concomitant to treatment and participated in one face-to-face prevention interview. PA (international physical activity questionnaire), 6-min walk distance (6MWD), sedentarity, anthropometrics, quality of life (QoL), and fatigue were assessed at baseline (T1) and end of intervention (T2). PA, satisfaction and cancer prevention behaviors were assessed 1 year after baseline (T3). Results: Fifty-nine AYAs (mean 19 years) participated in the study. Acceptability and attrition were 80% and 12%, respectively. Between T1 and T2, 6MWD and global QoL improved (p < 0.001), and fatigue decreased (p = 0.003). Total PA improved and sitting time decreased (p < 0.001) overall (T1-T3). Assessment at T3 showed interindividual differences in how participants considered risk factors (e.g., more attention to PA, UV exposures, nutrition). Conclusion: Combined supervised and unsupervised home-based PAS in AYAs undergoing cancer treatment is acceptable and feasible. The program contributes to maintaining and improving physical fitness and QoL, while reducing fatigue and other cancer and treatment symptoms. Larger randomized controlled trials are needed to confirm these results.
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Affiliation(s)
- Perrine Marec-Bérard
- Pediatric Department, Hematology and Oncology Pediatric Institute, Centre Léon Bérard, Lyon, France
| | - Lidia Delrieu
- Department Prevention, Cancer and Environment, Léon Bérard Cancer Center, Lyon, France
| | - Olivia Febvey-Combes
- Clinical Research and Innovation Department, Léon Bérard Cancer Center, Lyon, France
| | - Rodolf Mongondry
- Department Prevention, Cancer and Environment, Léon Bérard Cancer Center, Lyon, France
| | - Olivia Pérol
- Department Prevention, Cancer and Environment, Léon Bérard Cancer Center, Lyon, France
| | | | - Helen Boyle
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Béatrice Fervers
- Department Prevention, Cancer and Environment, Léon Bérard Cancer Center, Lyon, France.,UMR INSERM 1296 "Radiations: Defence, Health and Environment," Lyon, France
| | - Julien Carretier
- Department Prevention, Cancer and Environment, Léon Bérard Cancer Center, Lyon, France
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21
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Erickson JM, Tokarek N, Ke W, Swartz A. A Randomized Controlled Trial of a Physical Activity Intervention for Self-management of Fatigue in Adolescents and Young Adults With Cancer. Cancer Nurs 2021; 44:263-271. [PMID: 32568808 PMCID: PMC7744366 DOI: 10.1097/ncc.0000000000000834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Fatigue remains a persistent and troubling symptom for adolescents and young adults (AYAs) with cancer. Physical activity (PA) is recommended as a strategy for self-management of fatigue. OBJECTIVE The aim of the study was to examine a PA intervention to improve the self-management of fatigue in AYAs during chemotherapy. METHODS This randomized controlled trial enrolled AYAs (18-39 years) receiving chemotherapy. Adolescents and young adults in the intervention group received a 12-week PA intervention integrated into 5 clinic visits that included education, PA tracking, and collaboration. Physical activity was measured with an accelerometer, and participants completed measures of fatigue severity, self-efficacy for PA, and self-regulation at baseline and end of study. RESULTS Forty-four AYAs completed the study. At baseline, AYAs averaged 4290 (SD, 2423) steps/day and 14.4 (SD, 20.6) minutes/day of moderate- to vigorous-intensity PA; their average Patient-Reported Outcomes Measurement Information System fatigue score was 55.0 (SD, 9.2). At end of study, there were no significant differences between groups in fatigue, self-efficacy, self-regulation, or PA, but trends in the desired direction were observed for each of the variables in the intervention group. CONCLUSION During chemotherapy, AYAs had variable levels of PA and engaged in mostly light-intensity PA. Their average fatigue level was slightly worse than a national comparison group. IMPLICATIONS FOR PRACTICE Tailored interventions are needed to promote PA in AYAs as a self-management strategy for fatigue. Enhancing self-efficacy and self-regulation may be important approaches to promote PA.
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Affiliation(s)
- Jeanne M Erickson
- Author Affiliations: College of Nursing (Drs Erickson and Ke) and College of Health Sciences and Department of Kinesiology (Mr Tokarek and Dr Swartz), University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
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22
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Salchow J, Koch B, Mann J, von Grundherr J, Elmers S, Dwinger S, Escherich G, Vettorazzi E, Reer R, Sinn M, Baumann F, Bokemeyer C, Stein A, Jensen W. Effects of a structured counselling-based intervention to improve physical activity behaviour of adolescents and young adult cancer survivors - the randomized phase II Motivate AYA - MAYA trial. Clin Rehabil 2021; 35:1164-1174. [PMID: 33685232 PMCID: PMC8273535 DOI: 10.1177/0269215521997974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective: To explore whether a structured counselling-based intervention increases vigorous physical activity behaviour of adolescent and young adult cancer survivors. Design: Randomized controlled phase II trial. Setting: University Cancer Center Hamburg, Germany. Subjects: Eighty-nine participants (mean age 24.1 ± 6.3) were randomized to control (n = 44) or intervention group (n = 45). Interventions: The intervention group was consulted about physical activity behaviour via interview (week 0), and telephone counselling (weeks 1, 3 and 12). The control group only received general physical activity guidelines for cancer survivors (week 0). Main measures: The primary outcome was the rate of participants with ⩾9 metabolic equivalent (MET)-hours per week of vigorous activity post-intervention, measured with the International Physical Activity Questionnaire. Secondary outcomes included assessing physical activity behaviour (e.g. amount and type of physical activity) and quality of life. Assessments were completed in weeks 0 (baseline), 12 (post-intervention) and 52 (follow-up). Results: Sixty-nine participants completed the post-intervention- and 47 the follow-up-assessment. The rate of participants performing vigorous physical activity increased from baseline to post-intervention for both without differing significantly (P = 0.541). Both increased their total metabolic equivalent from baseline to post-intervention (intervention group from 55.2 ± 43.7 to 61.7 ± 29.4, control group from 75.3 ± 81.4 to 88.3 ± 80.2). At follow-up the intervention group (73.7 ± 80.2) was more active than baseline when compared to the control group (78.5 ± 50.0). Conclusions: A structured counselling-based physical activity intervention did not significantly impact the level of vigorous physical activity behaviour in adolescent and young adult cancer survivors.
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Affiliation(s)
- Jannike Salchow
- Department of Oncology and Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Koch
- Department of Oncology and Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Mann
- Department of Oncology and Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia von Grundherr
- Department of Oncology and Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon Elmers
- Department of Oncology and Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Dwinger
- Department for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriele Escherich
- Department of Pediatric Hematology and Oncology, Hubertus Wald Tumor Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rüdiger Reer
- Institute of Human Movement Science, Faculty of Psychology and Human Movement, University of Hamburg, Hamburg, Germany
| | - Marianne Sinn
- Department of Oncology and Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Freerk Baumann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University Hospital of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Carsten Bokemeyer
- Department of Oncology and Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Stein
- Department of Oncology and Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wiebke Jensen
- Department of Oncology and Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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23
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Moraitis AM, Seven M, Walker RK. Physical Activity in Young Adult Cancer Survivors: A Scoping Review. Oncol Nurs Forum 2021; 48:184-194. [PMID: 33600391 DOI: 10.1188/21.onf.184-194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Physical activity, a precision health strategy, positively affects biopsychosocial health in adult cancer survivors. However, understanding its effects among young adult (YA) cancer survivors is limited. The purpose of this scoping review was to explore existing research on physical activity in YA cancer survivors. LITERATURE SEARCH CINAHL®, PubMed®, PsycINFO®, SPORTDiscus, Web of Science, and Cochrane Library were searched, producing 63 articles and 28 grey materials. DATA EVALUATION Data extraction, guided by the revised symptom management model, included research aims, sample, design, primary outcome measures, and effects of physical activity. SYNTHESIS Findings of 35 review articles were reported under three main categories. IMPLICATIONS FOR RESEARCH Lack of clinical guidelines and limited research specific to YA cancer survivors hinders physical activity's use as a symptom management strategy. Research is needed that addresses the development and clinical implementation of physical activity guidelines.
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Ito N, Petrella A, Sabiston C, Fisher A, Pugh G. A Systematic Review and Narrative Synthesis of Exercise Interventions to Manage Fatigue Among Children, Adolescents, and Young Adults with Cancer. J Adolesc Young Adult Oncol 2021; 10:361-378. [PMID: 33625879 DOI: 10.1089/jayao.2020.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Exercise is known to improve fatigue among adult cancer patients however there is limited understanding of this relationship in children, adolescents, and young adults (AYA) with cancer. The aim is to evaluate the effect of exercise on fatigue outcomes among children and AYA with cancer and to identify important parameters of exercise (frequency, intensity, time, type, and setting), which may be relevant for future intervention design. A systematic search of PubMed, MedLine, CENTRAL, Embase, and Web of Science databases was conducted in December 2019, for studies within the last decade, reporting the effect of exercise on fatigue among cancer patients and survivors 0-24 years of age. Quality assessment was conducted using the Physiotherapy Evidence Database (PEDro) and "Before/After Studies with No Control Group" scales. Seventeen studies (n = 681 participants) were included, of which six were randomized controlled trials (RCTs), and the remaining being pilot (n = 5) or feasibility studies (n = 6). Across studies there was great heterogeneity in intervention delivery, frequency (range: 1-7 days a week), time (range: 10-60 minutes), and duration (range: 3-24 weeks). A positive effect of exercise on fatigue was observed, however, most changes in fatigue were not statistically significant. Exercise is beneficial for reducing fatigue in young cancer patients. However, due to the heterogeneity and quality of existing interventions, firm conclusions about the most effective mode and format of exercise intervention cannot be drawn. There is a need for more definitive large-scale RCTs that can provide data of sufficient quality.
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Affiliation(s)
- Nonoka Ito
- Centre for Sports and Exercise Medicine, Queen Mary University of London, London, United Kingdom
| | - Anika Petrella
- Department of Kinesiology, University of Toronto, Toronto, Canada
| | | | - Abigail Fisher
- Department of Behavioral Science and Health, University College London, London, United Kingdom
| | - Gemma Pugh
- Centre for Sports and Exercise Medicine, Queen Mary University of London, London, United Kingdom
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25
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Understanding adolescents' and young adults' self-perceptions after cancer treatment in the context of a two-arm, mixed-methods pilot randomized controlled physical activity trial. Support Care Cancer 2021; 29:4439-4450. [PMID: 33449169 DOI: 10.1007/s00520-020-05974-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The self-perceptions of adolescents and young adults (AYAs) after cancer treatment are not well understood. As part of a two-arm, mixed-methods pilot randomized controlled trial (RCT), this qualitative sub-study explored AYAs' self-perceptions after cancer treatment and investigated how physical activity (PA) may contribute to their self-perceptions. METHODS Data were collected from 16 AYAs who completed cancer treatment and who participated in a two-arm, mixed-methods pilot RCT. Recruited AYAs were randomized to a 12-week PA intervention or a wait-list control group, and semi-structured interviews were conducted at baseline (pre-randomization) and 12 weeks later (post-intervention or post-waiting period) to elicit discussions on self-perceptions and PA. Data were analyzed thematically using inductive and deductive approaches. The exercise and self-esteem model (EXSEM) was the theoretical lens for the deductive analysis. RESULTS Data were organized into four unified main themes: (1) I came out on top and am (re)discovering myself, (2) Comparison to my past self and others induces negative feelings, (3) My changed body brings me down, but it does not rule my life, and (4) My previous experience with PA informs my expectations for my future PA, and two themes contingent on group allocation: (5) Participating in a PA program made me feel better about myself, and (6) I did not notice any changes while waiting for the PA program, but I am anticipating support. CONCLUSION AYAs' self-perceptions are amenable to change, positively and negatively valenced, and influenced by PA. Although the EXSEM captured intrapersonal factors related to AYAs' self-perceptions after cancer treatment, interpersonal and contextual factors beyond the EXSEM also shaped their self-perceptions. TRIAL REGISTRATION Clinicaltrials.gov , NCT03016728. Registered January 11, 2017.
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26
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Atkinson M, Murnane A, Goddard T, Pendergrast C, Rogers P, Manudhane R, Osborn M. A randomized controlled trial of a structured exercise intervention after the completion of acute cancer treatment in adolescents and young adults. Pediatr Blood Cancer 2021; 68:e28751. [PMID: 33063932 DOI: 10.1002/pbc.28751] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 09/14/2020] [Accepted: 09/20/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cancer treatments are frequently associated with impaired physical fitness, quality of life (QOL), and fatigue, often persisting into survivorship. Studies in older adults with cancer have demonstrated benefits from exercise; however, this has not been rigorously investigated in adolescents and young adults (AYA). The aim of this study was to determine whether a structured 10-week exercise intervention was associated with improved cardiorespiratory fitness (VO2peak ), fatigue, and QOL in AYA who have recently completed cancer treatment. METHOD Forty-three AYA (median age 21 ± 6 years) were randomly assigned to an exercise group (n = 22) or a control group (n = 21). The exercise group received a structured 10-week exercise program comprising progressive aerobic and resistance exercise; the control arm received routine care. VO2peak was measured at baseline, 10 weeks, and six months. Fatigue and QOL were assessed by the FACIT fatigue scale and the PEDS QL, respectively. RESULTS Mean VO2peak at baseline was 26.5 ± 7.2 mL.kg-1 .min-1 , which is substantially lower than population norms. The exercise group demonstrated significant improvement in VO2peak at 10 weeks compared with controls (33.8 ± 8.1 vs 29.6 ± 7.6 mL.kg-1 .min-1 , P = 0.0002), but by six months, the difference was no longer significant (32.9 ± 7.0 vs 30.9 ± 11.0 mL.kg-1 .min-1 , P = 0.21). There were no significant differences in fatigue or total QOL scores between groups. CONCLUSION Cancer treatment is associated with reduced VO2peak in AYA. Improvement in VO2peak was accelerated by a 10-week exercise program; however, no significant benefit was observed in QOL or fatigue. The plateau in VO2peak at six months suggests that a maintenance exercise program may be beneficial.
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Affiliation(s)
- Morgan Atkinson
- Youth Cancer Service SA/NT, Royal Adelaide Hospital, Adelaide, Australia
| | - Andrew Murnane
- ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Melbourne, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, Australia
| | - Thomas Goddard
- Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, Australia.,School of Paediatrics and Reproductive Health, Faculty of Medicine, The University of Adelaide, Adelaide, Australia
| | - Cathy Pendergrast
- Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, Australia
| | - Paul Rogers
- Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, Australia
| | - Rebecca Manudhane
- Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, Australia
| | - Michael Osborn
- Youth Cancer Service SA/NT, Royal Adelaide Hospital, Adelaide, Australia.,Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, Australia
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27
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DeNysschen CA, Panek-Shirley LM, Zimmerman B. Exercise with Nutrition Education to Improve Quality of Life of Adolescent and Young Adult Cancer Survivors: A Pilot Study. J Adolesc Young Adult Oncol 2020; 10:454-461. [PMID: 32936030 DOI: 10.1089/jayao.2020.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Most evidence for the relationship between physical activity, nutrition education, and late effects from cancer treatment come from cross-sectional studies. The purpose of this pilot study was to determine if 8 weeks of exercise and nutrition education in adolescent and young adult (AYA) survivors positively affects fatigue, quality of life, health-related fitness, and dietary intake. Methods: The exercise program targeted improvement in multiple areas of health-related fitness. A Registered Dietitian conducted nutrition education sessions with goal setting. To encourage activity, social engagement, and support, participants connected to a study-specific group. Fatigue and QoL (FACIT, PedsQL Teen, and Young Adult), health-related fitness (cardiovascular endurance, flexibility, muscular strength and endurance, anthropometrics), nutrition knowledge, and dietary intake assessments were conducted at weeks 1 and 10. Participant perceptions of strengths and weaknesses within the program were assessed after program completion. Results: Twenty four (16.6 ± 2.8 years) AYA cancer survivors began and completed the program. Problems with fatigue (PedsQL Teen and Young Adult) significantly improved along with decreased perceived barriers to exercise. Participants significantly improved cardiovascular endurance, flexibility, and muscular strength and endurance. Trying to make healthy nutrition choices, understanding how to read nutrition labels, and identifying a saturated fat significantly improved without a significant change in dietary intake. Participants' favorite program components related to exercise and social support. Conclusion: In view of the short- and long-term impacts of cancer diagnosis, treatment, and survivorship, as well as the benefits of physical activity on these factors, exercise programs with social support should be considered adjuvant therapy among AYA cancer survivors.
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Affiliation(s)
- Carol A DeNysschen
- Buffalo State College State University of New York, Buffalo, New York, USA.,Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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28
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Zhi X, Xie M, Zeng Y, Liu JE, Cheng ASK. Effects of Exercise Intervention on Quality of Life in Adolescent and Young Adult Cancer Patients and Survivors: A Meta-Analysis. Integr Cancer Ther 2020; 18:1534735419895590. [PMID: 31845599 PMCID: PMC6918037 DOI: 10.1177/1534735419895590] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cancer and its treatment significantly impact the quality of life (QOL) of adolescent and young adult (AYA) patients. This meta-analysis examined the effects of exercise interventions on the generic and cancer-specific QOL of AYA cancer patients and survivors. METHODS Four databases were searched from January 2010 to September 2019. RevMan 5.3 was used to synthesize the effects of exercise intervention on the QOL of AYA cancer patients and survivors. RESULTS A total of 11 eligible studies have been included in this paper. Direct outcome comparisons found that pooled overall effects on generic QOL were in favor of exercise interventions, but only with marginal significance (Z= 1.96, P = 0.05). When performing the subscale analysis of the generic QOL, three trials assessed the effects of exercise interventions on the emotional domain of QOL, and the weighted mean difference (WMD) for the overall intervention effect was 3.47 (95% confidence interval [CI] = 0.42 to 6.51). Additionally, exercise interventions increased the minutes of physical activity per week undertaken by AYA cancer patients and survivors (Z= 2.88, P = 0.004). CONCLUSION Exercise interventions had positive effects on generic QOL and increased the minutes of physical activity per week undertaken by AYA cancer patients and survivors. In addition, exercise intervention programs appear to be safe, as there were no studies that reported adverse events. Future research, with rigorous methodological standards and larger sample sizes, should be designed to confirm the positive effects of exercise interventions on the QOL of AYA cancer patients and survivors.
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Affiliation(s)
- Xiaoxu Zhi
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, and The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Man Xie
- Jieyang People's Hospital, Jieyang, China
| | - Yingchun Zeng
- The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jun-E Liu
- Capital Medical University, Beijing, China
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Pugh G, Below N, Fisher A, Reynolds J, Epstone S. Trekstock RENEW: evaluation of a 12-week exercise referral programme for young adult cancer survivors delivered by a cancer charity. Support Care Cancer 2020; 28:5803-5812. [PMID: 32221668 PMCID: PMC7686001 DOI: 10.1007/s00520-020-05373-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/20/2020] [Indexed: 12/19/2022]
Abstract
Purpose To evaluate the uptake and effect of RENEW, a 12-week exercise referral programme for young adult cancer survivors delivered by Trekstock, a UK-based cancer charity. Methods The RENEW programme provides one-to-one individually tailored support from a level-4 cancer-rehabilitation-qualified gym instructor, free gym membership and access to information resources online. Objective and self-report data on cardiorespiratory function, strength, body composition, fatigue, sleep quality and general health-related quality of life (HRQoL) was collected from participants before the programme (week 0), immediately after (week 12) and 1 month later (week 16). Results Forty-eight young adults (83% female; mean age, 29 years) with a history of cancer took part within the 12-week programme and completed the evaluation measures. Physical activity (PA) levels significantly increased following the programme and remained raised at follow-up. Improvements in physical function were significant: peak expiratory flow (mean change, 30.96, p = 0.003), sit-and-reach test (mean change, 6.55 ± 4.54, p < 0.0001), and 6-mine-walk test (mean change, 0.12 ± 0.04, p < 0.0001). No significant changes in BMI, weight or muscle mass were observed. Improvements in fatigue, sleep and HRQoL were observed across the programme and at follow-up (mean change, weeks 0–16; 8.04 ± 1.49 p < 0.01; 1.05 ± 0.49 p < 0.05; and − 0.9 ± 0.46 p = 0.051, respectively). Changes in self-efficacy to exercise and motivations to exercise were not observed at 12 weeks or at follow-up. Conclusions Results suggest that the RENEW exercise referral programme has a positive impact upon some domains of physical function and well-being among young adult cancer survivors. Implication for cancer survivors Exercise referral programmes delivered by charity organisations are one means by which PA behaviour change support may be widely disseminated to young adult cancer survivors. Health professionals and charitable bodies specialising in the care of young adults with cancer should look to address factors which prevent engagement and uptake of ‘real-world’ PA interventions such as the RENEW programme.
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Affiliation(s)
- G Pugh
- Centre for Sports & Exercise Medicine, William Harvey Research Institute, School of Medicine & Dentistry, Queen Mary University of London, London, UK.
| | - N Below
- Centre for Sports & Exercise Medicine, William Harvey Research Institute, School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - A Fisher
- Department of Behavioural Science & Health, Institute of Epidemiology & Health Care, University College London, London, UK
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Kesting S, Weeber P, Schönfelder M, Renz BW, Wackerhage H, von Luettichau I. Exercise as a Potential Intervention to Modulate Cancer Outcomes in Children and Adults? Front Oncol 2020; 10:196. [PMID: 32154183 PMCID: PMC7047207 DOI: 10.3389/fonc.2020.00196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 02/05/2020] [Indexed: 12/21/2022] Open
Abstract
Exercise is recommended for the healthy population as it increases fitness and prevents diseases. Moreover, exercise is also applied as an adjunct therapy for patients with various chronic diseases including cancer. Childhood cancer is a rare, heterogeneous disease that differs from adult cancer. Improved therapeutic strategies have increased childhood cancer survival rates to above 80% in developed countries. Although this is higher than the average adult cancer survival rate of about 50%, therapy results often in substantial long-term side effects in childhood cancer survivors. Exercise in adult cancer patients has many beneficial effects and may slow down tumor progression and improve survival in some cancer types, suggesting that exercise may influence cancer cell behavior. In contrast to adults, there is not much data on general effects of exercise in children. Whilst it seems possible that exercise might delay cancer progression or improve survival in children as well, there is no reliable data yet to support this hypothesis. Depending on the type of cancer, animal studies of adult cancer types show that the exercise-induced increase of the catecholamines epinephrine and norepinephrine, have suppressive as well as promoting effects on cancer cells. The diverse effects of exercise in adult cancer patients require investigating whether these results can be achieved in children with cancer.
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Affiliation(s)
- Sabine Kesting
- Kinderklinik München Schwabing, Department of Pediatrics and Children's Cancer Research Center, TUM School of Medicine, Technical University of Munich, Munich, Germany.,Chair of Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Peter Weeber
- Exercise Biology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Martin Schönfelder
- Exercise Biology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Bernhard W Renz
- Department of General, Visceral, and Transplantation Surgery, Hospital of the University Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich; and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Henning Wackerhage
- Exercise Biology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Irene von Luettichau
- Kinderklinik München Schwabing, Department of Pediatrics and Children's Cancer Research Center, TUM School of Medicine, Technical University of Munich, Munich, Germany
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