A survey of cancer patients' interest in undertaking exercise to promote relaxation during radiotherapy for breast cancer and metastatic cancer

BACKGROUND

Approximately 25-50% of patients undergoing radiotherapy (RT) experience psychological distress and anxiety, which can detrimentally affect both their quality of life and treatment outcomes. While previous research has demonstrated that relaxation exercises can enhance the tolerability of RT and alleviate associated stress and anxiety, the specific needs for such therapies in radiation oncology remain under-explored. This study aims to investigate the demand for and preferences toward relaxation exercises among radiotherapy patients, addressing a critical gap in patient-centered care.

METHODS

A prospective pseudonymized survey study using a one-time paper-based questionnaire was conducted from 2022 to 2023 among patients undergoing curative-intent RT for breast cancer or patients undergoing palliative RT for bone metastases. Patients were asked in a 11-item questionnaire about their anxiety, pre-existing practice of relaxation exercises/interventions, their interest in relaxation exercises, and preferences on the type and format of instruction. Data were analyzed descriptively.

RESULTS

100 patients (74 female and 26 male) responded, of whom 68 received curative-intent adjuvant RT and 32 palliative RT. Median age was 62 years. 78% of patients indicated a desire to be actively involved in their radiotherapy, but only 27% had used relaxation exercises prior to RT. 44.8% of both curatively and palliatively treated patients who wanted to be actively involved in their therapy desired to learn how to best relax. 56.4% of respondents were willing to spend extra time learning offered exercises.

CONCLUSION

The survey indicates that patients undergoing RT, both for curative or palliative intent, desire relaxation exercises to relieve stress and anxiety from RT. It is therefore important to assess the need for relaxation interventions in individual patients and to develop suitable programs or collaborate with other healthcare professionals to meet these needs.

Management of Fatigue in Adult Survivors of Cancer: ASCO-Society for Integrative Oncology Guideline Update

PURPOSE

To update the ASCO guideline on the management of cancer-related fatigue (CRF) in adult survivors of cancer.

METHODS

A multidisciplinary panel of medical oncology, geriatric oncology, internal medicine, psychology, psychiatry, exercise oncology, integrative medicine, behavioral oncology, nursing, and advocacy experts was convened. Guideline development involved a systematic literature review of randomized controlled trials (RCTs) published in 2013-2023.

RESULTS

The evidence base consisted of 113 RCTs. Exercise, cognitive behavioral therapy (CBT), and mindfulness-based programs led to improvements in CRF both during and after the completion of cancer treatment. Tai chi, qigong, and American ginseng showed benefits during treatment, whereas yoga, acupressure, and moxibustion helped to manage CRF after completion of treatment. Use of other dietary supplements did not improve CRF during or after cancer treatment. In patients at the end of life, CBT and corticosteroids showed benefits. Certainty and quality of evidence were low to moderate for CRF management interventions.

RECOMMENDATIONS

Clinicians should recommend exercise, CBT, mindfulness-based programs, and tai chi or qigong to reduce the severity of fatigue during cancer treatment. Psychoeducation and American ginseng may be recommended in adults undergoing cancer treatment. For survivors after completion of treatment, clinicians should recommend exercise, CBT, and mindfulness-based programs; in particular, CBT and mindfulness-based programs have shown efficacy for managing moderate to severe fatigue after treatment. Yoga, acupressure, and moxibustion may also be recommended. Patients at the end of life may be offered CBT and corticosteroids. Clinicians should not recommend L-carnitine, antidepressants, wakefulness agents, or routinely recommend psychostimulants to manage symptoms of CRF. There is insufficient evidence to make recommendations for or against other psychosocial, integrative, or pharmacological interventions for the management of fatigue.Additional information is available at www.asco.org/survivorship-guidelines.

Stay on Track: A Pilot Randomized Control Trial on the Feasibility of a Diet and Exercise Intervention in Patients with Breast Cancer Receiving Radiotherapy

PURPOSE

Among patients with breast cancer undergoing radiotherapy, posttreatment cardiovascular disease and worsened quality of life (QoL) are leading causes of morbidity and mortality. To overcome these negative radiotherapy effects, this prospective, randomized clinical trial pilots a 12-week Stay on Track exercise and diet intervention for overweight patients with nonmetastatic breast cancer undergoing whole-breast radiotherapy.

EXPERIMENTAL DESIGN

The intervention group (n = 22) participated in three personal exercise and dietary counseling sessions, and received three text reminders/week to adhere to recommendations. The control group (n = 22) was administered a diet/exercise information binder. All patients received a Fitbit, and at baseline, 3 months, and 6 months, measurements of biomarkers, dual-energy X-ray absorptiometry scans, QoL and physical activity surveys, and food frequency questionnaires were obtained. A satisfaction survey was administered at 3 months.

RESULTS

Stay on Track was well received, with high rates of adherence and satisfaction. The intervention group showed an increase in self-reported physical activity and preserved QoL, a decrease in body mass index and visceral fat, and higher American Cancer Society/American Institute of Cancer Research dietary adherence. The control participants had reduced QoL, anti-inflammatory markers, and increased metabolic syndrome markers. Both groups had decreased overall body mass. These changes were within group effects. When comparing the intervention and control groups over time, there were notable improvements in dietary adherence in the intervention group.

CONCLUSIONS

Targeted lifestyle interventions during radiotherapy are feasible and could decrease cardiovascular comorbidities in patients with breast cancer. Larger-scale implementation with longer follow-up can better determine interventions that influence cardiometabolic health and QoL.

SIGNIFICANCE

This pilot study examines cardiometabolic benefits of a combined diet and exercise intervention for patients with breast cancer undergoing radiotherapy. The intervention included an activity tracker (FitBit) and text message reminders to promote adherence to lifestyle interventions. Large-scale implementation of such programs may improve cardiometabolic outcomes and overall QoL among patients with breast cancer.

Effects of different exercise interventions on chemotherapy-related cognitive impairment in patients with breast cancer: a study protocol for systematic review and network meta-analysis

INTRODUCTION

Breast cancer stands as the most prevalent type of cancer affecting women globally, and chemotherapy plays a pivotal role in its treatment by diminishing tumour recurrence and enhancing the survival rates of patients. However, chemotherapy-related cognitive impairment (CRCI) often occurs in patients undergoing treatment. Although multiple clinical trials have indicated that exercise therapy can improve CRCI in patients with breast cancer, there are variations in the types of exercise interventions and their effectiveness. We aim to perform a pioneering network meta-analysis (NMA) to assess and prioritise the effectiveness of various exercise interventions in enhancing cognitive function in patients with breast cancer undergoing chemotherapy.

METHODS AND ANALYSIS

We will search multiple databases, including PubMed, Web of Science, Cochrane, Embase, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, Wanfang and Sinomed databases, from their inception to May 2023. The main outcome is the cognitive function changes in patients with breast cancer, including subjective and objective results. We will specifically include randomised controlled trials reported in English and Chinese languages, whose primary outcome consists of an assessment of the cognitive function of patients with breast cancer using standardised and validated assessment tools, encompassing both subjective and objective outcomes. The quality of all the trials included will be evaluated based on 'Version 2 of the Cochrane tool for assessing the risk of bias in randomized controlled trials (RoB2)'. We will conduct a Bayesian NMA to thoroughly evaluate and compare the effectiveness of different exercise interventions. We will use cumulative ranking probability plots to estimate the ranking of the best interventions for various exercises. Network plots and funnel plots will be employed to display the study sizes and participants of each exercise intervention, as well as potential publication biases.

ETHICS AND DISSEMINATION

The study findings will be shared via peer-reviewed journals to ensure the highest quality and credibility of the research. As the reporting will not include any private patient data, there are no ethical considerations associated with this protocol.

PROSPERO REGISTRATION NUMBER

CRD42023406597.

Examining sociodemographic and health-related characteristics as moderators of an mHealth intervention on physical activity outcomes in young adult cancer survivors

PURPOSE

This study explored whether sociodemographic and health-related characteristics moderated mHealth PA intervention effects on total and moderate-to-vigorous physical activity (MVPA) at 6 months, relative to a self-help condition among young adult cancer survivors (YACS).

METHODS

We conducted exploratory secondary analyses of data from a randomized controlled trial among 280 YACS. All participants received digital tools; intervention participants also received lessons, adaptive goals, tailored feedback, text messages, and Facebook prompts. Potential moderators were assessed in baseline questionnaires. PA was measured at baseline and 6 months with accelerometers. Linear model repeated measures analyses examined within- and between-group PA changes stratified by levels of potential moderator variables.

RESULTS

Over 6 months, the intervention produced MVPA increases that were ≥ 30 min/week compared with the self-help among participants who were males (28.1 vs. -7.7, p = .0243), identified with racial/ethnic minority groups (35.2 vs. -8.0, p = .0006), had baseline BMI of 25-30 (25.4 vs. -7.2, p = .0034), or stage III/IV cancer diagnosis (26.0 vs. -6.8, p = .0041). Intervention participants who were ages 26-35, college graduates, married/living with a partner, had a solid tumor, or no baseline comorbidities had modest MVPA increases over 6 months compared to the self-help (ps = .0163-.0492). Baseline characteristics did not moderate intervention effects on total PA.

CONCLUSIONS

The mHealth intervention was more effective than a self-help group at improving MVPA among subgroups of YACS defined by characteristics (sex, race, BMI, cancer stage) that may be useful for tailoring PA interventions.

IMPLICATIONS FOR CANCER SURVIVORS

These potential moderators can guide future optimization of PA interventions for YACS.

CLINICALTRIALS

GOV IDENTIFIER

NCT03569605.

The efficacy of progressive muscle relaxation training on cancer-related fatigue and quality of life in patients with cancer: A systematic review and meta-analysis of randomized controlled studies

BACKGROUND

Cancer-related fatigue is one of the most common symptoms in cancer patients, usually accompanied by anxiety, depression and insomnia, which seriously affect patients' quality of life. Progressive muscle relaxation training is widely used for cancer-related fatigue, but the overall effect is unclear.

OBJECTIVES

The aim of this study was to summarize the evidence on the effects of progressive muscle relaxation training on cancer-related fatigue and quality of life in cancer patients.

DESIGN

Systematic review and meta-analysis.

METHODS

Nine electronic databases (PubMed, Excerpta Medica Database (Embase), The Cochrane Library (Cochrane Central Register of Controlled Trials, CENTRAL), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP) and Wanfang Database) were explored for randomized controlled trials (RCTs) published before February 2023. This study was reported based on the PRISMA 2020 statement. The Cochrane Collaboration's risk of bias assessment tool was used for methodological assessment, and the GRADE pro online assessment tool was used for evidence evaluation. The data were analyzed with the Review Manager 5.4 software.

RESULTS

Twelve studies involving 1047 patients were included. Meta-analysis showed that progressive muscle relaxation training plus routine nursing produced more positive effects than routine nursing in improving cancer-related fatigue [SMD = -1.06, 95 % CI -1.49, -0.62, P < 0.00001], anxiety [SMD = -1.09, 95 % CI -1.40, -0.77, P < 0.00001], depression [SMD = -1.43, 95 % CI -1.76, -1.10, P < 0.00001], and quality of sleep [MD = -1.41, 95 % CI -1.74, -1.08, P < 0.00001]. However, there was no significant difference in improving quality of life [SMD = 0.27, 95 % CI -0.62, 1.15, P = 0.55]. Progressive resistance exercise plus routine nursing improved cancer-related fatigue more than progressive muscle relaxation training plus routine nursing [SMD = 1.11, 95 % CI 0.43, 1.78, P = 0.001]. There was low certainty of evidence that progressive muscle relaxation training improved cancer-related fatigue and quality of sleep, and the evidence that improved quality of life, anxiety and depression was very low.

CONCLUSION

Current evidence suggested that progressive muscle relaxation training has the potential to improve cancer-related fatigue, anxiety, depression and quality of sleep in patients with cancer and is a low-load, simple exercise worthy of recommendation for cancer patients in fatigue state. Future research should focus on improving the methodological quality of randomized controlled trials to enhance the persuasive evidence of progressive muscle relaxation training efficacy.

Prehabilitation for Patients with Cancer Undergoing Radiation Therapy: a Scoping Review

AIMS

Prehabilitation is a process of identifying and assessing factors that could compromise the physical and psychological health of patients undergoing cancer treatment and implementing an intervention to combat such concerns. The use of prehabilitation in cancer surgery has yielded positive outcomes in rectal, lung and abdominal cancers. Prehabilitation strategies have potential to improve the management of patients receiving radiation therapy or chemoradiation. The aim of the present study was to map the evidence of the assessment and evaluation of prehabilitation for radiation therapy patients.

MATERIALS AND METHODS

A database search using EMBASE and PubMed was conducted. The PRISMA guidelines were adhered to. Keywords included prehabilitation, radiation therapy/radiotherapy, chemoradiotherapy/chemoradiation, intervention and exercise. Types of prehabilitation strategy, their purposes and impact, according to cancer site, were analysed.

RESULTS

Prehabilitation is most commonly evaluated in head and neck cancer, whereby unimodal, physical interventions manage dysphagia. Prehabilitation for lung cancer demonstrated its ability to widen treatment options for patients. Physical prehabilitation is administered to combat adverse effects of neoadjuvant chemoradiation therapy in patients with rectal cancer.

CONCLUSION

Prehabilitation is adaptive and tailored to specific patient and site needs; thus it is applied across a wide range of cancer sites. More interventions by which radiation therapy is the definitive treatment modality and larger sample sizes within these studies are warranted to increase prehabilitation utilisation for patients undergoing radiation therapy.

Assessment of Integrative Therapeutic Methods for Improving the Quality of Life and Functioning in Cancer Patients-A Systematic Review

Background: Cancer rehabilitation represents a series of measures adopted for the recovery of psychological, emotional, social, and financial functioning in the case of cancer patients. The purpose of this study is to identify the main elements of therapeutic management in the field of medical rehabilitation, as well as integrative, complementary medicine and holistic approaches that can be performed on the oncological patient. Methods: This systematic literature review follows the methodology outlined in the "Preferred Reporting Items for Systematic Reviews and Meta-Analysis" ("PRISMA") statement, which is an internationally recognized and widely accepted standard. Results: Active rehabilitative therapies offer therapeutic options for improving the functioning and quality of life of oncological patients; these therapies comprehensively address both the physical and psychological aspects of the disease. This review also includes the latest novelties and nanotechnologies applied in oncological rehabilitation, for example, drugs (or supplements) inspired by nature. Conclusions: Physical and rehabilitation medicine, mostly using stimulating therapeutic methods, was recently added to the list of contraindications in the management of oncological patients, both as an approach to the pathological concept itself and as an approach to the main clinical consequences and functional aspects of oncological therapies. Integrative, complementary medicine presents an important therapeutic resource in the case of oncological patients. Advanced studies are needed in the future to further ascertain the role of these therapies.

Various interventions for cancer-related fatigue in patients with breast cancer: a systematic review and network meta-analysis

Purpose

To investigate the effects of various intervention approaches on cancer-related fatigue (CRF) in patients with breast cancer.

Method

Computer searches were conducted on PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wanfang databases from their establishment to June 2023. Selection was made using inclusion and exclusion criteria, and 77 articles were included to compare the effects of 12 interventions on patients with breast cancer.

Results

Seventy-seven studies with 12 various interventions were examined. The network findings indicated that cognitive behavioral therapy (CBT) (SMD, -1.56; 95%CI, -3.08~-0.04), Chinese traditional exercises (CTE) (SMD, -0.85; 95%CI, -1.34~-0.36), aerobic exercise (AE) (SMD, -0.77; 95%CI, -1.09~-0.45), multimodal exercise (ME) (SMD, -0.75; 95%CI, -1.26~-0.25), music interventions (MI) (SMD, -0.74; 95%CI, -1.45~-0.03), and yoga (YG) (SMD, -0.44; 95%CI, -0.83 to -0.06) can reduce CRF more than the control group (CG). For relaxation exercises (RE) (MD, -6.69; 95%CI, -9.81~-3.57), MI (MD, -5.45; 95%CI, -7.98~-2.92), AE (MD, -4.34; 95%CI, -5.90~-2.78), ME (MD, -3.47; 95%CI, -4.95~-1.99), YG (MD, -2.07; 95%CI, -3.56~-0.57), and mindfulness training (MD, -1.68; 95%CI, -2.91~-0.46), PSQI improvement was superior to CG. In addition, for CTE (MD, 11.39; 95%CI, 4.11-18.66), YG (MD, 11.28; 95%CI, 1.63-20.93), and AE (MD, 9.34; 95%CI, 0.26~18.42), Functional Assessment of Cancer Therapy-Breast improvement was superior to CG.

Conclusion

Cognitive behavioral therapy (CBT) is the most effective measure for alleviating CRF in patients with breast cancer and Relaxation exercises (RE) is the most effective measure for improving sleep quality. In addition, Chinese traditional exercises (CTE) is the best measure for enhancing quality of life. Additional randomized controlled trials (RCTs) are expected to further investigate the efficacy and mechanisms of these interventions.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023471574.

Potential mechanisms underlying the effect of walking exercise on cancer-related fatigue in cancer survivors

PURPOSE

Cancer-related fatigue (CRF) is a common and debilitating long-term side effect of cancer and its treatment. While exercise has been shown to effectively reduce CRF, the underlying mechanisms are not fully clear. Therefore, the aim of this study was to explore the effects of a 4-month walking exercise program on fatigue severity and to explore potential underlying physiological, behavioral, and psychological mechanisms of action.

METHODS

We included 27 cancer survivors (59 ± 15 years, 37% female) with variable cancer diagnoses who were at least moderately fatigued and finished treatment between 6 and 36 months ago. This study with a quasi-experimental interrupted time-series design compared a 4-month walking intervention period with a 4-month control period. Measurements of fatigue and physiological, behavioral, and psychological factors were performed, supplemented with participants' perceptions on how exercise influenced their fatigue.

RESULTS

A significant and clinically relevant decrease in fatigue severity was found over time (β =  - 8.1, 95% CI =  - 12.1; - 4.2), but could not be attributed directly to the walking exercise intervention. Increases in muscle strength (β =  - 0.07, 95% CI =  - 0.12; - 0.02), physical activity (β =  - 0.1, 95% CI =  - 0.2; - 0.04), and sleep quality (β = 1.1, 95% CI = 0.3; 1.9), as well as decreases in muscle relaxation times (β = 0.09, 95% CI = 0.02; 0.16) and psychological distress (β = 1.1, 95% CI = 0.8; 1.3) were associated with reductions in fatigue severity. Resilience and physical well-being were perceived as most important constructs explaining the walking exercise effects on fatigue.

CONCLUSION

Our findings reveal potential physiological, behavioral, and psychological mechanisms underlying the multidimensional effects of exercise on fatigue severity.

IMPLICATIONS FOR CANCER SURVIVORS

Incorporating resistance exercise and addressing resilience and physical well-being might improve the efficacy of exercise interventions for cancer survivors.

Effect of Exercise Therapy on Cancer-Related Fatigue in Patients With Breast Cancer: A Systematic Review and Network Meta-analysis

OBJECTIVE

This study aimed to explore the efficacy of different exercise therapies in reducing fatigue in patients with breast cancer.

DESIGN

PubMed, Embase, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, China Biology Medicine, China National Knowledge Infrastructure, Database of Chinese Sci-tech Periodicals, and Wanfang databases were searched from their inception to March 2022. The authors independently screened all randomized controlled trials of exercise therapy in patients with breast cancer. A network meta-analysis was performed using Stata 16.0 software.

RESULTS

Seventy-eight studies were analyzed, with 167 comparisons and 6235 patients. The network results showed that stretching (standardized mean difference = -0.74, confidence interval = -1.43 to -0.06), yoga (standardized mean difference = -0.49, confidence interval = -0.75 to -0.22), combined exercise (standardized mean difference = -0.47, confidence interval = -0.70 to -0.24), aerobic exercise (standardized mean difference = -0.46, confidence interval = -0.66 to -0.26), and resistance exercise (standardized mean difference = -0.42, confidence interval = -0.77 to -0.08) significantly reduced fatigue. Pairwise comparisons confirmed that yoga, combined exercise, aerobic exercise, and resistance exercise were positively associated with fatigue relief. However, no significant association was identified between reduced fatigue and traditional Chinese exercises or stretching.

CONCLUSIONS

The most effective exercise therapy to relieve cancer-related fatigue in patients with breast cancer was yoga, followed by combined aerobic and resistance exercises. It is expected that more randomized controlled trials will be conducted to further explore the efficacy and mechanisms of exercise.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Effectiveness of aerobic and resistance exercise in cancer survivors with depression: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

AE and RE have been found to be effective for depressive symptoms. However, a systematic review and meta-analysis of studies examining the effectiveness of exercises for cancer survivors with depressive symptoms is lacking. We aimed to synthesize studies assessing AE and RE's efficacy and examine their effects on depressive symptoms among cancer survivors using meta-analyses.

METHODS

This review was registered on the PROSPERO website with ID CRD42023389760. A systematic literature search was conducted in the four databases. Data were synthesized using a random-effect model to analyze the impact of AE and RE on depressive symptoms at posttreatment and in medium-term follow-up relative to the control group. Subgroup analyses were conducted to investigate which factors are relevant to greater or lesser effects of treating depressive symptoms among cancer survivors.

RESULTS

28 RCTs (2942 participants) were identified. Analyses of the between-group showed that AE and/or RE were effective in alleviating depressive symptoms among cancer survivors in immediate posttreatment (SMD = -0.16; 95% CI = -0.29 to -0.03; p = 0.02) but not in medium-term follow-up (SMD = -0.01; 95% CI = -0.57 to 0.55; p = 0.97). Subgroup analyses suggested that AE and exercise 3 times per week were significant moderators.

CONCLUSION

AE and RE were feasible in mitigating depressive symptoms in cancer patients. Further studies are needed to examine if exercise is psychologically beneficial for patients with specific types of cancer.

Effectiveness of physical activity interventions on reducing perceived fatigue among adults with chronic conditions: a systematic review and meta-analysis of randomised controlled trials

Fatigue is barrier of physical activity participation in adults with chronic conditions. However, physical activity alleviates fatigue symptoms. This systematic review and meta-analysis aimed to (1) synthesise evidence from randomised controlled trials (RCTs) exploring the effects of physical activity interventions on fatigue reduction and (2) evaluate their effectiveness. Medline/CINAHL/EMBASE/Web of Science and Scopus were searched up to June 24th, 2023. Two reviewers independently conducted study screening and selection (RCTs), extracted data and assessed risk of bias (RoB2). Outcome was the standardised mean difference (SMD) with 95% confidence intervals in fatigue between experimental and control groups. 38 articles met the inclusion criteria. Overall, physical activity interventions moderately reduced fatigue (SMD = 0.54, p < 0.0001). Interventions lasting 2-6 weeks demonstrated a larger effect on fatigue reduction (SMD = 0.86, p < 0.00001). Interventions with 18-24 sessions showed a large effect on fatigue reduction (SMD = 0.97, p < 0.00001). Aerobic cycling and combination training interventions had a large to moderate effect (SMD = 0.66, p = 0.0005; SMD = 0.60, p = 0.0010, respectively). No long-term effects were found during follow-up. Physical activity interventions moderately reduced fatigue among adults with chronic conditions. Duration, total sessions, and mode of physical activity were identified as key factors in intervention effectiveness. Further research is needed to explore the impact of physical activity interventions on fatigue.

A scoping review of studies exploring physical activity and cognition among persons with cancer

PURPOSE

This scoping review aimed to identify and synthesize published studies on physical activity (PA) and cognition among persons with cancer and elucidate knowledge gaps.

METHODS

Articles were identified through electronic and manual searches (02/21 and 03/22) using the following inclusion criteria: (1) empirical, peer-reviewed publication in English, (2) sample comprised persons with cancer, and (3) reported at least one statistical association between PA and cognition. Multiple reviewers independently performed study selection and data extraction, and results were mapped in tabular and narrative form.

RESULTS

Ninety-seven articles were eligible; these were largely published from 2017 to 2022 (54.6%), conducted in high-income countries (96.9%), and presented (quasi-)experimental studies (73.2%). Samples predominantly comprised women with breast cancer (48.5%), and recruitment often occurred post-treatment (63.9%). PA interventions included: aerobic (32.3%), resistance (4.8%), combined aerobic/resistance (38.7%), mind-body (19.4%), or other PA (4.8%). Most (66%) articles reported inconclusive findings; 32% were positive (in support of PA promoting cognition or vice versa), and 2.1% were negative. Diverse samples and studies with long-term follow-up were scarce.

CONCLUSIONS

The state of knowledge is insufficient and more rigorous, large-scale studies are required to provide definitive conclusions about the cognitive benefits of PA among persons with cancer.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer-related cognitive impairment (CRCI) thwarts quality of life. This review summarizes what is known about the association between PA and cognition among persons with cancer and concludes that the evidence is currently equivocal. Hence, it remains uncertain if PA interventions can reduce CRCI, and large-scale PA intervention trials explicitly designed to promote cognition are greatly needed.

Governor vessel moxibustion for cancer-related fatigue in colorectal patients: a randomized trial

Objective

This study aimed to investigate the efficacy and mechanism of action of Governor Vessel Moxibustion (GVM) in the treatment of Cancer-Related Fatigue (CRF) in patients who have completed treatment for colorectal cancer.

Methods

We randomly assigned 80 CRF patients in a 1:1 ratio to either the experimental group or the control group. During the three-week treatment period, both groups of patients received usual care for CRF provided by professional nurses. The experimental group received additional GVM treatment (three times a week, nine times total). The primary outcome was the mean change in total fatigue score from baseline to the end of treatment, assessed using the Chinese version of the Piper Fatigue Scale.

Results

At baseline, the total fatigue scores were 6.20 ± 0.12 in the experimental group and 6.16 ± 0.14 in the control group. At the end of treatment, the total fatigue scores decreased by 2.03 points (32.7% decrease from baseline) in the experimental group and by 0.99 points (15.6% decrease from baseline) in the control group. The absolute reduction in total fatigue scores in the experimental group was 1.04 points higher than in the control group (95% CI, 0.93 to 1.15; P<0.001), corresponding to a relative difference of 17.1% (95% CI, 15.2% to 18.9%; P<0.001). At the end of treatment, the experimental group showed greater reductions in interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels compared to the control group. No serious adverse events related to GVM treatment were observed.

Conclusion

GVM appears to be safe and effective for alleviating CRF in patients who have completed colorectal cancer treatment, which may be related to the modulation of IL-6 and TNF-α levels.

Trial registration

Chinese Clinical Trials Registry: ChiCTR2300069208.

Which Exercise Approaches Work for Relieving Cancer-Related Fatigue? A Network Meta-analysis

OBJECTIVE: To determine the most effective exercise modalities for managing cancer-related fatigue during and after cancer treatment. DESIGN: Network meta-analysis (NMA) of randomized controlled trials. LITERATURE SEARCH: Seven electronic databases were systematically searched from inception to January 2022. STUDY SELECTION CRITERIA: Randomized controlled trials testing the effects of exercise on relieving cancer-related fatigue in adult patients with cancer. DATA SYNTHESIS: An NMA of 56 studies was conducted, and the PRISMA-NMA guidelines were followed when reporting results. To determine the most effective interventions, the surface under the cumulative ranking curve (SUCRA) value was calculated for each exercise modality. RESULTS: Combined aerobic and resistance exercise (standardized mean difference [SMD], 1.57; credible interval [CrI], 1.03-2.10), yoga (SMD, 1.02; CrI: 0.44, 1.60), and regular physical activity (SMD, 1.07; CrI: 0.21, 1.92) could significantly alleviate cancer-related fatigue compared to control groups (usual care, wait-list, and regular physical activity). Combined aerobic and resistance exercise (SUCRA, 97.2%) had the highest probability of efficacy, followed by yoga (SUCRA, 75.5%) and regular physical activity (SUCRA, 74.1%). During cancer treatment, combined aerobic and resistance exercise (SUCRA, 94.5%) ranked first in efficacy, followed by regular physical activity (SUCRA, 82.1%) and yoga (SUCRA, 73.8%). After cancer treatment, only combined aerobic and resistance exercise (SMD, 0.99; CrI: 0.13, 1.84) had a significant effect on cancer-related fatigue. CONCLUSION: Combined aerobic and resistance exercise, yoga, and regular physical activity were the most effective exercise modalities for alleviating cancer-related fatigue. Combined aerobic and resistance exercise is recommended during and after cancer treatment. J Orthop Sports Phys Ther 2023;53(6):1-10. Epub: 23 March 2023. doi:10.2519/jospt.2023.11251.

Mind-Body Therapies for Sleep Disturbance among Patients with Cancer: A Systematic Review and Meta-analysis

OBJECTIVE

s: To assess whether mind-body therapies (MBTs) are effective for relieving sleep disturbance among patients with cancer.

DESIGN

Systematic review and meta-analysis of randomized controlled trials (RCTs).

METHODS

Seven English electronic databases were searched from the date of inception to September 2022. All RCTs that included adults (≥18 years) who were treated with mindfulness, yoga, qigong, relaxation, and hypnosis were screened. The outcome was subjective and/or objective sleep disturbance.The revised Cochrane tool (RoB 2.0) was applied to evaluate the risk of bias. The RevMan software was applied to assessed each outcome according different control groups and assessment time points. Subgroup analyses were performed according to different categories of MBTs.

RESULTS

Sixty-eight RCTs (6339 participants) were identified. After requesting for missing data from corresponding authors of included RCTs, 56 studies (5051 participants) were included in the meta-analysis. The meta-analysis showed a significant immediate effect of mindfulness, yoga, relaxation, and hypnosis on subjective sleep disturbance, compared with usual care or wait list control, and the effect of mindfulness lasted at least 6 months. For objective sleep outcomes, we observed significant immediate effects of yoga on wake after sleep onset and of mindfulness on sleep onset latency and total sleep time. Compared with active control interventions, MBTs had no significant effect on sleep disturbance.

CONCLUSIONS

Mindfulness, yoga, relaxation, and hypnosis were effective in sleep disturbance severity reduction among patients with cancer at post-intervention, and the effect of mindfulness lasted at least 6 months. Future MBTs studies should apply both objective and subjective sleep measurement tools.

Moderators of exercise effects on self-reported cognitive functioning in cancer survivors: an individual participant data meta-analysis

PURPOSE

This individual participant data meta-analysis (IPD-MA) assesses exercise effects on self-reported cognitive functioning (CF) and investigates whether effects differ by patient-, intervention-, and exercise-related characteristics.

METHODS

IPD from 16 exercise RCTs, including 1987 patients across multiple types of non-metastatic cancer, was pooled. A one-stage IPD-MA using linear mixed-effect models was performed to assess exercise effects on self-reported CF (z-score) and to identify whether the effect was moderated by sociodemographic, clinical, intervention- and exercise-related characteristics, or fatigue, depression, anxiety, and self-reported CF levels at start of the intervention (i.e., baseline). Models were adjusted for baseline CF and included a random intercept at study level to account for clustering of patients within studies. A sensitivity analysis was performed in patients who reported cognitive problems at baseline.

RESULTS

Minimal significant beneficial exercise effects on self-reported CF (β=-0.09 [-0.16; -0.02]) were observed, with slightly larger effects when the intervention was delivered post-treatment (n=745, β=-0.13 [-0.24; -0.02]), and no significant effect during cancer treatment (n=1,162, β=-0.08 [-0.18; 0.02]). Larger effects were observed in interventions of 12 weeks or shorter (β=-0.14 [-0.25; -0.04]) or 24 weeks or longer (β=-0.18 [-0.32; -0.02]), whereas no effects were observed in interventions of 12-24 weeks (β=0.01 [-0.13; 0.15]). Exercise interventions were most beneficial when provided to patients without anxiety symptoms (β=-0.10 [-0.19; -0.02]) or after completion of treatment in patients with cognitive problems (β=-0.19 [-0.31; -0.06]). No other significant moderators were identified.

CONCLUSIONS

This cross-cancer IPD meta-analysis observed small beneficial exercise effects on self-reported CF when the intervention was delivered post-treatment, especially in patients who reported cognitive problems at baseline.

IMPLICATIONS FOR CANCER SURVIVORS

This study provides some evidence to support the prescription of exercise to improve cognitive functioning. Sufficiently powered trials are warranted to make more definitive recommendations and include these in the exercise guidelines for cancer survivors.

Effects of exercise mode and intensity on patient-reported outcomes in cancer survivors: a four-arm intervention trial

PURPOSE

The aim of this study was to compare the effects of different exercise modes (aerobic, resistance) and intensity prescriptions (standard, polarized, undulating) on patient-reported outcomes (PROs) in cancer survivors.

METHODS

107 breast or prostate cancer survivors (52% females, age 58 ± 10 years, 6-52 weeks after primary therapy) performed one out of four training programs, two sessions/week, over 12 weeks: work rate-matched vigorous intensity aerobic training (AT_Standard, n = 28) and polarized intensity aerobic training (AT_Polarized, n = 26) as well as volume-matched moderate intensity resistance training (RT_Standard, n = 26) and daily undulating intensity resistance training (RT_Undulating, n = 27). Health-related quality of life (HRQoL, EORTC-QLQ-C30) and cancer-related fatigue (CRF, MFI-20) were assessed at baseline, at the end of intervention and after a 12-week follow-up without further prescribed exercise.

RESULTS

Over the intervention period, HRQoL-function-scales of the EORTC-QLQ-C30 improved over time (p = .007), but no group*time interaction was observed (p = .185). Similarly, CRF values of the MFI-20 improved over time (p = .006), but no group*time interaction was observed (p = .663). When including the follow-up period and pooling the AT and the RT groups, HRQoL-function-scales developed differently between groups (p = .022) with further improvements in RT and a decline in AT. For CRF no significant interaction was found, but univariate analyses showed a non-significant trend of more sustainable effects in RT.

CONCLUSIONS

AT and RT with different work rate-/volume-matched intensity prescriptions elicits positive effects on HRQoL and CRF, without one regimen being significantly superior to another over the intervention period. However, RT might result in more sustainable effects compared to AT over a follow-up period without any further exercise prescription.

CLINICAL TRIAL REGISTRATION

The study was registered at clinicaltrials.gov (NCT02883699).

The role of exercise for pain management in adults living with and beyond cancer: a systematic review and meta-analysis

BACKGROUND

Pain is a common side effect of cancer or cancer treatment that negatively impacts biopsychosocial wellbeing and quality of life. Exercise is a potential intervention to manage pain that is safe and has multiple benefits. The objective was to determine the role of exercise in cancer pain management.

METHODS

We completed a systematic review and meta-analysis of exercise interventions in adults with any type or stage of cancer by searching Ovid MEDLINE®, Embase, APA PsycInfo, the Cochrane Central Register of Controlled Trials, CINAHL, and SPORTDiscus. We included experimental and quasi-experimental designs where pain was measured as an outcome. Data synthesis included narrative and tabular summary. A meta-analysis was performed on studies powered to detect the effect of exercise on pain. Study quality was evaluated using the Cochrane risk of bias tool and certainty of evidence was evaluated using the GRADE tool.

RESULTS

Seventy-six studies were included. Studies were predominantly conducted in breast cancer and exercise usually included a combination of aerobic and strength training. Ten studies were included in the meta-analysis demonstrating a significant effect for exercise in decreasing pain (estimated average standard mean difference (SMD) was g =  - 0.73 (95% CI: - 1.16 to - 0.30)); however, the overall effect prediction interval was large. Overall risk of bias for most studies was rated as some concerns and the grading of evidence certainty was low.

CONCLUSION

There are limitations in the evidence for exercise to manage cancer-related pain. Further research is needed to understand the role of exercise in a multimodal pain management strategy.

Effects of physical exercise on rehabilitation of cancer patients undergoing radiotherapy

Background

According to the World Health Organization and American Cancer Society, cancer survivors should involve in mild-to-moderate intensity exercises and consume vegetarian diet. These lifestyle alterations show improvement in cancer recurrence, risk reduction, and quality of life (QOL).

Objective

The purpose of this study was to study the effect of physical activity on health/behavioural changes among adult cancer survivors.

Materials and Methods

The study is randomized controlled trial which included 100 patients (Group A - Exercise group - 50 patients and Group B - Control group - 50 patients). Assessment of cardiopulmonary fitness, endurance, and QOL was done.

Results

Significant improvement in pulse rate, SpO2 and endurance, mental health, and social dimension was found in exercising group with no significant improvement in spiritual dimension.

Conclusion

Remodelling the lifestyle by diet adjustment, strength training, and exercises alters the incidence and prognosis of cancer.

An Overview of the Fundamentals of Data Management, Analysis, and Interpretation in Quantitative Research

OBJECTIVES

To provide an overview of three consecutive stages involved in the processing of quantitative research data (ie, data management, analysis, and interpretation) with the aid of practical examples to foster enhanced understanding.

DATA SOURCES

Published scientific articles, research textbooks, and expert advice were used.

CONCLUSION

Typically, a considerable amount of numerical research data is collected that require analysis. On entry into a data set, data must be carefully checked for errors and missing values, and then variables must be defined and coded as part of data management. Quantitative data analysis involves the use of statistics. Descriptive statistics help summarize the variables in a data set to show what is typical for a sample. Measures of central tendency (ie, mean, median, mode), measures of spread (standard deviation), and parameter estimation measures (confidence intervals) may be calculated. Inferential statistics aid in testing hypotheses about whether or not a hypothesized effect, relationship, or difference is likely true. Inferential statistical tests produce a value for probability, the P value. The P value informs about whether an effect, relationship, or difference might exist in reality. Crucially, it must be accompanied by a measure of magnitude (effect size) to help interpret how small or large this effect, relationship, or difference is. Effect sizes provide key information for clinical decision-making in health care.

IMPLICATIONS FOR NURSING PRACTICE

Developing capacity in the management, analysis, and interpretation of quantitative research data can have a multifaceted impact in enhancing nurses' confidence in understanding, evaluating, and applying quantitative evidence in cancer nursing practice.

"I'm Hooked on e-cycling, I Can Finally Be Active Again": Perceptions of e-cycling as a Physical Activity Intervention during Breast Cancer Treatment

Electrically-assisted bicycles (e-bikes) are a means through which to increase individual physical activity (PA) and overcome some commonly reported barriers to engaging in conventional cycling. Fatigue is a common side effect to breast cancer treatment, and the rate of PA engagement drops significantly following a breast cancer diagnosis. The aim of this qualitative study was to examine perceptions of e-cycling as a means of increasing PA in this population. Twenty-four participants (mean age = 57.88 (standard deviation 10.8), 100% female) who have had a breast cancer diagnosis, completed two semi-structured interviews via Zoom. One interview was conducted prior to an e-bike taster session and a second, after the session. Taster sessions were conducted by certified cycling instructors in the community. Interviews were conducted between December 2021 and May 2022. Data were transcribed verbatim and analyzed thematically using NVivo 12 software. An inductive and deductive approach to analysis was adopted. Five themes were generated: (1) Perceived role of e-bikes during treatment, (2) The relationship between e-bikes and fatigue, (3) Cancer-specific considerations, (4) Is e-cycling 'enough'?, and (5) Optimizing the intervention. Negative perceptions of e-bikes noted before the taster session were altered following riding an e-bike. The multiple levels of assistance made cycling manageable and less impacted by fatigue, thereby enabling individuals to re-establish previous cycling habits. E-cycling may be a suitable option to increase PA behavior amongst individuals being treated for breast cancer, with the potential to overcome many of the barriers of conventional cycling. Enabling this population to trial an e-bike elicits positive physical and psychological responses that may help to promote future engagement.

Exercise interventions for adults with cancer receiving radiation therapy alone

BACKGROUND

Radiation therapy (RT) is given to about half of all people with cancer. RT alone is used to treat various cancers at different stages. Although it is a local treatment, systemic symptoms may occur. Cancer- or treatment-related side effects can lead to a reduction in physical activity, physical performance, and quality of life (QoL). The literature suggests that physical exercise can reduce the risk of various side effects of cancer and cancer treatments, cancer-specific mortality, recurrence of cancer, and all-cause mortality.

OBJECTIVES

To evaluate the benefits and harms of exercise plus standard care compared with standard care alone in adults with cancer receiving RT alone.

SEARCH METHODS

We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid), CINAHL, conference proceedings and trial registries up to 26 October 2022.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that enrolled people who were receiving RT without adjuvant systemic treatment for any type or stage of cancer. We considered any type of exercise intervention, defined as a planned, structured, repetitive, objective-oriented physical activity programme in addition to standard care. We excluded exercise interventions that involved physiotherapy alone, relaxation programmes, and multimodal approaches that combined exercise with other non-standard interventions such as nutritional restriction.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodology and the GRADE approach for assessing the certainty of the evidence. Our primary outcome was fatigue and the secondary outcomes were QoL, physical performance, psychosocial effects, overall survival, return to work, anthropometric measurements, and adverse events.

MAIN RESULTS

Database searching identified 5875 records, of which 430 were duplicates. We excluded 5324 records and the remaining 121 references were assessed for eligibility. We included three two-arm RCTs with 130 participants. Cancer types were breast and prostate cancer. Both treatment groups received the same standard care, but the exercise groups also participated in supervised exercise programmes several times per week while undergoing RT. Exercise interventions included warm-up, treadmill walking (in addition to cycling and stretching and strengthening exercises in one study), and cool-down. In some analysed endpoints (fatigue, physical performance, QoL), there were baseline differences between exercise and control groups. We were unable to pool the results of the different studies owing to substantial clinical heterogeneity. All three studies measured fatigue. Our analyses, presented below, showed that exercise may reduce fatigue (positive SMD values signify less fatigue; low certainty). • Standardised mean difference (SMD) 0.96, 95% confidence interval (CI) 0.27 to 1.64; 37 participants (fatigue measured with Brief Fatigue Inventory (BFI)) • SMD 2.42, 95% CI 1.71 to 3.13; 54 participants (fatigue measured with BFI) • SMD 1.44, 95% CI 0.46 to 2.42; 21 participants (fatigue measured with revised Piper Fatigue Scale) All three studies measured QoL, although one provided insufficient data for analysis. Our analyses, presented below, showed that exercise may have little or no effect on QoL (positive SMD values signify better QoL; low certainty). • SMD 0.40, 95% CI -0.26 to 1.05; 37 participants (QoL measured with Functional Assessment of Cancer Therapy-Prostate) • SMD 0.47, 95% CI -0.40 to 1.34; 21 participants (QoL measured with World Health Organization QoL questionnaire (WHOQOL-BREF)) All three studies measured physical performance. Our analyses of two studies, presented below, showed that exercise may improve physical performance, but we are very unsure about the results (positive SMD values signify better physical performance; very low certainty) • SMD 1.25, 95% CI 0.54 to 1.97; 37 participants (shoulder mobility and pain measured on a visual analogue scale) • SMD⁠⁠⁠⁠⁠⁠ 3.13 (95% CI 2.32 to 3.95; 54 participants (physical performance measured with the six-minute walk test) Our analyses of data from the third study showed that exercise may have little or no effect on physical performance measured with the stand-and-sit test, but we are very unsure about the results (SMD 0.00, 95% CI -0.86 to 0.86, positive SMD values signify better physical performance; 21 participants; very low certainty). Two studies measured psychosocial effects. Our analyses (presented below) showed that exercise may have little or no effect on psychosocial effects, but we are very unsure about the results (positive SMD values signify better psychosocial well-being; very low certainty). • SMD 0.48, 95% CI -0.18 to 1.13; 37 participants (psychosocial effects measured on the WHOQOL-BREF social subscale) • SMD 0.29, 95% CI -0.57 to 1.15; 21 participants (psychosocial effects measured with the Beck Depression Inventory) Two studies recorded adverse events related to the exercise programmes and reported no events. We estimated the certainty of the evidence as very low. No studies reported adverse events unrelated to exercise. No studies reported the other outcomes we intended to analyse (overall survival, anthropometric measurements, return to work).

AUTHORS' CONCLUSIONS

There is little evidence on the effects of exercise interventions in people with cancer who are receiving RT alone. While all included studies reported benefits for the exercise intervention groups in all assessed outcomes, our analyses did not consistently support this evidence. There was low-certainty evidence that exercise improved fatigue in all three studies. Regarding physical performance, our analysis showed very low-certainty evidence of a difference favouring exercise in two studies, and very low-certainty evidence of no difference in one study. We found very low-certainty evidence of little or no difference between the effects of exercise and no exercise on quality of life or psychosocial effects. We downgraded the certainty of the evidence for possible outcome reporting bias, imprecision due to small sample sizes in a small number of studies, and indirectness of outcomes. In summary, exercise may have some beneficial outcomes in people with cancer who are receiving RT alone, but the evidence supporting this statement is of low certainty. There is a need for high-quality research on this topic.

An 8-week exercise study to improve cancer treatment related fatigue and QOL among African American breast cancer patients undergoing radiation treatment: A pilot randomized clinical trial

BACKGROUND

Cancer treatment related fatigue (CTRF) is one of the most debilitating side effects of adjuvant radiation therapy (RT). Several studies have found that physical activity (PA) may be an effective intervention to decrease fatigue and enhance QOL in cancer survivors. The primary objective of the PEDLAR study is to test the feasibility of an easily administered 8-week structured moderate-intensity PA intervention, delivered concurrently with RT, in reducing CTRF and improving health-related QOL among African-American breast cancer patients. This study is also designed to provide pilot data on the acceptability and adherence of PA interventions in African-American women with breast cancer.

METHODS

It is a prospective, 2-arm, 8-week feasibility trial. Participants are randomized to either a structured, moderate-intensity aerobic training exercise regimen concurrent with radiotherapy or a control group.

RESULTS

Participants in intervention group reported high satisfaction with exercise and adherence was >75% for exercise sessions.

CONCLUSIONS

African-American breast cancer patients in a moderate-intensity 75 min/wk aerobic exercise intervention had marginally lower fatigue at 8-wk follow-up compared to baseline. The control group participants had marginally higher fatigue at 8-wk follow-up compared to baseline. Participants in the intervention group reported slightly better quality of life at 8-wk follow-up compared to baseline (P = 0.06).

Is physical activity effective against cancer-related fatigue in lung cancer patients? An umbrella review of systematic reviews and meta-analyses

OBJECTIVES

To discuss the effects of physical activity on cancer-related fatigue (CRF) in lung cancer patients, summarize the types of physical activity in the published reviews, assess the quality of the evidence, and provide suggestions for the clinical selection of exercise intervention.

METHODS

PubMed, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews were searched through 8 November 2021 to identify relevant systematic reviews and meta-analyses. We also performed a manual search of the reference lists of included articles as supplements. Two researchers independently performed literature screening, data extraction, and quality assessment. The umbrella review has been registered in the International Prospective Register of Systematic Review (PROSPERO) registry (CRD42021292548).

RESULTS

From the 13 systematic reviews or meta-analyses identified, 10 physical activity interventions were included. The most mentioned intervention was aerobic combined with resistance exercise; however, no reduction of the symptoms of CRF was observed in lung cancer patients by this exercise intervention. Most of the patients who performed aerobic exercises alone showed improvement in CRF after the intervention. In addition, Tai Chi and breathing exercises have been shown to improve fatigue, but more high-quality research is still needed to support its effectiveness.

CONCLUSIONS

Aerobic exercise, respiratory muscle training, aerobic combined with balance training, and other exercise interventions have been shown to improve CRF in lung cancer patients. But it should be noted that according to the different treatment methods and disease stages of patients, individualized rehabilitation programs should be developed for patients. Due to the low methodological quality and evidence quality of some systematic reviews and meta-analyses included in this study, more high-quality clinical studies and systematic reviews are still needed for validation in the future. This umbrella review helps to identify effective ways of exercise to improve fatigue in lung cancer patients before dedicated evidence-based medical guidelines are established.

Chronic stress in solid tumor development: from mechanisms to interventions

Chronic stress results in disturbances of body hormones through the neuroendocrine system. Cancer patients often experience recurrent anxiety and restlessness during disease progression and treatment, which aggravates disease progression and hinders treatment effects. Recent studies have shown that chronic stress-regulated neuroendocrine systems secret hormones to activate many signaling pathways related to tumor development in tumor cells. The activated neuroendocrine system acts not only on tumor cells but also modulates the survival and metabolic changes of surrounding non-cancerous cells. Current clinical evidences also suggest that chronic stress affects the outcome of cancer treatment. However, in clinic, there is lack of effective treatment for chronic stress in cancer patients. In this review, we discuss the main mechanisms by which chronic stress regulates the tumor microenvironment, including functional regulation of tumor cells by stress hormones (stem cell-like properties, metastasis, angiogenesis, DNA damage accumulation, and apoptotic resistance), metabolic reprogramming and immune escape, and peritumor neuromodulation. Based on the current clinical treatment framework for cancer and chronic stress, we also summarize pharmacological and non-pharmacological therapeutic approaches to provide some directions for cancer therapy.

Long-term effects of exercise interventions on physical activity in breast cancer patients: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Benefits of exercise interventions for cancer patients are well established. This systematic review aimed to investigate the sustainability of exercise interventions with respect to physical activity behaviour of breast cancer patients in the longer term.

METHODS

The databases Pubmed, Cochrane, Embase, and Web of Science were systematically searched for randomized controlled trials (RCTs) investigating aerobic exercise, resistance exercise, or combined exercise interventions in breast cancer patients and assessing physical activity at least 2 months after the intervention. Random-effect models were used to calculate standardized mean differences (SMD).

RESULTS

A total of 27 RCTs with 4120 participants were included in the review, of which 11 RCTs with 1545 participants had appropriate data for the meta-analyses. Physical activity was mainly self-reported, and most exercise interventions were supervised. Exercise interventions tended to show a moderate significant effect up to 6 months for moderate to vigorous physical activity (SMD [95% CI] = 0.39 [0.07, 0.70]) and small, non-significant effects on total physical activity at 6 months (SMD [95% CI] = 0.14 [- 0.00, 0.28]) and up to 60 months after the intervention (SMD = 0.29 [-0.31, 0.90]). Differences between intervention characteristics, such as supervised versus unsupervised, were inconclusive due to the small number of RCTs.

CONCLUSIONS

The physical activity behaviour in breast cancer patients remained improved for several months beyond the end of exercise interventions, but effects were small to moderate and diminished over time. Future studies should clarify how to maintain a healthy level of physical activity after completion of an exercise intervention.

Physical rehabilitation for the management of cancer-related fatigue during cytotoxic treatment: a systematic review with meta-analysis

OBJECTIVE

To assess the effect of physical therapy on cancer-related fatigue (CRF) during cytotoxic anticancer treatment.

METHODS

Systematic review with meta-analysis of randomized clinical trials published from 2010 to 2021 (EMBASE, MEDLINE, PEDro; SciELO, and LILACS). Studies assessing the effect of supervised physical therapy (IG) for the management of CRF on adults undergoing anticancer treatment compared with a control group (CG) covering usual care or any uncontrolled practice, such as recommendations about exercise and health education, were included in this review.

RESULTS

A total of 22 studies were included in the SR and 21 in the meta-analysis, resulting in 1.992 individuals (CG = 973 and IG = 1.019). There was a reduction in general fatigue [SMD =  - 0.69; 95%CI (- 1.15, - 0.22) p < 0.01; I² = 87%; NNT = 3], with greater weight attributed to combined exercise (44%). Physical fatigue also reduced [SMD =  - 0.76; 95%CI (- 1.13, - 0.39) p < 0.01; I² = 90%; NNT = 2], with greater weight for resistance exercise (50%) and greater effect with combined exercise [SMD =  - 1.90; 95%CI (- 3.04, - 0.76) p < 0.01; I ² = 96%]. There was reduction in general fatigue with moderate intensity (74%) [SMD =  - 0.89; 95%CI (- 1.61, - 0.17) p < 0.02; I² = 90%] and physical fatigue [SMD =  - 1.00; 95%CI (- 1.54, - 0.46) p < 0.01; I² = 92%], while high intensity reduced only general fatigue [SMD =  - 0.35; 95%CI (- 0.51, - 0.20) p < 0.01; I² = 0%]. The number of overall and weekly sessions has been shown to contribute to the reduction of CRF.

CONCLUSION

Physical rehabilitation with moderate intensity promoted greater relief of general and physical fatigue. Even after controlling for high heterogeneity, the quality of evidence, summarized in GRADE, was considered moderate for general fatigue and low for physical fatigue.

Quality of Life of Cancer Patients during Chemotherapy in Indonesia: A Comparison of EORTC QLQ-C30 and EQ-5D-5L, Based on Patients' Characteristics

One of the important outcomes to define the success of cancer treatment is the health-related quality of life (HRQoL) that can be measured using generic and/or specific instruments. Our study aims to define the cancer patients' HRQoL in some hospitals in Indonesia as measured by the European Organization for Research and Treatment for Cancer (EORTC QLQ-C30) and the EQ-5D-5L, to define the differences of cancer patients' HRQoL referring to patients' characteristics, and to explore determinants of cancer patients' HRQoL. We recruited 451 cancer patients using a cross-sectional design in two referral hospitals in Central Java, Indonesia, using the purposive sampling technique. All subjects, recruited from July 2020 to October 2021, met the inclusion criteria, namely, adult patients diagnosed with cancers in all stages who willingly participated in the study. The Indonesian value set was used to obtain the EQ-5D-5L index score. We further analyzed the data based on cancer stages and compared two questionnaires using independent t test. We highlighted that most of the cancer patients are female (69.4%), young (86%), and at advanced stages of cancer (54.1%). The physical and role functions and global health status of the cancer patients are poor, and the most severe symptom is fatigue. Moreover, most of them experience severe pain and perform daily activities with difficulties. Some patients' characteristics show significant influences on the HRQoL domains in both questionnaires (p < 0.05). Interestingly, both of the questionnaires have shown significant correlations between similar domains and revealed the poor HRQoL of advanced cancer patients (p < 0.05). Our study finds that cancer patients still have poor HRQoL in some domains. We suggest to the health providers that they apply education and psychological intervention to increase their HRQoL.

The effects of home-based exercise therapy for breast cancer-related fatigue induced by radical radiotherapy

BACKGROUND

Radiotherapy (RT) can lead to cancer-related fatigue (CRF) and decreased health-related quality of life (HRQoL) in breast cancer patients. The purpose of this trial was to examine the feasibility and efficacy of a home-based resistance and aerobic exercise intervention for reducing CRF and improving HRQoL in breast cancer patients during RT.

METHODS

Women with breast cancer (N = 106) commencing RT were randomized to 12 weeks of home-based resistance and aerobic exercise (EX) or usual care/control (CON). The primary endpoint was CRF, with secondary endpoints of HRQoL, sleep duration and quality, and physical activity. Measurements were undertaken prior to RT, at completion of RT (~ 6 weeks), at completion of the intervention (12 weeks), and 6 and 12 months after RT completion, while CRF was also measured weekly during RT.

RESULTS

Eighty-nine women completed the study (EX = 43, CON = 46). Over the 12-week intervention, EX completed 1-2 resistance training sessions and accumulated 30-40 min of aerobic exercise weekly. For CRF, EX had a quicker recovery both during and post-RT compared to CON (p < 0.05). Moreover, there was a significant difference in HRQoL between groups at RT completion, with HRQoL unchanged in CON and higher in EX (p < 0.05). There was no change in sleep duration or quality for either group and there were no exercise-related adverse effects.

CONCLUSIONS

Home-based resistance and aerobic exercise during RT is safe, feasible, and effective in accelerating CRF recovery and improving HRQoL. Improvements in CRF and HRQoL for these patients can be achieved with smaller exercise dosages than stated in the generic recommendations for breast cancer.

Moderators of physical activity and quality of life response to a physical activity intervention for breast cancer survivors

PURPOSE

Moderate-to-vigorous physical activity (MVPA) can improve the quality of life (QoL) for breast cancer survivors (BCS), yet, most do not achieve 150 + weekly minutes of MVPA. This study investigated moderators of response to a physical activity (PA) behavior change intervention for BCS.

METHODS

BCS (N = 222) were randomized to the 3-month intervention (BEAT Cancer) or usual care. Measurements occurred at baseline, post-intervention, and 3 months post-intervention. Measures included accelerometry, self-reported MVPA, and Functional Assessment of Cancer Therapy (FACT-General, FACT-Breast, physical well-being (PWB), social well-being (SWB), emotional well-being (EWB), functional well-being (FWB), additional concerns (AC), and Trial Outcome Index (TOI)).

RESULTS

Adjusted linear mixed-model analyses indicated individuals ≤ 24 months post-diagnosis and who were single reported smaller increases in weekly self-reported MVPA than those > 24 months (44.07 vs 111.93) and partnered (- 16.24 vs. 49.16 min), all p < 0.05. As for QoL, participants < 12 months post-diagnosis who received chemotherapy experienced smaller improvements than those ≥ 12 months in FACT-General, FACT-Breast, PWB, and SWB scores. Survivors with a history of chemotherapy had smaller improvements in FACT-General, FACT-Breast, PWB, SWB, TOI, and AC scores, all p < 0.05.

CONCLUSION

These findings indicate that being < 2 years post-diagnosis, single, and prior chemotherapy may limit MVPA and QOL responses to a PA intervention. Further studies are needed to determine if and/or what additional PA supports and resources these subgroups of BCS might find beneficial and effective.

TRIAL REGISTRATION

ClinicalTrials.gov number: NCT00929617.

Effects of a Clinical Exercise Program on Health-Related Fitness and Quality of Life in Spanish Cancer Patients Receiving Adjuvant Therapy

OBJECTIVE

To report the feasibility and effectiveness of a newly developed clinical exercise program for improving maximal cardiorespiratory fitness in Spanish cancer patients receiving adjuvant chemotherapy or radiation. We also examined the effectiveness of the exercise program for improving maximal muscular strength, body composition, fatigue, and quality of life, and explored if the effectiveness varied based on selected patient characteristics.

DESIGN

The study was a single group implementation feasibility study using a pre-posttest design.

METHODS

Participants performed a 12-week, twice-weekly, supervised, multi-component exercise program during adjuvant therapy. Paired t-tests were used to assess pre-post changes, and analyses of covariance were used to compare effectiveness based on selected patient characteristics.

RESULTS

We had 100 cancer patients referred to the clinical exercise program of which 85 (85%) initiated the exercise program and 76 (89%) completed the post-intervention fitness assessment. Exercise significantly improved VO_2max by 4.8 mL/kg/minutes (P < .001, d = 0.74). Exercise also significantly improved chest strength (P < .001, d = 0.82), leg strength (P < .001, d = 1.27), lean body mass (P < .001, d = 0.11), skeletal muscle mass (P < .001; d = 0.09), fat mass (P < .001; d = 0.10), % body fat (P < .001; d = 0.17), quality of life (P = .0017; d = 0.41), and fatigue (P = .007; d = 0.46). Treatment modality, cancer type, and age affected some exercise responses, especially related to body composition changes.

CONCLUSIONS

A 12-week, supervised, multi-component exercise program was effective for improving health-related fitness and quality of life in Spanish cancer patients receiving adjuvant therapy. Our results show the benefits of incorporating clinical exercise programming into the supportive care of cancer patients receiving treatments.

REGISTRATION

The study protocol is registered at ClinicalTrials.gov (NCT05078216).

Physical Activity and Health-Related Quality of Life in Women With Breast Cancer: A Meta-Analysis

BACKGROUND

Physical activity (PA) is associated with improved health-related quality of life (HRQoL) among women with breast cancer; however, uncertainty remains regarding PA types and dose (frequency, duration, intensity) and various HRQoL measures. A systematic review and meta-analysis of randomized controlled trials was conducted to clarify whether specific types and doses of physical activity was related to global and specific domains of HRQoL, as part of the Global Cancer Update Programme, formerly known as the World Cancer Research Fund-American Institute for Cancer Research Continuous Update Project.

METHODS

PubMed and CENTRAL databases were searched up to August 31, 2019. Weighted mean differences (WMDs) in HRQoL scores were estimated using random effects models. An independent expert panel graded the evidence.

RESULTS

A total of 79 randomized controlled trials (14 554 breast cancer patients) were included. PA interventions resulted in higher global HRQoL as measured by the Functional Assessment of Cancer Therapy-Breast (WMD = 5.94, 95% confidence intervals [CI] = 2.64 to 9.24; I2 = 59%, n = 12), Functional Assessment of Cancer Therapy-General (WMD = 4.53, 95% CI = 1.94 to 7.13; I2 = 72%, n = 18), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (WMD = 6.78, 95% CI = 2.61 to 10.95; I2 = 76.3%, n = 17). The likelihood of causality was considered probable that PA improves HRQoL in breast cancer survivors. Effects were weaker for physical function and mental and emotional health. Evidence regarding dose and type of PA remains insufficient for firm conclusions.

CONCLUSION

PA results in improved global HRQoL in breast cancer survivors with weaker effects observed for physical function and mental and emotional health. Additional research is needed to define the impact of types and doses of activity on various domains of HRQoL.

Health Behavior and Cancer Prevention among Adults with Li-Fraumeni Syndrome and Relatives in Germany-A Cohort Description

Li-Fraumeni-syndrome (LFS) is a rare, highly penetrant cancer predisposition syndrome (CPS) caused by pathogenic variants (PVs) in TP53. Physical activity (PA) and a Mediterranean diet lead to cancer reduction or survival benefits and increased quality of life (QoL), but this is yet unstudied among LFS. TP53 PV carriers (PVC) and their relatives were questioned on dietary patterns (Mediterranean Diet Adherence Screener), PA (Freiburg Questionnaire), QoL (Short-form-Health-Survey-12), smoking, alcohol consumption and perception of cancer risk in a German bi-centric study from March 2020-June 2021. The study enrolled 70 PVC and 43 relatives. Women compared to men (6.49 vs. 5.38, p = 0.005) and PVC to relatives (6.59 vs. 5.51; p = 0.006) showed a healthier diet, associated with participation in surveillance (p = 0.04) and education (diet p = 0.02 smoking p = 0.0003). Women smoked less (2.91 vs. 5.91 packyears; p = 0.03), psychological well-being was higher among men (SF-12: males 48.06 vs. females 41.94; p = 0.004). PVC rated their own cancer risk statistically higher than relatives (72% vs. 38%, p < 0.001) however, cancer risk of the general population was rated lower (38% vs. 70%, p < 0.001). A relative's cancer-related death increased the estimated personal cancer risk (p = 0.01). The possibilities of reducing cancer through self-determined health behavior among PVC and relatives has not yet been exhausted. Educating families with a CPS on cancer-preventive behavior requires further investigation with regard to acceptance and real-life implementation.

The effect of nonsupervised physical activity before and after breast cancer surgery on quality of life: Results from a randomized controlled trial (PhysSURG-B)

Background and objective:

The PhysSURG-B trial of prehabilitation before breast cancer surgery randomized patients to a nonsupervised physical activity or a control group. The effects of the intervention on short- and long-term quality of life (QoL) were examined, with a subgroup analysis of patients receiving adjuvant chemotherapy.

Methods:

Female patients planned for surgery were randomly assigned to either an intervention of 30 min of self-administered physical aerobic activity daily 2 weeks before and 4 weeks after surgery or control. QoL was assessed with questionnaires at baseline, 4 weeks and 12 months postoperatively using the instruments FACT-B, RAND-36, and EQ-VAS.

Results:

Of 354 included participants at 12 months after surgery, 287 were available for analysis. FACT- B scores at 4 weeks and 12 months showed no differences between intervention compared to control, odds ratio (OR) of 0.975 (95% confidence interval (CI) 0.636–1.495) and 0.883 (95% CI 0.581–1.342), respectively. There was no difference in EQ-VAS comparing intervention to control at 4 weeks and 12 months, respectively, OR 1.163 (95% CI 0.760–1.779) and 0.817 (95% CI 0.559–1.300). RAND-36 domains “role limitations due to physical health” and “pain” showed a decrease at 4 weeks in both groups, returning toward baseline at 12 months follow-up. The subgroup who received adjuvant chemotherapy had significantly lower QoL measured using FACT-B at 12 months compared to patients not receiving chemotherapy (OR 0.475; 95% CI 0.300–0.753).

Conclusions:

An intervention of non-supervised physical activity before and after surgery for breast cancer showed no effect on short or long-term QoL, compared to control.

Trial registration:

ClinicalTrials.gov registration number: NCT 02560662.

Systematic Review of Functional Outcomes in Cancer Rehabilitation

OBJECTIVE

To systematically review the evidence regarding rehabilitation interventions targeting optimal physical or cognitive function in adults with a history of cancer and describe the breadth of evidence as well as strengths and limitations across a range of functional domains.

DATA SOURCES

PubMed, Cumulative Index to Nursing and Allied Health Plus, Scopus, Web of Science, and Embase. The time scope was January 2008 to April 2019.

STUDY SELECTION

Prospective, controlled trials including single- and multiarm cohorts investigating rehabilitative interventions for cancer survivors at any point in the continuum of care were included, if studies included a primary functional outcome measure. Secondary data analyses and pilot/feasibility studies were excluded. Full-text review identified 362 studies for inclusion.

DATA EXTRACTION

Extraction was performed by coauthor teams and quality and bias assessed using the American Academy of Neurology (AAN) Classification of Evidence Scheme (class I-IV).

DATA SYNTHESIS

Studies for which the functional primary endpoint achieved significance were categorized into 9 functional areas foundational to cancer rehabilitation: (1) quality of life (109 studies), (2) activities of daily living (61 studies), (3) fatigue (59 studies), (4) functional mobility (55 studies), (5) exercise behavior (37 studies), (6) cognition (20 studies), (7) communication (10 studies), (8) sexual function (6 studies), and (9) return to work (5 studies). Most studies were categorized as class III in quality/bias. Averaging results found within each of the functional domains, 71% of studies reported statistically significant results after cancer rehabilitation intervention(s) for at least 1 functional outcome.

CONCLUSIONS

These findings provide evidence supporting the efficacy of rehabilitative interventions for individuals with a cancer history. The findings should be balanced with the understanding that many studies had moderate risk of bias and/or limitations in study quality by AAN criteria. These results may provide a foundation for future work to establish clinical practice guidelines for rehabilitative interventions across cancer disease types.

Effectiveness of Resistance Training on Fatigue in Patients Undergoing Cancer Treatment: A Meta-Analysis of Randomized Clinical Trials

Objective. To assess the effectiveness of the resistance training to improve fatigue levels in people with cancer who are enrolled in adjuvant and/or neoadjuvant treatment. Methods. MEDLINE, Web of Science, Embase, SPORTDiscus, LILACS, CENTRAL, and CINAHL databases were searched from May to December 7, 2021. Randomized clinical trials (RCT) that evaluate the effects of resistance training on fatigue levels in people undergoing cancer treatment were included. The PEDro scale was considered to assess methodological quality of studies, and the evidence was summarized through the GRADE system. The standardized average differences, effect size, and inverse variance model for meta-analysis were calculated. Results. Fifteen RCT for qualitative synthesis and thirteen for meta-analysis were selected. A moderate to high level of evidence of resistance training was identified to improve fatigue in people undergoing cancer treatment. Meta-analysis showed a significant reduction in fatigue ( $\text{SMD}=-0.31$ , $\text{CI}95\%=-0.58$ , -0.12, $P=0.001$ ) after 10 to 35 sessions of resistance training. Conclusion. The 10 to 35 sessions of resistance training are effective in reducing fatigue level in cancer patients who are undergoing cancer treatment and have a moderate level of quality evidence.

Impact of a 12-week strength training program on fatigue, daytime sleepiness, and apathy in men with myotonic dystrophy type 1

Background: Myotonic dystrophy type 1 (DM1) is a multisystemic neuromuscular disorder causing a plea of impairments, of which fatigue and apathy are some of the most frequent non-muscular symptoms. No curative treatment exists to date, and patients only have access to limited effective care, which are intended to decrease the burden of specific symptoms in daily life. Objective: This study aimed to assess whether a 12-week strength-training program has an impact on fatigue/daytime sleepiness, apathy, and patient-reported health in men with DM1. Methods: Eleven participants completed the Fatigue and Daytime Sleepiness Scale (FDSS) and the Myotonic Dystrophy Health Index (MDHI) at baseline, at 6 and 12 weeks, and 6 and 9 months. Also, the Apathy Evaluation Scale (AES) was filled out at baseline, at 12 weeks, and 6 and 9 months. Results: Results show significant effects of the training program both on apathy and fatigue/daytime sleepiness, effects that are respectively greater at three and six months after the end of the program than at its very end. However, no difference was observed regarding the overall disease burden. Conclusion: These findings are promising for patients with DM1 considering that few non-pharmacological treatments are available.

Supervised and Non-Supervised Exercise Programs for the Management of Cancer-Related Fatigue in Women with Breast Cancer: A Systematic Review and Meta-Analysis

Physical exercise is considered to be a non-pharmacological strategy for reducing symptoms of cancer-related fatigue (CRF) in women with breast cancer (BC). This systematic review and meta-analysis aims to assess the effects of non-supervised exercise programs in comparison with the effects of supervised exercise interventions for CRF in BC patients. Randomized controlled trials that investigated the effect of exercise on CRF in women were searched for until 29 June 2022. Inclusion criteria comprised women diagnosed with BC; exercise-based interventions; trials comparing at least one exercise group vs. a control group; trials that assessed exercise effects on CRF. Thirty-one studies met the inclusion criteria (n = 2964). Both non-supervised and supervised exercise programs significantly reduced CRF (standard mean difference (SMD) = −0.46, confidence interval (CI) = (−0.64, −0.28), p < 0.0001 and SMD = −0.74, CI = (−0.99, −0.48), p < 0.0001, respectively), without statistical difference (p = 0.09). However, a short-term training program subgroup analyses showed significant differences between supervised and non-supervised training programs (p = 0.01), showing that supervised training programs have a greater effect (SMD = −1.33, CI = (−1.92, −0.73), p < 0.0001) than non-supervised ones (SMD = −0.44, CI = (−0.78, −0.11), p = 0.009). Both supervised and non-supervised exercise programs may reduce CRF in BC patients; however, in the short-term, supervised exercise may have a greater effect on CRF in BC patients.

Effects of multimodal training program on muscle deoxygenation in women with breast cancer: A randomized controlled trial

Purpose

Chemotherapy and/or radiation are the most often delivered treatments to cancer patients. Usually during the adjuvant treatment, patients complain about fatigue. In addition, physical exercise during adjuvant treatment of cancer seems to have beneficial effects. The aim of this investigation was to assess the effects of multimodal aerobic and strength exercises programs on muscle deoxygenation of patients with breast cancer undergoing adjuvant chemotherapy treatment.

Methods

Thirty-two women with breast cancer (20 patients as the training group and 12 patients as the control group) undergoing adjuvant chemotherapy participated in the study. The training group took part in 6 weeks of supervised intermittent aerobic cycling, home-based walking, isometric and electrical muscle stimulation (EMS) exercise training programs. The Outcome measures were muscle deoxygenation (ΔHHb), Maximal Voluntary isometric Contraction (MViC) and Endurance Time (ET) before and after the training period.

Results

Compared to the control group, a significant increase in ΔHHb (P < 0.01) accompanied with an increase in ET (P < 0.01) and MViC (P < 0.01) of the quadriceps was obtained in the training group. However, no significant differences of MViC, ET and ΔHHb were observed in the control group.

Conclusion

Multimodal aerobic and strength exercise programs enhance muscle oxygen utilization, which may partly explain the improvement in muscular strength and endurance, and the reduction of muscle fatigue in patients with breast cancer during an adjuvant chemotherapy period.

Kynurenine Metabolism as a Mechanism to Improve Fatigue and Physical Function in Postmenopausal Breast Cancer Survivors Following Resistance Training

This pilot examines whether resistance training (RT) can induce changes in kynurenine (KYN) metabolism, which may contribute to improved physical function in breast cancer survivors (BCSs). Thirty-six BCSs (63.2 ± 1.1 years) underwent assessments of physical function and visual analog scale (100 cm) fatigue and quality of life before and after 12 weeks of RT (N = 22) or non-exercise control (CBCT©: Cognitively Based Compassion Training, N = 10). Blood was collected before and after interventions for assessment of KYN, kynurenic acid (KYNA), and peroxisome proliferator-activated receptor γ co-activator 1α (PGC-1α). At baseline, the women were moderately fatigued (mean score: 46 cm) and at risk of poor functional mobility. A group*time interaction was observed for all measures of strength with improvements (~25−35%) following RT (p’s < 0.01), but not CBCT. Time effects were observed for fatigue (−36%) and quality of life (5%) (p’s < 0.01), where both groups improved in a similar manner. A group*time interaction was observed for KYN (p = 0.02) and PGC-1α (p < 0.05), with KYN decreasing and PGC-1α increasing following RT and the opposite following CBCT. These changes resulted in KYN/KYNA decreasing 34% post-RT, but increasing 21% following CBCT. These data support RT as a therapeutic intervention to counteract the long-term side effect of fatigue and physical dysfunction in BCSs. Additionally, the results suggest that this effect may be mediated through the activation of PGC-1α leading to alterations in KYN metabolism.

Impact on fatigue of different types of physical exercise during adjuvant chemotherapy and radiotherapy in breast cancer: systematic review and meta-analysis

BACKGROUND

Physical exercise in women with breast cancer has shown benefits in reducing fatigue levels during adjuvant radiotherapy and chemotherapy. However, it is not well understood which type of exercise is more effective.

OBJECTIVE

Assess the impact of different types of physical exercises on fatigue and which is the most effective in reducing this adverse effect during adjuvant treatment in breast cancer.

METHODS

The inclusion criteria were randomized clinical trials of physical exercise in women diagnosed with breast cancer in stages I to IV, above 18 years, evaluating fatigue using validated questionnaires. The meta-analysis pooled results by standardized mean difference (SMD).

RESULTS

A total of 20 randomized clinical trials involving 1793 participants revealed that the practice of physical exercise was statistically effective in reducing fatigue (SMD =  - 0.46; 95% CI: - 0.66, - 0.27). Our analysis of subgroups suggests that the supervised combination of resistance training (RT) with aerobic training (AT) is the most effective physical exercise to reduce fatigue (SMD =  - 1.13; 95% CI: - 2.09, - 0.17). The supervised RT was more effective (SMD =  - 0.30; 95% CI: - 0.46, - 0.15) than supervised AT or mind-body techniques. It was observed that only during chemotherapy, women with breast cancer in the intervention groups showed a significant reduction in fatigue (SMD =  - 0.38; 95% CI: - 0.55 to - 0.20).

CONCLUSION

Physical exercise during adjuvant chemotherapy and/or radiotherapy in women with breast cancer can be considered beneficial in reducing fatigue, especially for women undergoing chemotherapy and for supervised training of resistance or combined RT and AT.

Effects of physical exercise on cognitive function of breast cancer survivors receiving chemotherapy: A systematic review of randomized controlled trials

Background

Cognitive impairment has a great negative impact on quality of life for breast cancer survivors. Emerging evidence suggested that physical exercise can improve cognitive function in order adults with Alzheimer's disease. However, less is known about the effects of physical exercise on cognitive function for breast cancer survivors. The purpose of this meta-analysis was to evaluate the effect of physical exercise on cognitive function in breast cancer survivors.

Methods

EMBASE, the Cochrane Library, Web of Science and PubMed were searched from the establishment of the databases to June 2021. Randomized controlled trials were included. All analysis were conducted using the Revman 5.3.

Results

12 studies (936 participants) indicated that exercise improved self-reported cognitive function (MD 10.12, 95% CI [5.49,14.76], p < 0.0001), cognitive fatigue (MD -5.41, 95% CI [-10.31,-0.51], p = 0.03) and executive function (MD -13.63, 95% CI [-21.86,-5.39], p = 0.0001).

Conclusion

Physical exercise can improve cognitive function for breast cancer survivors, particularly in self-reported cognitive function, and executive function. Future studies need to explore the effect of exercise on cognitive function from the frequency and duration of exercise.

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Physical exercise can improve cognitive function among breast cancer survivors.

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Aerobic exercise and combined exercise intervention were more effective than other exercise.

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Physical exercise can improve self-reported cognitive function, cognitive fatigue and executive function in breast cancer patients.

Effective non-pharmacological interventions for cancer related cognitive impairment in adults (excluding central nervous system or head and neck cancer): systematic review and meta-analysis

INTRODUCTION

Cancer-related cognitive impairment (CRCI) is prevalent in cancer survivors, and impairments affect daily living tasks and overall wellbeing. This review aimed to identify and evaluate published randomized controlled trials (RCTs) of interventions to manage CRCI in adult populations, to analyze their effectiveness and to investigate the quality of the studies.

EVIDENCE ACQUISITION

Seven databases were searched (Medline, Scopus, CINAHL, AMED, PsychINFO, OTseeker, and the Cochrane Database of Systematic Reviews), including years 2005-2020, for randomized controlled trials (RCTs) investigating interventions to address cognition for adults with cancer. The final search was conducted in February 2021. The quality of studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for RCTs. Meta-analysis used comprehensive meta-analysis software. The study protocol was registered with PROSPERO (registration N. CRD42017076868).

EVIDENCE SYNTHESIS

A total of 45 studies involving 4727 participants examined interventions for CRCI and met selection criteria. Categories of interventions included cognitive training-based intervention (N.=15), cognitive behavior therapy (CBT) (N.=4), physical activity (N.=16) and other supportive therapies (N.=10). Meta-analysis indicated beneficial overall effects for all categories of interventions: cognitive training (standardized mean difference [SMD]=0.41, 95% CI: 0.28-0.53, I2=88.87%); CBT (SMD=0.30, 95% CI: 0.14-0.46, I2=44.86%); physical activity (SMD=0.27, 95% CI: 0.20-0.35, I2=37.67%); and supportive therapies (SMD=0.27, 95% CI: 0.16-0.39, I2=64.94%). Studies used self-report cognitive outcome measures and neurocognitive testing, or a mixture.

CONCLUSIONS

Findings suggest that effective intervention for CRCI exist, and cognitive training is consistently supported as an effective intervention; however, a high level of heterogeneity was found. CRCI research is currently dominated by breast cancer survivors, and quality research is also needed to address the broader population of cancer survivors who experience CRCI.

Impact of exercise interventions on physical fitness in breast cancer patients and survivors: a systematic review

Background

This systematic review aims to identify the effects of exercise interventions in patients with breast cancer (BCP) and survivors (BCS) on selected variables of physical fitness.

Methods

A comprehensive literature search was conducted using Medline and Scopus. Randomized controlled trials with isolated exercise interventions in BCP and BCS women (< 5 years from therapy completion) were included. The risk of bias (RoB) assessment was conducted using the Cochrane RoB-2-tool. Variables regarding cardiorespiratory fitness (CRF), strength (ST), fatigue (F) and health-related quality of life (HRQoL) were discussed.

Results

Of the 336 studies initially identified, 22 met all the inclusion criteria and were deemed eligible. RoB assessment indicated that the studies had predominantly “some concerns” or had “low RoB”, with only 3 studies presenting a “high RoB”. The mean duration and frequency of exercise interventions were 19 weeks and 3 sessions/week, performed at moderate intensity (65% VO₂max and 66% 1RM, for aerobic and resistance-training interventions, respectively).

Conclusions

Exercise interventions seem to be a valuable strategy in BCP to avoid the decline of CRF, ST, F and HRQoL. Conversely, improved physical function among BCS is observed for the same variables. Resistance training and combined interventions seem to provide the most encouraging variations of the selected outcomes.

PROSPERO registration ID

CRD42021237917.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12282-022-01347-z.

Supportive Care in Oncology-From Physical Activity to Nutrition

The diagnosis and treatment of cancer are associated with impairment at the physical and at psychological level. In addition, side effects are a potentially treatment-limiting factor that may necessitate dose reduction, delay, or even discontinuation of therapy, with negative consequences for outcome and mean survival. Numerous studies have shown that physical activity and sports and exercise therapy programs are not only practicable but also recommendable for oncologic patients during the acute phase and in the aftercare. Furthermore, nutrition plays an important role in all stages of tumor therapy. A timely integration of a nutrition therapy and physical activity in the form of physiotherapy and sports therapy serves to prevent and reduce treatment-associated side effects. Evidence-based recommendations on cancer prevention through nutrition therapy, physical activity, and sports and exercise therapy should be integrated into treatment plans for oncology patients as well as in health care services for the general population. Individual counselling by trained nutrition and exercise specialists may be advisable to receive concrete recommendations on the respective tumor entity or specific side effects. This mini review is based on a selective literature search in the PubMed database and Cochrane Central Register of Controlled Trials on the subjects of healthy diet and physical activity in primary prevention and follow-up about cancer.

The lasting effects of resistance and endurance exercise interventions on breast cancer patient mental wellbeing and physical fitness

Breast cancer is a persisting global burden for health services with cases and deaths projected to rise in future years. Surgery complemented by adjuvant therapy is commonly used to treat breast cancer, however comes with detrimental side effects to physical fitness and mental wellbeing. The aim of this systematic review and meta-analysis is to determine whether resistance and endurance interventions performed during adjuvant treatment can lastingly ameliorate these side effects. A systematic literature search was performed in various electronic databases. Papers were assessed for bias and grouped based on intervention design. RStudio was used to perform the meta-analyses for each group using the ‘meta’ package. Publication bias and power analyses were also conducted. These methods conform to PRISMA guidelines. Combined resistance and endurance interventions elicited significant long-lasting improvements in global fatigue and were beneficial to the remaining side effects. Individually, resistance and endurance interventions non-significantly improved these side effects. Resistance interventions elicited higher benefits overall. Exercise interventions have lasting clinical benefits in ameliorating adjuvant therapy side effects, which negatively impact physical fitness and mental wellbeing. These interventions are of clinical value to enhance adherence rates and avoid comorbidities such as sarcopenia, thus improving disease prognosis.

Resistance Exercise for Breast Cancer Patients? Evidence from the Last Decade

Background

Breast cancer is associated with many therapy-induced side effects that impact patients' lives from diagnosis to long-term survivorship. Physical activity has become an important and proven supportive measure in treating side effects like loss of muscle strength, fatigue, chemotherapy-induced peripheral neuropathy, lymphedema, and loss of quality of life. Resistance training (RT) is an established exercise intervention for breast cancer patients, but the correct type, timing, intensity, and duration of exercise remain unclear. It is necessary to investigate different resistance training interventions and their effects on breast cancer patients by covering all stages of treatment, beginning with prehabilitation, through the period of acute therapy, to long-term survivorship.

Conclusion

Upon evaluation of randomized controlled trials (RCTs) from the past decade, RT was found to be feasible and safe. Furthermore, there is evidence on the impact of RT on muscle strength, CRF and QoL amongst other factors. Studies implementing mixes of aerobic and strength exercises are rather common, but RCTs of RT-only protocols remain scarce. Different strength training protocols at distinct stages of breast cancer treatment have been conducted, but with the complexity of treatments and the variety of training styles, a large field of study remains.

Key Messages

Although the overall data on RT for breast cancer patients has increased, there are many different methodological approaches and testing measures as well as gaps in study documentation. There is still very little of the evidence that would facilitate the compilation of standardized and individualized guidelines.