Physical Activity and Mortality in Cancer Survivors: A Systematic Review and Meta-Analysis

Association between recorded physical activity and cancer progression or mortality in individuals diagnosed with cancer in South Africa

OBJECTIVES

This study aimed to determine the association between progression and mortality in individuals with stage 1 cancer and their recorded physical activity before the diagnosis of the cancer.

METHODS

We included 28 248 members with stage 1 cancers enrolled in an oncology programme in South Africa. Physical activity was recorded using fitness devices, logged gym sessions and participation in organised fitness events. Levels of physical activity over the 12 months before cancer diagnosis were categorised as no physical activity, low physical activity (an average of <60 min/week) and moderate to high physical activity (≥60 min/week). Measured outcomes were time to progression, time to death and all cause mortality.

RESULTS

Physically active members showed lower rates of cancer progression and lower rates of death from all causes. The HR for progression to higher stages or death was 0.84 (95% CI 0.79 to 0.89), comparing low activity with no physical activity, and 0.73 (95% CI 0.70 to 0.77), comparing medium to high physical activity with no physical activity. The HR for all cause mortality was 0.67 (95% CI 0.61 to 0.74), comparing low physical activity with no activity, and 0.53 (95% CI 0.50 to 0.58), comparing medium to high physical activity with no physical activity.

CONCLUSIONS

Individuals engaging in any level of recorded physical activity showed a reduced risk of cancer progression or mortality than those not physically active. There was a further reduction among individuals with moderate to high levels of physical activity compared with those with lower levels.

The Swaying Pendulum: Factors Influencing Physical Activity Participation in Women With Recurrent Ovarian Cancer

BACKGROUND

Physical activity levels decline following diagnosis of ovarian cancer, and there is limited research investigating the factors that influence participation across the cancer continuum. The objective of this study is to explore barriers, facilitators, perceptions, and preferences of physical activity for women with recurrent ovarian cancer and to explore whether these factors change across the cancer continuum.

METHODS

Women enrolled in the Exercise During Chemotherapy for Recurrent Ovarian Cancer trial were invited to participate. Semistructured interviews, guided by social cognitive theory, were conducted by 2 interviewers via video conferencing. All interviews were recorded and transcribed verbatim. Data were analyzed using an adaptive thematic approach.

RESULTS

An overarching theme, "The swaying pendulum," emerged following 13 participant interviews, representing the instability of physical activity participation in women with recurrent ovarian cancer. Five themes captured factors swaying the "pendulum": (1) the "priority ladder" of physical activity and the importance of social support and the physical environment, (2) the "hurdles" of treatment- and disease-related side effects, (3) the power of physical activity support and advice from health professionals in the face of uncertainty and fear, (4) a "yearning" for the outdoors, and (5) resorting to walking.

CONCLUSIONS

Physical activity participation in women with recurrent ovarian cancer is swayed by a complex combination of internal and external factors, unique to each individual, and continually changing circumstances across the cancer continuum.

Supporting wellness after cancer treatment for women from Chinese, Vietnamese, and Arabic backgrounds: a qualitative study of healthcare provider views

INTRODUCTION

Over one million Australians live with a cancer diagnosis, with nearly a quarter speaking a language other than English. Cancer survivors from culturally and linguistically diverse (CALD) backgrounds often face significant unmet needs during survivorship, including navigating the healthcare system and accessing culturally appropriate support. For example, Chinese- and Vietnamese-speaking survivors report physical and psychosocial impacts, compounded by limited availability and access to tailored information on symptom management and recurrence prevention. This study aimed to explore healthcare providers' perspectives on designing supportive care programs for women cancer survivors from Vietnamese, Arabic, and Chinese-speaking backgrounds, focusing on culturally appropriate content, delivery formats, and barriers and facilitators to engagement.

METHOD

Thirteen healthcare providers experienced in cancer survivorship and supportive care for CALD women participated in semi-structured interviews. Participants were recruited from healthcare settings in Western Sydney, a culturally diverse region, using purposive sampling to ensure diverse professional perspectives. Interviews were guided by an advisory committee, audio-recorded, transcribed verbatim, and analyzed thematically using NVivo.

RESULTS

Three key areas were identified: program content, delivery preferences, and barriers/enablers. A holistic approach addressing physical, emotional, and social dimensions was recommended, incorporating culturally tailored guidance on diet, exercise, and mindfulness. Non-hospital, community-based settings were favored for accessibility and comfort, with a stepped-care model offering varying levels of support based on individual needs. Challenges included language barriers, privacy concerns, and logistical issues, while facilitators encompassed culturally sensitive outreach, community partnerships, and bilingual facilitators. Participants emphasized the importance of low-cost programs with flexible delivery formats.

CONCLUSIONS

This study provides valuable insights from healthcare providers on the design of culturally and linguistically tailored supportive care programs for women cancer survivors from Vietnamese-, Arabic-, and Chinese-speaking backgrounds. Providers emphasized the importance of a holistic approach addressing physical, emotional, and social needs, with delivery in accessible, community-based settings. Key recommendations included culturally sensitive outreach, bilingual facilitators, and flexible, low-cost program options to overcome barriers such as language, privacy concerns, and logistical challenges. These programs have the potential to advance health equity by improving survivorship experiences and outcomes for culturally diverse women.

Physical activity guidelines in oncology: A systematic review of the current recommendations

This review aims to summarize the recommendations endorsed by scientific societies regarding physical activity for patients with cancer. A systematic search was conducted to identify guidelines endorsed by scientific societies and published in the last 15 years dedicated to physical activity for cancer patients. The AGREE II instrument was used to assess the methodological quality of the guidelines. Results are presented as qualitative synthesis. A total of 11 guidelines met the inclusion criteria. Seven were considered high quality, scoring ≥60 % in the AGREE II tool. All the guidelines recommended to include aerobic and resistance training as types of activities. Regarding the physical activity dosage, most suggested a generic 150 minutes/week of moderate-intensity activity plus resistance training twice a week. Three guidelines reported instructions for exercise prescription, including frequency, intensity, and duration of training sessions. Six guidelines reported exercise testing/medical clearance instructions, 9 provided considerations regarding adaptation/precautions, and 7 detailed the specialists for referral. Four guidelines considered motivational aspects related to physical activity and cancer. Although important steps have been made in the more recent recommendations, effort is needed to produce high-quality research in the exercise-oncology field, with the ultimate aim of developing more tailored guidelines.

The effects of nutritional habits and physical activity on treatment response and survival in patients with lung cancer

BACKGROUND

Lung cancer is a malignancy marked by low treatment response rates and poor survival outcomes, despite significant advancements in diagnostic and therapeutic approaches. This study aims to examine the impact of dietary habits and physical activity levels on chemotherapy response and survival in patients diagnosed with advanced-stage non-small cell lung cancer.

METHODS

Patients diagnosed with stage IV non-small cell lung cancer and scheduled to receive platinum-based chemotherapy as the initial treatment were included in the study. Sociodemographic and cancer-related characteristics were documented. At the beginning of treatment, the patients' dietary habits and physical activity levels were evaluated using the "Mediterranean Diet Adherence Scale," the "International Physical Activity Questionnaire," and the "Food Consumption Frequency Form," while their average daily step count was calculated. The study investigated the relationships between dietary habits and physical activity levels with treatment response, 6-month survival, progression-free survival, and chemotherapy-related side effects.

RESULTS

The study included a total of 37 patients, 35 of whom were male, with a mean age of 63.49 years. The 6-month survival rate among these patients was 81.1%. In terms of treatment response, 35.1% of patients experienced disease progression, 54.1% demonstrated partial regression, and 8.1% achieved complete regression. Notably, the 6-month survival rate was significantly higher in minimally physically active patients compared to inactive patients (p = 0.022). Furthermore, patients adhering to the Mediterranean diet exhibited a significantly higher 6-month survival rate compared to those who did not follow the diet (p = 0.019). High adherence to the Mediterranean diet was also associated with a significantly lower incidence of chemotherapy-related gastrointestinal side effects (p < 0.001).

CONCLUSION

This study demonstrated that physical activity and adherence to the Mediterranean diet positively impact 6-month survival and reduce the incidence of chemotherapy-related side effects.

Following the American Cancer Society guideline for cancer survivors and obesity-related cancer survival

BACKGROUND

In 2022, the American Cancer Society updated its guideline for cancer survivors. However, the impact of post-diagnosis adherence on mortality risk for those with obesity-related cancers remains unclear.

METHODS

This study followed nonsmoking participants from the Cancer Prevention Study-II Nutrition Cohort diagnosed with obesity-related cancers between 1992 and 2002 through 2020. Post-diagnosis adherence to ACS guidelines-body mass index (BMI), physical activity, diet, and alcohol consumption-was scored on a scale from 0 to 8. Cox proportional hazards regression models were used to calculate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Among 3,742 cancer survivors (mean age 67.6 years) with a median follow-up of 15.6 years, 2,430 deaths occurred. Survivors with a score of 6-8 had a 24% lower risk of all-cause mortality (HR, 0.76; 95% CI, 0.68-0.85), a 33% lower risk of cardiovascular disease mortality (HR, 0.67; 95% CI, 0.54-0.83), and a 21% lower risk of cancer-specific mortality (HR, 0.79; 95% CI, 0.64-0.97) compared to those with a score of 0-3. Higher BMI and physical activity scores were associated with lower all-cause mortality. Compared to survivors with a consistently low ACS guideline score (<5) both before and after diagnosis, those with a consistently high score (≥5) had lower all-cause and cardiovascular disease mortality. Additionally, survivors who improved their score from low to high had lower all-cause mortality.

CONCLUSIONS

A lifestyle aligned with the ACS nutrition and physical activity guideline is associated with lower mortality risk among nonsmoking survivors of obesity-related cancers.

Physical activity levels among long-term cancer survivors of more than 5 years: a propensity score matching analysis

PURPOSE

As both the number of long-term cancer survivors and cases of late cancer recurrence increased, understanding aspects of lifestyle, such as participation in physical activity (PA), is of importance among long-term cancer survivors. This study aimed to investigate PA levels among long-term cancer survivors compared with age-, sex-, and body mass index (BMI)-matched non-cancer participants.

METHODS

The study analyzed data from 648 cancer survivors (66% female, average age of 60.0 ± 10.9 years) who visited the Cancer Prevention Center, Yonsei Cancer Center, between 2015 and 2022. A total of 3240 participants were randomly selected from the Korea National Health and Nutrition Examination Survey (2000-2020) using propensity score matching based on age, sex, and BMI.

RESULTS

Among long-term cancer survivors, the majority of participants were survivors of colorectal (43.1%), gastric (23.8%), and breast cancer (24.1%). Long-term cancer survivors participated more in moderate-to-vigorous leisure-time PA (106.2 ± 244.3 vs. 47.3 ± 135.8 min/week, P < 0.05), transportation PA (130.3 ± 231.8 vs. 101.2 ± 174.9 min/week, P < 0.05), and total walking time (311.4 ± 380.1 vs. 227.6 ± 347.7 min/week, P < 0.05) compared with matched non-cancer participants. However, long-term cancer survivors were less likely to participate in less resistance exercises (0.7 ± 1.8 vs. 1.5 ± 1.5 day/week, P < 0.05) compared with the non-cancer matched participants. Although long-term cancer survivors are generally more physically active, a significant proportion of long-term cancer survivors (76.1%) still did not meet the PA guidelines for moderate-intensity aerobic exercise.

CONCLUSION

Although long-term cancer survivors participated in more PA compared to the matched non-cancer participants, the majority of long-term cancer survivors still do not meet the PA guidelines, suggesting that further strategies to increase PA are required.

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Effects of resistance training vs high intensity interval training on body composition, muscle strength, cardiorespiratory fitness, and quality of life in survivors of breast cancer: a randomized trial

PURPOSE

Breast cancer treatments often lead to unfavourable changes in body composition, physical fitness, and quality of life (QoL). We compared the effects of resistance training (RT) and high-intensity interval training (HIIT) on these outcomes in survivors of breast cancer.

METHODS

Twenty-eight survivors of breast cancer, post-treatment (Stage I-III), aged 55.5 ± 8.8 years and body mass index 27.9 ± 5 kg/m2 were randomly allocated to a 12-week supervised RT (n = 14) or HIIT (n = 14) intervention, 3 days per week. Body composition (dual energy x-ray absorptiometry), upper and lower body muscle strength (1-repetition maximum), cardiorespiratory fitness (CRF) (Ekblom Bak Cycle Test), and QoL domains (EORTC QLQ-C30 and EORTC QLQ-BR45) were assessed at baseline and 12 weeks.

RESULTS

There were no significant differences between groups at baseline. Exercise attendance ranged from 81 to 85%. Between groups, there were significant differences (p ≤ 0.001) after 12 weeks in chest press strength for RT (mean difference [MD] = 4.7 kg) and CRF for HIIT (MD = 1.9 ml/min/kg). Within groups, there were significant improvements (p < 0.05) for % lean mass and % fat mass in both RT and HIIT, as well as for upper and lower body muscle strength, CRF, and QoL domains. No major adverse events were noted.

CONCLUSION

Both exercise groups improved body composition, physical fitness, and QoL domains over 12 weeks of RT or HIIT, although mode-specific benefits were apparent with more substantial improvements in lean mass and muscle strength with RT and reductions in % fat mass and improved CRF with HIIT. Tailored exercise programs should address the specific health needs of each patient.

Joint Associations of Sedentary Time and Intensity-Specific Physical Activity With Cancer Mortality: A Device-Based Cohort Study of 72,458 UK Adults

BACKGROUND

There are no studies examining the prospective joint association of device-based measures of sedentary time and physical activity (PA) with cancer mortality. We examined the joint associations of sedentary time and intensity-specific PA with cancer mortality in 72,458 adults from UK Biobank.

METHODS

Participants wore an Axivity AX3 accelerometer on their dominant wrist for at least 3 days (with at least 1 weekend day). Cox regression was performed to estimate hazard ratios (HR) and 95% confidence intervals (CIs) for joint associations of sedentary time and intensity-specific PA (light [LPA], moderate [MPA], and vigorous PA [VPA]) with cancer mortality (reference group: high intensity-specific PA and low sedentary time) adjusted for confounders and mutually adjusted for other PA intensities.

RESULTS

Associations between sedentary time and cancer mortality were stronger among participants with low PA, irrespective of the intensity. Compared with participants with lower sedentary time (<11 h/d) and high MPA (median of 49 min/d), HR were 1.27 (95% CI, 0.90-1.78) for high sedentary time and high MPA, 1.35 (95% CI, 1.03-1.77) for high sedentary time and medium MPA (49 min/d), and 1.49 (95% CI, 1.15-1.92) for high sedentary time and low MPA (13 min/d). HR for high sedentary time and low light PA (61 min/d) and high sedentary time and low vigorous PA (1 min/d) were 1.25 (95% CI, 1.02-1.59) and 1.57 (95% CI, 1.20-2.06), respectively.

CONCLUSIONS

Relatively large amounts of LPA and MPA and small amounts of VPA appeared to attenuate the association between sedentary time and cancer mortality.

Promoting Physical Activity to Cancer Survivors in Practice: Challenges and Solutions for Implementation

Objectives: This study explored the challenges and solutions to the effective promotion of physical activity (PA) to cancer survivors in practice in Ireland amongst a variety of stakeholders, including healthcare professionals (HCPs), policy makers, community providers of cancer care, and academics. Methods: Focus groups (n = 5) were conducted with participants (n = 40), including oncologists, oncology nurses, physiotherapists, cancer support centre managers, academics, consumers, cancer policy representatives, exercise specialists, community providers of exercise programmes, and a chartered psychologist. The data were analysed using reflexive thematic analysis. Results: Four primary themes were identified: (i) embedding PA into the cancer pathway (including the sub-themes of 'singing from the same hymn sheet', 'PA as an essential element of treatment', and 'intervention opportunities and models of care'); (ii) education and training; (iii) access to appropriate PA interventions; and (iv) tailored programmes. Conclusions: The importance of embedding PA into the cancer pathway such that PA is viewed by clinicians and patients as a key part of their treatment was emphasised. Opportunities for PA intervention within existing practice were highlighted, such as the chemotherapy education sessions run by Daffodil nurses. Findings pointed to a need for education and training for HCPs that include how to coach and counsel cancer patients concerning PA in clinic. Finally, a major barrier to PA promotion was limited access to appropriate PA interventions.

The Role of Physical Activity on Quality of Life Among Breast Cancer Survivors in the Black Women's Health Study

PURPOSE

Black breast cancer survivors (BCS) are more likely to experience poor quality of life (QoL) compared to White BCS. Physical activity (PA) has been shown to improve QoL in cancer survivors. However, there is limited evidence demonstrating associations between PA and multiple QoL domains among Black BCS. This study examined the association between PA duration and intensity level (e.g., ≥ 150 min/week of moderate activity) and multiple QoL domains (e.g., physical health) among BCS in the Black Women's Health Study (BWHS).

METHODS

A total of 904 BWHS participants were eligible to participate in this study. The 2019 BWHS follow questionnaire, which assessed multiple QoL domains was used to address the primary aim. Adjusted multinomial logistic regression models were fit to estimate the odds ratios and 95% confidence intervals for the associations with each exposure variable (PA) and outcome variable (QoL). Multiple imputation was used to address missing data.

RESULTS

The average participant age was 66, and the average body mass index was 29 kg/m2 at the time of QoL assessment. There were significant and positive associations between PA duration and intensity level and multiple domains of QoL (p < 0.05). Participants who engaged in higher durations of moderate PA (e.g., ≥ 150 minutes/week) had increased odds of optimal social functioning (aOR = 2.67; 95% CI 1.40, 5.08) and functional wellbeing (aOR = 4.10; 95% CI 1.71, 9.83) than those who engaged in lower durations of moderate PA (e.g., < 150 minutes/week). Compared to participants who engaged in lower durations of vigorous PA (e.g., < 60 minutes/week), those who engaged in higher durations of vigorous PA (e.g., ≥ 60 minutes/week) had greater odds of optimal physical health (aOR = 4.27; 95% CI 2.04, 8.90), social functioning (aOR = 4.48; 95% CI 2.27, 8.86), and financial wellbeing (aOR = 1.64; 95% CI 1.03, 2.63).

CONCLUSIONS

Black BCS who engage in higher durations of moderate and vigorous PA tend to have better QoL. These findings may help to build upon the importance of PA and the relevance of PA in the context of supportive care for racial and ethnic minority BCS. Future longitudinal studies are needed to establish clear temporal associations between PA and QoL in this group.

Giving support to close others increases affective risk perceptions: longitudinal and experimental studies

Risk perceptions are instrumental in predicting how people will process and react to threats. While social contexts have long been associated with changes in risk perception, whether and which social contexts alter risk perceptions is not well understood. This paper explores one such social context--support-giving--which has previous links to affect, cognition, and behavior, including how threats are processed. Using a tripartite model in which risk perceptions are split between deliberative (logical), affective (emotional), and experiential (lived) assessments, we used two studies, a longitudinal-correlational (Study 1) and experimental (Study 2), to explore whether support-giving relates to and impacts risk perceptions. Findings from Study 1 revealed that support-giving toward a close other at Time 1 was associated with an increase in affective risk perceptions at Time 2. Study 2 clarified the direction of this association, finding that there was an increase in affective and experiential risk perceptions for those randomly assigned to a support-giving condition, as compared to the control. Deliberative risk perceptions did not differ between conditions. Given that affective risk perceptions strongly predict behavior, support-giving may be a promising new avenue by which to inspire preventative behavior.

Effects of a Targeted Concurrent Training Program on the Exercise Adherence in Female Breast Cancer Survivors: A Randomized Controlled Trial

Background/Objectives: Increased time and adherence to physical activity, as well as increased intensity of physical activity, is one of the determining factors in improving survival and avoiding disease recurrence in female breast cancer survivors. The study aims to determine the effect of a 12-session concurrent training program on increasing moderate/vigorous physical activity time in this population. Methods: A total of (N = 72) female breast cancer survivors were randomized into an intervention group and a control group to perform a 12-session concurrent training program. The GPAQ questionnaire measured the time and intensity of physical activity and work they performed before starting the program and three months after completion of the program. Results: A total of (N = 15) women in the intervention group and (N = 22) women in the control group completed the questionnaire before and three months after completing the program. A significant increase in moderate, vigorous, and combined physical activity (PA) was observed in the intervention group (IG) in comparison to the control group (CG) at three months following the intervention. While these results are promising, it is important to note that the observed improvements in PA adherence reflect associations rather than direct causal relationships. While these changes are statistically significant, they also reflect meaningful improvements in clinical outcomes. A notable finding was the significant decrease in sedentary time observed in the IG, which is likely to have contributed to the observed improvement in adherence. Conclusions: Concurrent training shows an increment in the time and intensity of daily physical activity performed by breast cancer survivors, which is a determining aspect of the survival and non-relapse of the disease in this population.

Neutrophil-to-lymphocyte ratio is associated with accelerometer-measured physical activity levels in breast cancer survivors

INTRODUCTION

Physical activity (PA) has been associated with remarkable benefits in breast cancer (BC) survivors. However, the physiological mechanisms that underlie these benefits are not well understood and the published results are inconsistent and weak. Some authors suggest that some biomarkers, particularly those related with inflammation, insulin resistance, or sexual hormones may account for some of these benefits. Most studies have used self-reported tools to assess PA.

OBJECTIVE

To explore the association between objectively assessed PA and potentially related biomarkers.

METHODS

A cross-sectional study was performed in a single hospital in Madrid, Spain. Candidates were BC survivors older than 18, who had finished their treatments. PA was assessed through accelerometers. Biomarkers related with insulin resistance (glucose, insulin, IGF-1, IGFBP-3), inflammation (C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), interleukin (IL) 1, IL-6, IL-8, IL-10, TNF, sexual hormones (progesterone, testosterone, estrogens, androsterone), hypothalamic-pituitary axis (HPA) (cortisol), autonomic nervous system (ANS) (noradrenaline), and oxidative stress (8-hydroxy-2'-deoxyguanosine, 8-OHdG) were assessed.

RESULTS

Data of 91 women (mean age: 51.4 ± 8.1 years, mean BMI (kg/m2): 25.9 ± 4.5) were analyzed. Sedentary time (β (SE): - 0.001 (0.001), p-value 0.040) and vigorous PA time (β (SE): 0.010 (0.004), p-value 0.026) were significantly associated with NLR, but not with other biomarkers.

CONCLUSIONS

PA was not associated with biomarkers related to insulin resistance, sexual hormones, HPA, ANS, and oxidative stress. Neither was it associated with typical biomarkers of inflammation. An unexpected but consistent direct association with NLR was found. This relationship deserves further confirmation.

Impact of Lifestyle Modifications on Cancer Mortality: A Systematic Review and Meta-Analysis

Background and Objectives: Cancer survival poses significant challenges in oncology, with lifestyle modifications increasingly recognized as crucial in modifying patient outcomes post-diagnosis. This meta-analysis aims to systematically evaluate the impact of various lifestyle interventions on cancer survival across different types of cancer. Methods: A comprehensive literature search of electronic databases including PubMed, Scopus and Cochrane was performed to identify relevant studies up to 30 November 2024. Relevant studies were chosen and data were extracted and analyzed using SPSS Version 29.0 software. Results: Our systematic review included data from 98 studies involving a total of 1,461,834 cancer patients to evaluate the impact of lifestyle factors on cancer survival. Out of these, 64 studies were included in the meta-analysis. Our meta-analysis demonstrates that adherence to specific dietary patterns significantly improves cancer-specific outcomes. The Healthy Eating Index (HEI) diet was associated with a reduction in cancer-specific mortality (pooled log HR: -0.22; 95% CI: [-0.32, -0.12]; p < 0.001). Similar benefits were observed with the Mediterranean diet (aMED), which also reduced cancer mortality and recurrence (pooled log HR: -0.24; 95% CI: [-0.40, -0.07]; p < 0.001), and the Dietary Approaches to Stop Hypertension (DASH) diet (pooled log HR: -0.22; 95% CI: [-0.33, -0.12]; p < 0.001). Additionally, general dietary improvements were beneficial for breast cancer-specific mortality across 17 cohort studies (pooled log HR: -0.15; 95% CI: [-0.25, -0.06]; p < 0.001). Engaging in any form of physical activity post-diagnosis was associated with significant improvements in cancer-specific mortality or recurrence (pooled log HR: -0.31; 95% CI: [-0.38, -0.25]; p < 0.001). Participants who ceased smoking after diagnosis exhibited more favorable cancer outcomes (pooled log HR: -0.33; 95% CI: [-0.42, -0.24]; p < 0.001), with smoking cessation notably reducing cancer-specific mortality among lung cancer survivors (pooled log HR: -0.34; 95% CI: [-0.48, -0.20]; p < 0.001). Additionally, reducing alcohol intake post-diagnosis significantly improved cancer outcomes (pooled log HR: -0.26; 95% CI: [-0.33, -0.19]; p < 0.001). Alcohol moderation in gastrointestinal tract cancer survivors specifically decreased both cancer-specific mortality and recurrence (pooled log HR: -0.22; 95% CI: [-0.29, -0.15]; p < 0.001). Conclusions: Lifestyle modifications after cancer diagnosis significantly improve cancer-specific outcomes. Specific dietary patterns, increased physical activity, smoking cessation, and reduced alcohol intake are all associated with lower cancer-specific mortality. Integrating these lifestyle changes into oncology care may enhance patient survival and quality of life.

The associations of obesity with demographic and lifestyle factors among Hong Kong adults

Background: Obesity is a risk factor for leading causes of death. Aim: This study investigated the associations of obesity with demographic and lifestyle factors among adults aged 18-64 in Hong Kong. Methods: The study uses data (n = 24,855) from the government online database. It uses T-tests to compare mean values for body mass index (BMI), waist circumference, and weight-to-height ratio obese; analysis of variance for not-obese, BMI-obese-only, central-obese, and BMI + central-obese; Pearson chi-square tests for categorical variables; and multinomial logistic regression to obtain the odd ratios. It uses IBM SPSS version 26 to conduct all analyses, and at a 95% confidence level. Results: The analyses show that the risks of central-obese, and BMI + central-obese increase by 4%, and 4%/year of age, respectively. Females have 60%, 38%, and 60% lower risks of BMI-obese-only, central-obese, and BMI + central-obese, respectively, and people with tertiary education have 28%, 20%, and 20% lower risks, respectively. Employed people have a 40% higher risk of BMI-obese-only when compared with the unemployed; students have a 46% lower risk of BMI + central-obese and home-makers have a 38% higher risk. The risk of central-obese decreases by 14%/10 min/day of moderate physical activity, but could be different among females, and vigorous physical activity yielded mixed results. The risk of BMI + central-obese decreases by 9%/day/week of vegetable intake. Conclusions: Obesity is associated with multiple demographic and lifestyle factors. Keep doing vigorous and moderate physical activity but state alert to obesity risk factors, and frequent vegetable intake are recommended. Lifelong learning and continuing education could be an effective strategy to combat obesity.

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

Background

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

Methods

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

Results

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

Conclusions

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

Clinical Trials Registration

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

Determinants of physical activity maintenance and the acceptability of a remote coaching intervention following supervised exercise oncology rehabilitation: a qualitative study

PURPOSE

The purpose of the study was to investigate perceived determinants of physical activity (PA) maintenance following supervised exercise oncology rehabilitation and the acceptability of a remote coaching intervention during this period.

METHODS

A phenomenological qualitative study with semi-structured interviews was conducted. Nineteen participants (16 women, 3 men) were recruited from the intervention (n = 12) and control group (n = 7) of a randomized controlled trial on the effectiveness of remote coaching following hospital-based, supervised exercise oncology rehabilitation. Participants in the intervention group received a 6-month remote coaching intervention after completing the exercise program, aimed at stimulating PA maintenance. The interviews were based on the Capability, Opportunity, and Motivation model of Behaviour (COM-B model) and the framework of acceptability (TFA) and were coded using template analysis.

RESULTS

Key themes regarding determinants of PA maintenance were self-efficacy, PA habits, accountability, physical complaints, and facilities. Remote coaching was perceived acceptable because it stimulated PA maintenance by offering a source of structure and social support and thereby increased accountability. Moreover, it improved confidence to perform PA, leading to increased levels of self-efficacy. The remote nature of the intervention was perceived as convenient by some of the participants, while others would have preferred additional physical appointments.

CONCLUSIONS

Cancer survivors considered remote coaching acceptable to stimulate PA maintenance following supervised rehabilitation. Interventions should focus on increasing accountability, self-efficacy, forming habits, and helping cancer survivors to overcome barriers.

IMPLICATIONS FOR CANCER SURVIVORS

The ability to maintain PA beyond supervised exercise oncology programs depends on many determinants. Remote coaching interventions have potential to target individually relevant determinants following exercise programs in cancer survivors.

Patient-reported outcomes, and perceptions and knowledge about recurrence in women with hormone receptor-positive breast cancer

PURPOSE

Over half of hormone receptor-positive (HR+) breast cancer recurrences occur >5 years from diagnosis, however, little is known about well-being or breast cancer risk perceptions and knowledge in long-term HR+ breast cancer survivors.

METHODS

From 1/2021 to 1/2022, we surveyed patients with a history of stage II/III, HR+ breast cancer, ≥5 years from diagnosis, without recurrence about concerns and perceptions related to their diagnosis and recurrence risk, physical and emotional health, knowledge, and risk reduction. Logistic regression identified factors associated with overestimation of 5-10 year distant recurrence risk.

RESULTS

Among 166 women, median age at diagnosis was 51, 2.4% were Black and 1.2% Hispanic; 19.3% did not have a college degree. Median time from diagnosis was 10 years (range: 5-23). Median PROMIS anxiety (53; range: 37-73), physical (51, range: 32-68), and mental (51, range: 25-68) scores were similar to population norms (score of 50). 40% of women estimated metastatic recurrence risk to be ≥20% 5-10 years post-treatment; patients without a college degree were more likely to overestimate this risk (multivariable prevalence odds ratio: 3.69, 95% confidence interval: 1.49, 9.18). Only 17% correctly indicated HR+ breast cancer as having a higher risk of recurrence after 5 years; over one-third inaccurately responded that alcohol in moderation decreases recurrence risk.

CONCLUSION

While physical and emotional health were comparable to the general population, many survivors harbored inaccurate risk perceptions and knowledge. The association between lower educational attainment and risk overestimation underscores the importance of attention to literacy and numeracy when developing interventions to improve risk communication.

Information sharing and seeking about nutrition-related complementary and alternative medicines in online forums for people affected by cancer: A content analysis of discussion threads

BACKGROUND

Online forums are a key source of information about complementary and alternative medicine (CAM) for people affected by cancer, especially when information needs are not met in healthcare settings. This study therefore investigated nutrition-related CAM information seeking and sharing in online forums for people affected by cancer.

METHODS

This study was conducted in a major online platform that hosts over 10 forums for people affected by cancer and has more than 10,000 registered users. A search strategy was applied to the forums to identify discussion threads with nutrition-related CAM information from January 2020 to December 2023. Content analysis was used to code the topic of, reason for, and source of nutrition-related CAM information sought or shared.

RESULTS

Of 121 threads retrieved, 40 eligible threads contained 155 instances of nutrition-related CAM information seeking or sharing across 86 posts authored by 54 unique users. Most (89%) instances were information sharing rather than seeking. Topics commonly shared included using food items for medicinal purposes (e.g., ginger to reduce nausea) (25%), other sources of nutrition-related CAM information (e.g., book or naturopath) (17%), and oral nutrition supplements (16%). Most common reasons for sharing nutrition-related CAM information were strategies to manage treatment side effects (52%) and as complementary treatment (22%). Information shared was mostly sourced from personal opinion (44%) or experience (33%).

CONCLUSIONS

Information sharing about nutrition-related CAM is relatively common in online forums for people affected by cancer. Healthcare professionals should facilitate access to evidence-based information and advise caution when interpreting information shared in forums.

A randomized controlled trial of gamification to increase physical activity among black and Hispanic breast and prostate cancer survivors: Rationale and design of the ALLSTAR clinical trial

BACKGROUND

Survivors of breast and prostate cancer, especially those that are Black and/or Hispanic, are at high risk for cardiovascular events. Physical activity can reduce the risk of cardiovascular events in cancer survivors, but Black and Hispanic people are less likely to engage in routine physical activity. Concepts from behavioral economics have been used to design scalable, low-touch gamification interventions that increase physical activity in individuals at high risk for cardiovascular events, but the effectiveness of these strategies in Black and Hispanic survivors of breast and prostate cancer is uncertain.

STUDY DESIGN AND OBJECTIVES

ALLSTAR (NCT05176756) is a pragmatic, virtual randomized controlled trial designed to evaluate the effectiveness of a gamification intervention informed by behavioral economic concepts to increase daily physical activity in Black and Hispanic breast and prostate cancer survivors who received cardiotoxic therapies and have additional risk factors for cardiovascular disease. Patients are either referred by their cancer care team or identified by electronic health record searches; contacted by letter, email, text message and/or phone; and complete enrollment and informed consent on the Penn Way to Health online platform. Patients are then provided with a wearable fitness tracker, establish a baseline daily step count, set a goal to increase daily step count by 1,500-3,000 steps from baseline, and are randomized 1:1 to control or gamification. Interventions continue for 6 months, with follow-up for an additional 3 months to evaluate the durability of behavior change. The trial has met its enrollment goal of 150 participants, with a primary endpoint of change from baseline in daily steps over the 6-month intervention period. Key secondary endpoints include change from baseline in daily steps over the 3-month post-intervention follow-up period, change in moderate to vigorous physical activity over the intervention and follow-up periods, and change in patient-reported measures of physical function, fatigue, and overall quality of life.

CONCLUSIONS

ALLSTAR is a virtual, pragmatic randomized clinical trial powered to demonstrate whether gamification is superior to control in increasing physical activity in Black and Hispanic breast and prostate cancer survivors. Its results will have important implications for strategies to promote physical activity in survivors of breast and prostate cancer, specifically among minority populations.

CLINICAL TRIAL REGISTRATION

clinicaltrials.gov; https://clinicaltrials.gov/study/NCT05176756.

The Role of Maintaining Nutritional Adequacy Status and Physical Activity in Onco-Nephrology: Not a Myth Anymore, but a Reality

Background: Physical Activity (PA) provides numerous biological and psychological benefits, especially for cancer patients. PA mitigates treatment side effects, influences hormones, inflammation, adiposity, and immune function, and reduces symptoms of anxiety, depression, and fatigue. This study evaluates the impact of PA on these positive outcomes. Materials and Methods: An observational retrospective study enrolled 81 patients: 31 with CKD stages II-V and 50 with CKD and urological malignancies. Baseline and 6-month follow-up visits included clinical (Iohexol, Creatinine, Cystatin C) and anthropometric parameters (Bioimpedance Analysis, body circumferences). Physical activity levels were assessed using the Rapid Assessment of Physical Activity (RAPA) test. Patients followed a Mediterranean-like diet with controlled protein intake (MCPD) and received PA improvement advice. Statistical analysis was performed using linear regression and Pearson's Chi-Squared test with R programming. Results: Significant reductions in total adiposity and abdominal fat and improved body fluid distribution were observed. Post intervention, there was a 25.4% reduction in inactive individuals and an 88% increase in active lifestyles. Patients aged 75+ were more likely to be sedentary, indicating a need for increased professional attention. No correlation was found between increased PA and creatinine, cystatin, and eGFR values, but a positive correlation with GFR measured by iohexol clearance remained significant in multivariate analysis. Post intervention, regular PA engagement increased from 12.3% to 48% (p < 0.002). Conclusions: Incorporating PA and nutritional assessments into standard clinical care, supported by a collaborative nephrologist-nutritionist approach, can enhance the quality of life of CKD patients.

A cross-sectional study exploring the perception of exercise oncology in the Italian population

Introduction

We aim to examine the population's perception of physical exercise in patients with cancer.

Materials and methods

An anonymous survey was conducted to reach a sample of Italian adults. The questionnaire investigated sociodemographic factors, physical exercise levels, and perceptions about the importance, benefits, and safety of exercise, the support from oncologists and family/friends, as well as the capability and ease of patients of exercise.

Results

Overall, 838 persons participated in this survey. The majority of respondents agree that exercise is important (60.5%) and beneficial (61.5%) for patients with cancer during anticancer treatments, whereas 40.2% believed in its safety. Forty-two percent and 51.9% of participants expressed a positive opinion regarding the advice of oncologists and the encouragement of family/friends to exercise, respectively. Only 27.2% of respondents feel that patients are capable of exercising, and 9.0% agree that it is easy for them.

Conclusion

Although the population has a favorable perception of the importance and benefits of physical exercise, they do not still believe that patients are capable of performing it. Increasing awareness of the feasibility of a physical exercise intervention in the context of cancer is crucial to supporting patients.

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

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

Physical activity before and after cancer diagnosis and mortality risk in three large prospective cohorts

PURPOSE

Physical activity (PA) can improve cancer survival; however, whether the timing of PA differentially affects mortality risk is unclear. We evaluated the association between PA levels pre- and post-diagnosis and mortality risk in the Women's Health Study (WHS), Physicians' Health Study (PHS)-I, and PHS-II prospective cohorts.

METHODS

We categorized PA pre- and post-diagnosis as active (WHS: ≥ 7.5 metabolic equivalent (MET)-h/week; PHS: vigorous PA ≥ 2-4 times/week) or inactive. We analyzed changes in pre- and post-diagnosis PA levels as four joint categories: (1) Inactive → Inactive, (2) Active → Inactive, (3) Inactive → Active, and (4) Active → Active, on mortality risk using multivariable Cox proportional hazards regression.

RESULTS

We identified 10,541 participants with incident cancer and 3,696 deaths during follow-up. Compared to maintaining inactivity in both periods, remaining active pre- and post-diagnosis observed lower all-cause (Hazard Ratio [95% confidence interval]: WHS: 0.55 [0.47-0.64]; PHS-I: 0.77 [0.67-0.88]), cancer (WHS: 0.55 [0.45-0.67]; PHS-I: 0.75; [0.61-0.92]) and non-cancer/cardiovascular disease (CVD) mortality risks (WHS: 0.49 [0.38-0.65]). Similarly, becoming active post-diagnosis was associated with lower all-cause (WHS: 0.60 (0.48-0.75]; PHS-I: 0.72 [0.61-0.88]), cancer (WHS: 0.65 [0.49-0.86]; PHS-I: 0.64 [0.49-0.84]), and non-cancer/CVD mortality risk (WHS: 0.49 [0.33-0.75]). Being active pre- and post-diagnosis was associated with lower mortality risks in separate analyses, although significance differed by cohort and outcome.

CONCLUSIONS

Remaining active pre- and post-diagnosis and becoming active post-diagnosis may be associated with improvements in cancer survival, however, research is needed across diverse cancer populations.

Exercise in cancer care for people with lung cancer: A narrative synthesis

OBJECTIVES

Lung cancer is the second most common cancer diagnosed worldwide, resulting in significant physical and psychological consequences. In this narrative review, we explore the role of exercise as an adjunct therapy to counteract health issues experienced by people before, during and after treatment for lung cancer, and offer recommendations for exercise prescription and future research.

DESIGN

Narrative cornerstone review.

METHODS

A narrative review was conducted to explore the role of exercise in cancer care for people diagnosed with lung cancer.

RESULTS

Improvements in fitness, strength and quality of life have been demonstrated in people with lung cancer following participation in exercise programmes before, during and post treatment. Whilst combined aerobic (50-100 % heart rate maximum) and resistance (50-85 % of 1 repetition maximum) training, 2-5 times per week across the cancer continuum is typically prescribed, few people with lung cancer currently access exercise services. 'Optimal' exercise prescription is unclear, although is likely individual-specific. The immediate priority is to identify a tolerable starting exercise dosage, with the side effects of lung cancer and its treatment on the respiratory system, particularly shortness of breath (dyspnoea), likely driving the initial maximum threshold for session mode, duration and intensity. To date, exercise safety for people with lung cancer has been poorly evaluated and reported - few trials report it, but those that do report small numbers of serious adverse events.

CONCLUSIONS

Recommendations for health professionals prescribing exercise therapy to people with lung cancer are provided, with consideration of the strengths and limitations of the current evidence base.

Adapted physical activity programs for the prevention and treatment of musculoskeletal pain induced by aromatase inhibitors in non-metastatic breast cancer patient: A scoping review

BACKGROUND

Aromatase inhibitor is associated with a high incidence of Aromatase Inhibitor-Associated Musculoskeletal Syndrome (AIMSS) in postmenopausal women with hormone-sensitive breast cancer.

OBJECTIVE

This scoping review aims to identify available information regarding the frameworks, models, or strategies of adapted physical activity (APA) programs implemented for the prevention and management of AIMSS.

METHODS

Search was realized by two independent reviewers in six databases following PRISMA-ScR guidelines. Data of included articles were extracted, and risk of bias analyzed.

RESULTS

Finally, 14 were included. No study has examined APA in the prevention of AIMSS. There is no solid evidence supporting the impact of APA on the management of AIMSS. However, evidence suggests that an APA program can reduce the worst joint pain and improve the quality of life.

CONCLUSION

Future research will enlighten clinical practices with the development of personalized APA programs in hormone-sensitive breast cancer.

Combined lifestyle factors on mortality and cardiovascular disease among cancer survivors: a systematic review and meta-analysis of cohort studies

PURPOSE

Lifestyle factors in cancer survivors are frequently studied individually even though they are often interconnected. This systematic review and meta-analysis investigated the association of combined lifestyle factors on health outcomes among cancer survivors.

METHODS

EMBASE, PubMed and Web of Science were searched up to March 2024. Cohort studies examining the associations of at least three combined lifestyle factors with mortality (all-cause/cancer-specific) and cardiovascular disease (CVD) among cancer survivors, were selected. Pooled hazard ratios (pHRs) and 95% confidence intervals (CIs) were estimated using random effects models. Tests for heterogeneity and publication bias were conducted.

RESULTS

Twenty-two studies involving 209,659 survivors with an average follow-up duration ranging from 4.1 to 29.1 years were included. pHRs(95%CI) comparing cancer survivors with the healthiest lifestyles versus those with the least healthy lifestyles were 0.57 (0.51-0.65) for all-cause mortality, 0.70 (0.61-0.80) for cancer-specific mortality, and 0.53 (0.46-0.63) for CVD incidence. These associations were largely consistent across subgroup analyses. Colorectal cancer survivors with the healthiest lifestyle experienced 37% lower all-cause mortality and 25% lower cancer-specific mortality, while breast cancer survivors had a 45% reduction in all-cause mortality. Although studies were limited, significant associations for all-cause mortality were observed among lung, liver, nasopharyngeal, gastric, kidney, gynecologic cancer survivors. However, no significant relationship between healthy lifestyles and CVD-specific mortality was detected.

CONCLUSIONS

Having an overall healthy lifestyle is associated with lower CVD incidence and better survival among cancer survivors. The long-term management of cancer survivors should consider encouragement for a modification of multiple lifestyles.

The physical activity in cancer survivors (PACES) trial: a factorial randomized trial to optimize intervention for breast cancer survivors

Multiple intervention strategies have been found effective for increasing physical activity among breast cancer survivors, yet most breast cancer survivors fail to meet physical activity recommendations. Optimization of interventions can facilitate real word implementation to ensure effective and efficient intervention delivery. Using a full-factorial design based on the Multiphase Optimization Strategy, 337 breast cancer survivors were randomized to receive a combination of four intervention components: (1) supervised exercise sessions, (2) facility membership, (3) Active Living Every Day (ALED), and (4) Fitbit. Moderate-to vigorous (MVPA) and light-intensity physical activity (LPA) were measured at baseline, 3 months, and 6 months with a hip-worn Actigraph GT3X+. Normal linear mixed models with separate intercepts for each subject were fit in the SAS 9.4 Mixed procedure. Participants who received supervised exercise sessions engaged in more MVPA, 153.58 min/week vs. 133.0 min/week (F = 3.97, p = 0.048) and LPA, 170.26 min/day versus 160.98 light PA minutes/day (F = 4.67, p = 0.032), compared to participants who did not receive supervised exercise. The effects of the three other intervention components on MVPA were not significant; however, those that received ALED engaged in less LPA (F = 6.6, p = 0.011). Supervised exercise sessions resulted in significant increases in MVPA and LPA in a sample of breast cancer survivors. Of note, these sessions were provided only during the first 6 weeks of the intervention and effects remained significant at 6 months. Results of this trial could inform future implementation efforts to ensure effective and efficient delivery of physical activity programs for breast cancer survivors.

Exercise and tumor proteome: insights from a neuroblastoma model

The impact of exercise on pediatric tumor biology is essentially unknown. We explored the effects of regular exercise on tumor proteome profile (as assessed with liquid chromatography with tandem mass spectrometry) in a mouse model of one of the most aggressive childhood malignancies, high-risk neuroblastoma (HR-NB). Tumor samples of 14 male mice (aged 6-8 wk) that were randomly allocated into an exercise (5-wk combined aerobic and resistance training) or nonexercise control group (6 and 8 mice/group, respectively) were analyzed. The Search Tool for the Retrieval of Interacting Genes/Proteins database was used to generate a protein-protein interaction (PPI) network and enrichment analyses. The Systems Biology Triangle (SBT) algorithm was applied for analyses at the functional category level. Tumors of exercised mice showed a higher and lower abundance of 101 and 150 proteins, respectively, than controls [false discovery rate (FDR) < 0.05]. These proteins were enriched in metabolic pathways, amino acid metabolism, regulation of hormone levels, and peroxisome proliferator-activated receptor signaling (FDR < 0.05). The SBT algorithm indicated that 184 and 126 categories showed a lower and higher abundance, respectively, in the tumors of exercised mice (FDR < 0.01). Categories with lower abundance were involved in energy production, whereas those with higher abundance were related to transcription/translation, apoptosis, and tumor suppression. Regular exercise altered the abundance of hundreds of intratumoral proteins and molecular pathways, particularly those involved in energy metabolism, apoptosis, and tumor suppression. These findings provide preliminary evidence of the molecular mechanisms underlying the potential effects of exercise in HR-NB.NEW & NOTEWORTHY We used liquid chromatography with tandem mass spectrometry to explore the impact of a 5-wk exercise intervention on the tumor proteome profile in a mouse model of one of the most aggressive childhood malignancies, high-risk neuroblastoma. Exercise altered the abundance of hundreds of proteins and pathways, particularly those involved in energy metabolism and tumor suppression. These molecular changes could mediate, at least partly, the potential antitumorigenic effects of exercise.

Unraveling the role of exercise in cancer suppression: insights from a mathematical model

Recent experimental studies have shown that physical exercise has the potential to suppress tumor progression. Such suppression has been reported to be mediated by the exercise-induced activation of natural killer (NK) cells through the release of IL-6, a cytokine. Aimed at shedding light on how exercise-induced NK cell activation helps in the suppression of cancer, we developed a coarse-grained mathematical model based on a system of ordinary differential equations describing the interaction between IL-6, NK-cells, and tumor cells. The model is then used to study how exercise duration and exercise intensity affect tumor suppression. Our results show that increasing exercise intensity or increasing exercise duration leads to greater and sustained tumor suppression. Furthermore, multi-bout exercise patterns hold promise for improving cancer treatment strategies by adjusting exercise intensity and frequency. Thus, the proposed mathematical model provides insights into the role of exercise in tumor suppression and can be instrumental in guiding future experimental studies, potentially leading to more effective exercise interventions.

Self protective health care in childhood cancer survivors from the perspective of survivors, parents, and professionals: a qualitative study

INTRODUCTION

Childhood cancer survivors experience many health problems that they must protect themselves from their destructive physical and psychological effects. Understanding experiences of children about self-protective care will help health care providers manage long-term care plans. Therefore, this study was conducted with the aim of exploring self-protection care in childhood cancer survivors.

METHODS

This is a phenomenological study that was conducted in the clinics and cancer care centers of Urmia and Khoy in Iran. 27 participants were selected by purposive sampling until data saturation. The data was collected using a semi-structured and in-depth face to face interview. Content analysis approach used for data analysis and MAXQUDA 10 software used for data management.

RESULTS

Data analysis led to the emergence of "self-protection health care" as a main category, two categories "maintaining physical health" and "keeping a strong mindset" and 9 sub-categories including "abstain activities that may cause harm", "refusing contact with others for possible infection", "monitoring symptoms and side-effects of cancer coming back", "avoiding unhealthy diet", "knowing about cancer from similar others", "keep away negative thoughts and emotions", "drawing on spiritual resources", "creating a bridge to life again" and "being healthy for the sake of one's family".

CONCLUSION

According to the results of this study, self-protection is one of the most important cares for childhood cancer survivors. Over time, the influence of the clinical team and parents on children's health care diminishes. Therefore, they should promote their health and well-being behaviors and use a variety of protective approaches to self-care.

Breast cancer and its determinants in Ethiopia: a systematic review and meta-analysis

OBJECTIVES

Breast cancer is the leading cause of cancer morbidity and mortality among women. Still, there is a paucity of studies to know the magnitude of the problem in Ethiopia. Hence, this review was intended to pool the prevalence and identify the determinants of breast cancer in Ethiopia.

DESIGN

A systematic review and meta-analysis was conducted.

DATA SOURCES

Databases like PubMed/MEDLINE, HINARI, Science Direct, and Google Scholar, as well as websites of organisationsI organizations,rewere searched between 25 February and 6 March 2023.

ELIGIBILITY CRITERIA

All observational studies in Ethiopia that reported either the magnitude and/or determinants of breast cancer regardless of publication status were included.

DATA EXTRACTION AND SYNTHESIS

Two authors independently assessed and extracted the data. The Joanna Briggs Institute meta-analysis of statistics assessment and review instrument quality appraisal tool was used to assess the quality of the articles. Effect estimates were done by using the random-effects model. The meta-analysis results were displayed by using forest plots.

RESULTS

Seventeen articles were reviewed with 24 435 total participants. The pooled proportion of breast cancer morbidity among patients with cancer was 20. 58% (95% CI 17.25%, 23.90%) in Ethiopia. Consuming packed foods (POR=2.12, 95% CI 1.41, 3.17), presence of high cholesterol (POR=4.08; 95% CI 2.75, 6.07), physical inactivity (POR=3.27; 95% CI 1.80, 5.94), high body mass index (BMI) (POR=2.27; 95% CI 0.85, 6.03), postmenopause (POR=2.25; 95% CI 1.63, 3.10), family history of cancer (POR=3.65; 95% CI 0.85, 15.71) and lack of breastfeeding (POR=2.76; 95% CI 0.90, 7.92) were the determinants of breast cancer.

CONCLUSIONS

One of five patients with cancer is diagnosed with breast cancer in Ethiopia. Furthermore, more than a quarter of women with cancer suffer from breast cancer. Processed food consumption, high cholesterol in the body, lack of physical activity, high BMI, postmenopause, family history of cancer and lack of breastfeeding were the risk factors for breast cancer. The use of healthy food sources such as fruits and vegetables, and homegrown varieties of crops rather than seeking processed foods would help.

PROSPERO REGISTRATION NUMBER

CRD42023417733.

[Physical medicine for coincidence of cancer and inflammatory rheumatic disease : What speaks in favour and what to consider?]

The coincidence of an inflammatory rheumatic and a malignant disease causes a physical, cognitive and psychological reduction in performance. The prescription of physical therapy is therefore essential to address safety issues associated with both diseases, as well as side effects associated with antirheumatic and antineoplastic therapy that can impact the treatment. It is important to perform a risk assessment prior to physical therapy to identify potential safety issues and to determine baseline physical and functional status. In this review article descriptive information and the current literature on the safety of physical therapy interventions for people with rheumatic and malignant disease are highlighted, taking the disease process, treatment side effects and associated precautions and contraindications into account.

Association between leisure-time physical activity and incident cancer risk: a nationwide population-based cohort study

BACKGROUND

The effects of physical activity on the development of different types of cancers have not been comprehensively studied. This nationwide, population-based cohort study investigated the effects of leisure-time physical activity (LTPA) on the development of different types of cancer in Taiwanese adults. A total of 67,890 adult participants (≥ 18 y old) from five rounds (2001, 2005, 2009, 2013, and 2017) of the Taiwan National Health Interview Survey were included. LTPA was measured as the metabolic equivalent of task (MET) expenditure per week and was classified as inactive (< 1 MET-h), low (1-7.49 MET-h), or high (≥ 7.5 MET-h). The LTPA and other covariates were collected through in-person interviews at baseline. New-onset cancer was ascertained from histopathological reports. The Fine-Gray sub-distribution method, with death as a competing risk, was used to determine the impact of LTPA on incident cancer risk.

RESULTS

During the 844,337 person-years of follow-up, 4,435 individuals developed cancer. Compared to inactive adults, individuals engaging in high levels of LTPA (≥ 7.5 MET-h/week) were significantly associated with a reduced risk of developing cancer (adjusted hazard ratio [aHR] = 0.93; 95% confidence interval [CI] = 0.87-0.99). However, those with low levels of LTPA (1-7.49 MET-h/week) did not exhibit a significant association with a reduced risk of developing cancer (aHR = 1.00; 95% CI = 0.92-1.10). When considering specific types of cancers, participants with high levels of LTPA (≥ 7.5 MET-h/week) had a significantly lower risk of developing bladder cancer (aHR = 0.68; 95% CI = 0.47-0.99), cervical cancer (aHR = 0.48; 95% CI = 0.24-0.95), and thyroid cancer (aHR = 0.64; 95% CI = 0.44-0.93).

CONCLUSIONS

Our findings suggest that high LTPA (≥ 7.5 MET-h/week) is significantly associated with a low risk of incident bladder, cervical, and thyroid cancers.

Association Between Physical Activity and Pancreatic Cancer Risk and Mortality: A Systematic Review and Meta-Analysis

Background: Physical activity has been associated with a lower risk of various types of cancer and reduced cancer-specific mortality. Less is known about its impact on pancreatic cancer. The aim of this systematic review and meta-analysis was to summarize evidence on the association between physical activity and pancreatic cancer risk and mortality. Methods: PubMed and Embase were searched until May 2024 for studies examining physical activity in relation to pancreatic cancer incidence and mortality. Summary risk estimates for highest vs. lowest physical activity levels were calculated using a random-effects model. The risk of publication bias was assessed with a funnel plot and Egger's regression test. Results: A total of seven case-control and eighteen prospective cohort studies were included that investigated the association between physical activity and pancreatic cancer incidence. Our meta-analysis showed a summary estimate of 0.75 (95% CI 0.64-0.88) for case-control studies (I2 = 23%, n = 7) and a summary estimate of 0.91 (95% CI 0.86-0.97) for prospective cohort studies (I2 = 5%, n = 18). Among the six prospective cohort studies that assessed pancreatic cancer mortality, the summary estimate was 1.03 (95% CI 0.83-1.27), I2 = 50%. Conclusions: Higher levels of physical activity were associated with reduced pancreatic cancer risk. Evidence from a limited number of studies suggests that pre-diagnosis physical activity does not affect pancreatic cancer mortality.

Associations of Wearable Activity Tracker Use With Physical Activity and Health Outcomes in Patients With Cancer: Findings from a Population-Based Survey Study

BACKGROUND

Physical inactivity is a global issue for cancer survivors. Wearable activity trackers are promising to address physical inactivity by providing real-time feedback on physical activity and offering opportunities for self-monitoring and goal setting. Meta-analysis has reported the effects of interventions that incorporate wearable activity trackers on improved physical inactivity and related health outcomes (eg, BMI, anxiety and depression, and self-rated health status). However, wearable activity trackers were often used as an adjunct to physical activity interventions, and the effectiveness of wearable activity trackers alone is unknown.

OBJECTIVE

This study aims to determine the association of wearable activity trackers with physical activity and health outcomes in patients with cancer.

METHODS

Data from 957 cancer survivors from the Health Information National Trends Survey-Surveillance, Epidemiology, and End Results (HINTS-SEER) were analyzed. The outcome variables examined were time spent in moderate to vigorous physical activity, weekly frequency of strength training, BMI, anxiety and depression levels, and self-assessed health status. The primary independent variable was whether cancer survivors had used wearable activity trackers within the past 12 months. Design-based linear regression for continuous outcome variables and ordinal logistic regression for ordinal outcome variables were conducted to determine the associations after controlling for sociodemographic, cancer-related, and health-related factors. All data analyses accounted for the complex survey design and sample weights.

RESULTS

Only 29% of cancer survivors reported wearable activity tracker use. Bivariate analyses showed that younger age (P<.001), higher education (P=.04), higher income (P<.001), and an employed status (P<.001) were significantly associated with wearable activity tracker use. Wearable activity tracker use was significantly associated with higher time spent in moderate to vigorous physical activity (adjusted =37.94, 95% CI 8.38-67.5; P=.01), more frequent strength training per week (adjusted odds ratio [OR] 1.50, 95% CI 1.09-2.06; P=.01), and better self-rated health status (adjusted OR 1.58, 95% CI 1.09-2.29; P=.01), but not with BMI or anxiety and depression.

CONCLUSIONS

This study suggests that the uptake of wearable activity trackers is low and highlights the digital divide among patients with cancer. This study has confirmed the associations of wearable activity tracker use with physical activity and self-rated health, supporting using wearable activity trackers as a promising tool to facilitate physical activity promotion.

Physical activity levels are positively related to progression-free survival and reduced adverse events in advanced ER+ breast cancer

BACKGROUND

Increased levels of physical activity are associated with a reduction of breast cancer mortality, especially in postmenopausal women with positive hormone receptor status. So far, previous observational case-control and cohort studies have focused on associations between overall leisure time physical activity and survival of women with breast cancer in general.

METHODS

In this multicenter prospective cohort study, conducted in Germany between 30th August 2012 to 29th December 2017, we investigated general physical activity in a homogenous sample of n = 1440 postmenopausal women with advanced (inoperable locally advanced or metastatic), hormone receptor-positive breast cancer receiving the same therapy (everolimus and exemestane). Self-reported physical activity was assessed using the Godin Leisure Time Exercise Questionnaire (GLTEQ) before and every 3 months during treatment. Participants were then classified into "active" and "insufficiently active" to screen their activity behavior the week prior to medical treatment. In addition, changes in physical activity patterns were assessed. Adjusted Cox regression analyses were performed for the activity categories to determine hazard ratios (HR). Besides progression-free survival (PFS), adverse events (AEs), QoL, and fatigue were assessed every 3 months until study termination.

RESULTS

Compared to "insufficiently active" patients, "active" individuals indicated a significantly longer PFS (HR: 0.84 [0.74; 0.984], p = .0295). No significant differences were observed for changes of physical activity behavior. Patients who reported to be "active" at baseline revealed significantly fewer AEs compared to "insufficiently" active patients. In detail, both severe and non-severe AEs occurred less frequently in the "active" patients group. In line with that, QoL and fatigue were better in physical "active" patients compared to their insufficient active counterparts at the last post-baseline assessment. Participants who remained or become active indicated less AEs, a higher QoL, and reduced fatigue levels.

CONCLUSIONS

Physical activity behavior prior to medical treatment might have prognostic value in patients with advanced breast cancer in terms of extending the PFS. Moreover, physical activity before and during treatment may reduce treatment-related side effects and improve patients' QoL and fatigue.

TRIAL REGISTRATION

EUPAS9462. Registered 30th October 2012 "retrospectively registered."

Effects of short- and long-term exercise training on cancer cells in vitro: Insights into the mechanistic associations

Exercise is a therapeutic approach in cancer treatment, providing several benefits. Moreover, exercise is associated with a reduced risk for developing a range of cancers and for their recurrence, as well as with improving survival, even though the underlying mechanisms remain unclear. Preclinical and clinical evidence shows that the acute effects of a single exercise session can suppress the growth of various cancer cell lines in vitro. This suppression is potentially due to altered concentrations of hormones (e.g., insulin) and cytokines (e.g., tumor necrosis factor alpha and interleukin 6) after exercise. These factors, known to be involved in tumorigenesis, may explain why exercise is associated with reduced cancer incidence, recurrence, and mortality. However, the effects of short- (<8 weeks) and long-term (≥8 weeks) exercise programs on cancer cells have been reported with mixed results. Although more research is needed, it appears that interventions incorporating both exercise and diet seem to have greater inhibitory effects on cancer cell growth in both apparently healthy subjects as well as in cancer patients. Although speculative, these suppressive effects on cancer cells may be driven by changes in body weight and composition as well as by a reduction in low-grade inflammation often associated with sedentary behavior, low muscle mass, and excess fat mass in cancer patients. Taken together, such interventions could alter the systemic levels of suppressive circulating factors, leading to a less favorable environment for tumorigenesis. While regular exercise and a healthy diet may establish a more cancer-suppressive environment, each acute bout of exercise provides a further "dose" of anticancer medicine. Therefore, integrating regular exercise could potentially play a significant role in cancer management, highlighting the need for future investigations in this promising area of research.

Combined influence of physical activity and C-reactive protein to albumin ratio on mortality among older cancer survivors in the United States: a prospective cohort study

BACKGROUND

Although a high C-reactive protein-to-albumin ratio (CAR) is believed to increase mortality risk, the association between the physical activity (PA), CAR, and mortality among cancer survivors has not been investigated. This study aimed to examine this association among cancer survivors in the United States.

METHODS

This cohort study used data from the National Health and Nutrition Examination Survey from 1999 to 2010. PA was self-reported using the Global Physical Activity Questionnaire, and C-reactive protein and albumin levels were obtained from laboratory data files. Mortality data were obtained by linkage of the cohort database to the National Death Index as of December 31, 2019. The analysis was conducted from November 1 to December 31, 2023. We used Cox proportional hazards multivariable regression to assess hazard ratios (HRs) and 95% confidence interval (CIs) for total and cancer-specific mortality risks attributable to PA and CAR.

RESULTS

Among 2,232 cancer survivors, 325 (14.6%) reported no PA with a high CAR. During a follow-up of up to 20.75 years (median, 12.3 years; 27,453 person-years), 1,174 deaths occurred (cancer, 335; other, 839). A high CAR was observed to be consistently associated with the highest risks of total (HR, 1.59; 95% CI, 1.37-1.85) and cancer-specific (HR, 2.06; 95% CI, 1.55-2.73) mortality compared with a low CAR in a series of adjusted models. Multivariable models showed that PA was associated with a lower risk of all-cause (HR, 0.60; 95% CI, 0.52-0.69) and cancer-specific (HR, 0.64; 95% CI, 0.49-0.84) mortality compared with no PA. In the joint analyses, survivors with PA ≥ 600 metabolic equivalent min/wk and a low CAR were more likely to reduce the risk of total (HR, 0.41; 95% CI, 0.32-0.51) and cancer-specific (HR, 0.32; 95% CI, 0.20-0.50) mortality by 59% and 68% compared with those with no PA and a high CAR.

CONCLUSION

The pairing of adequate PA and a low CAR was significantly associated with reduced all-cause and cancer-related mortality risks.

An integrated framework for the study of exercise across the postdiagnosis cancer continuum

Exercise plays many important roles across the entire cancer continuum that have been described in previous frameworks. These frameworks, however, have generally provided a simplified description of the roles of exercise postdiagnosis. The modern cancer treatment landscape has become complex and often consists of multiple lines of multimodal treatments combined concurrently and/or sequentially and delivered over many months or years. This complexity requires a more multifaceted and targeted approach to the study of exercise after a cancer diagnosis. Here, we propose a new integrated framework-Exercise Across the Postdiagnosis Cancer Continuum (EPiCC)-that highlights the distinct roles of exercise for disease treatment and supportive care from diagnosis until death. We also propose new terminology to clarify the distinct roles of exercise that emerge in the context of the modern cancer treatment landscape. The EPiCC Framework is structured around multiple sequential cancer treatments that highlight six distinct cancer treatment-related time periods for exercise-before treatments, during treatments, between treatments, immediately after successful treatments, during longer term survivorship after successful treatments, and during end of life after unsuccessful treatments. The EPiCC Framework proposes that the specific roles of exercise as a disease treatment and supportive care intervention will vary depending on its positioning within different cancer treatment combinations. As a cancer treatment, exercise may serve as a "priming therapy", primary therapy, neoadjuvant therapy, induction therapy, "bridging therapy", adjuvant therapy, consolidation therapy, maintenance therapy, and/or salvage therapy. As a supportive care intervention, exercise may serve as prehabilitation, intrahabilitation, interhabilitation, rehabilitation, "perihabilitation", health promotion/disease prevention, and/or palliation. To date, exercise has been studied during all of the cancer treatment-related time periods but only in relation to some cancer treatments and combinations. Moreover, fewer studies have examined exercise across multiple cancer treatment-related time periods within any cancer treatment combination. Future research is needed to study exercise as a disease treatment and supportive care intervention within and across the distinct cancer treatment-related time periods contained within different cancer treatment combinations. The aim of the EPiCC Framework is to stimulate a more targeted, integrated, and clinically-informed approach to the study of exercise after a cancer diagnosis.

Impact of the Promoting Physical Activity in Regional and Remote Cancer Survivors intervention on health-related quality of life in breast and colorectal cancer survivors

Background

The PPARCS trial examined the efficacy of a distance-based wearable and health coaching intervention to increase physical activity (PA) in breast and colorectal cancer (CRC) survivors living in non-metropolitan areas. This paper examines the effects of the intervention on health-related quality of life (HRQoL) at 12 weeks (T2; end of intervention) and 24 weeks (T3; follow-up).

Methods

Participants that were insufficiently physically active and had successfully completed cancer treatment were randomised to an intervention or control group. PA was assessed using an ActiGraph (GT9X) at baseline, T2, and T3. Intervention effects on HRQoL were analysed using quantile regression comparing treatment groups across time.

Results

A total of 87 were randomised to intervention and control groups. There were generally no statistically significant differences between the groups on any HRQoL item except for pain. There was an arm (F(1, 219) = 5.0. p = 0.027) and time (F(2,221) = 4.8, p = 0.009) effect, reflecting the higher pain scores in the control group when collapsed across time points (median difference 16.7, CI 1.9 to 31.4, p = 0.027). For global HRQoL, the intervention group increased by 8.3 points between T1 and T2. The overall group median when collapsed across time was 16.7 points CI 8.2 to 25.2, p <0.001) greater in the intervention group than controls.

Conclusions

While the PPARCS intervention resulted in significant increases in PA, participants indicated a high HRQoL at baseline, leaving little room for improvement. Findings suggest that PA may improve global HRQoL and pain in breast and CRC survivors.

Physical activity and prognosis and factors associated with low physical activity in patients with advanced or recurrent lung cancer: a retrospective, observational study

OBJECTIVES

To investigate the relationship between physical activity and prognosis, and the significant factors associated with physical activity in patients with advanced or recurrent lung cancer.

METHODS

This retrospective, observational study enrolled 50 outpatients with lung cancer who received chemotherapy. Patients were evaluated for physical function, physical activity (International Physical Activity Questionnaire-Short Form), and nutritional status (Mini Nutritional Assessment-Short Form [MNA-SF]). The relationship between physical activity and prognosis was examined using the log-rank test and Cox proportional hazards model. Multivariate logistic regression analysis was performed to examine factors associated with low physical activity. A receiver operating characteristic curve was used to calculate the MNA-SF cut-off value for low physical activity.

RESULTS

Low physical activity was significantly associated with survival (HR, 4.35; 95% confidence interval [CI], 1.16-16.27; p=0.029). The MNA-SF was a significant factor associated with low physical activity (OR, 0.71; 95% CI, 0.52 to 0.98; p=0.038). The MNA-SF cut-off value for low physical activity was 9.5 points.

CONCLUSIONS

Low physical activity may be a prognostic factor in lung cancer, with nutritional status associated with low physical activity. Regular assessments using the MNA-SF cut-off and physical activity interventions considering nutrition are needed in clinical practice.

Dose/Exposure Relationship of Exercise and Distant Recurrence in Primary Breast Cancer

PURPOSE

Postdiagnosis exercise is associated with lower breast cancer (BC) mortality but its link with risk of recurrence is less clear. We investigated the impact and dose-response relationship of exercise and recurrence in patients with primary BC.

METHODS

Multicenter prospective cohort analysis among 10,359 patients with primary BC from 26 centers in France between 2012 and 2018 enrolled in the CANcer TOxicities study, with follow-up through October 2021. Exercise exposure was assessed using the Global Physical Activity Questionnaire-16, quantified in standardized metabolic equivalent of task-hours per week (MET-h/wk). We examined the dose/exposure response of pretreatment exercise on distant recurrence-free interval (DRFI) for all patients and stratified by clinical subtype and menopausal status using inverse probability treatment weighted multivariable Cox models to estimate hazard ratios (HRs).

RESULTS

For the overall cohort, the relationship between exercise and DRFI was nonlinear: increasing exercise ≥ 5 MET-h/wk was associated with an inverse linear reduction in DRFI events up to approximately 25 MET-h/wk; increasing exercise over this threshold did not provide any additional DRFI benefit. Compared with <5 MET-h/wk, the adjusted HR for DRFI was 0.82 (95% CI, 0.61 to 1.00) for ≥ 5 MET-h/wk. Stratification by subtype revealed the hormone receptor-/human epidermal growth factor receptor 2- (HR-/HER2-; HR, 0.59 [95% CI, 0.38 to 0.92]) and HR-/HER2+ (HR, 0.37 [95% CI, 0.14 to 0.96]) subtypes were preferentially responsive to exercise. The benefit of exercise was observed especially in the premenopausal population.

CONCLUSION

Postdiagnosis/pretreatment exercise is associated with lower risk of DRFI events in a nonlinear fashion in primary BC; exercise has different impact on DRFI as a function of subtype and menopausal status.

Cardiovascular disease and cancer: shared risk factors and mechanisms

Cardiovascular disease (CVD) and cancer are among the leading causes of morbidity and mortality globally, and these conditions are increasingly recognized to be fundamentally interconnected. In this Review, we present the current epidemiological data for each of the modifiable risk factors shared by the two diseases, including hypertension, hyperlipidaemia, diabetes mellitus, obesity, smoking, diet, physical activity and the social determinants of health. We then review the epidemiological data demonstrating the increased risk of CVD in patients with cancer, as well as the increased risk of cancer in patients with CVD. We also discuss the shared mechanisms implicated in the development of these conditions, highlighting their inherent bidirectional relationship. We conclude with a perspective on future research directions for the field of cardio-oncology to advance the care of patients with CVD and cancer.

Hormone replacement therapy and cancer mortality in women with 17 site-specific cancers: a cohort study using linked medical records

BACKGROUND

There is limited evidence on the safety of Hormone Replacement Therapy (HRT) in women with cancer. Therefore, we systematically examined HRT use and cancer-specific mortality in women with 17 site-specific cancers.

METHODS

Women newly diagnosed with 17 site-specific cancers from 1998 to 2019, were identified from general practitioner (GP) records, hospital diagnoses or cancer registries in Scotland, Wales and England. Breast cancer patients were excluded because HRT is contraindicated in breast cancer patients. The primary outcome was time to cancer-specific mortality. Time-dependent Cox regression models were used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (95% CIs) for cancer-specific mortality by systemic HRT use.

RESULTS

The combined cancer cohorts contained 182,589 women across 17 cancer sites. Overall 7% of patients used systemic HRT after their cancer diagnosis. There was no evidence that HRT users, compared with non-users, had higher cancer-specific mortality at any cancer site. In particular, no increase was observed in common cancers including lung (adjusted HR = 0.98 95% CI 0.90, 1.07), colorectal (adjusted HR = 0.79 95% CI 0.70, 0.90), and melanoma (adjusted HR = 0.77 95% CI 0.58, 1.02).

CONCLUSIONS

We observed no evidence of increased cancer-specific mortality in women with a range of cancers (excluding breast) receiving HRT.

Cancer and Heart Failure: Dangerous Liaisons

Cancer and heart failure (HF) are increasingly relevant worldwide, both from an epidemiologic and clinical point of view. This review aims to explore the relationship between cancer and HF by underscoring risk factors and disclosing the cardiotoxic effects of the current chemotherapy agents. We also deal with the current evidence on the diagnosis and management of HF related to cancer therapy. Finally, we will address the main gaps in knowledge and future perspectives in this field.