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Martínez-Vizcaíno V, Cavero-Redondo I, Reina-Gutiérrez S, Gracia-Marco L, Gil-Cosano JJ, Bizzozero-Peroni B, Rodriguez-Artalejo F, Ubago-Guisado E. Comparative effects of different types of exercise on health-related quality of life during and after active cancer treatment: A systematic review and network meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:726-738. [PMID: 36736726 PMCID: PMC10658325 DOI: 10.1016/j.jshs.2023.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/22/2022] [Accepted: 11/28/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND The positive influence of most types of exercise has been reported repeatedly, but what the most effective exercise approaches are for improving health-related quality of life (HRQoL) in people with cancer remains unknown. The aim of this systematic review and network meta-analysis was to synthesize the evidence from intervention studies to assess the effects of different types of exercise on HRQoL during and after cancer treatment. METHODS MEDLINE, SPORTDiscus, the Cochrane Library, Web of Science, and Scopus were searched for randomized controlled trials aimed at testing the effects of exercise interventions meant to improve HRQoL in people with cancer. Separate analyses were conducted for HRQoL as measured by general and cancer-specific questionnaires. We also evaluated whether the effects of exercise were different during and after cancer treatment in both the physical and mental HRQoL domains. RESULTS In total, 93 studies involving 7435 people with cancer were included. Network effect size estimates comparing exercise intervention vs. usual care were significant for combined exercise (0.35, 95% confidence interval (95%CI): 0.14-0.56) for HRQoL as measured by general questionnaires, and for combined (0.31, 95%CI: 0.13-0.48), mind-body exercise (0.54, 95%CI: 0.18-0.89), and walking (0.39, 95%CI: 0.04-0.74) for HRQoL as measured by cancer-specific questionnaires. CONCLUSION Exercise programs combining aerobic and resistance training can be recommended to improve HRQoL during and after cancer treatment. The scarcity and heterogeneity of these studies prevents us from making recommendations about other exercise modalities due to insufficient evidence.
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Affiliation(s)
- Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca 16071, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca 3460000, Chile
| | - Iván Cavero-Redondo
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca 3460000, Chile.
| | - Sara Reina-Gutiérrez
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca 16071, Spain
| | - Luis Gracia-Marco
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18012, Spain
| | - José J Gil-Cosano
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18012, Spain
| | - Bruno Bizzozero-Peroni
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca 16071, Spain; Higher Institute for Physical Education, Universidad de la República, Rivera 40000, Uruguay
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid 28029, Spain; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid 28029, Spain; Epidemiology and Control of Chronic Diseases, CIBER of Epidemiology and Public Health (CIBERESP), Madrid 28029, Spain
| | - Esther Ubago-Guisado
- Epidemiology and Control of Chronic Diseases, CIBER of Epidemiology and Public Health (CIBERESP), Madrid 28029, Spain; Cancer Registry of Granada, Escuela Andaluza de Salud Pública, Granada 18011, Spain; Cancer Epidemiology Group, Instituto de Investigación Biosanitaria, Granada 18012, Spain
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McCloy K, Hughes C, Dunwoody L, Marley J, Cleland I, Cruciani F, Saunders C, Gracey J. Evaluating the effectiveness of mindfulness alone compared to exercise and mindfulness on fatigue in women with gynaecology cancer (GEMS): Protocol for a randomised feasibility trial. PLoS One 2023; 18:e0278252. [PMID: 37883461 PMCID: PMC10602305 DOI: 10.1371/journal.pone.0278252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 05/30/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND In 2020 Globocan reported nearly 1.4 million new cases of gynaecology cancer worldwide. Cancer related fatigue has been identified as a symptom that can be present for gynaecology cancer patients many years after treatment. The current evidence around the management of this symptom suggests that exercise has the most positive outcome. However, some ambiguity remains around the evidence and whether it can address all areas of fatigue effectively. More recently, other interventions such as mindfulness have begun to show a favourable response to the management of symptoms for cancer patients. To date there has been little research that explores the feasibility of using both these interventions together in a gynaecology cancer population. This study aims to explore the feasibility of delivering an intervention that involves mindfulness and mindfulness and exercise and will explore the effect of this on fatigue, sleep, mood and quality of life. METHODS/DESIGN This randomised control trial will assess the interventions outcomes using a pre and post design and will also include a qualitative process evaluation. Participants will be randomised into one of 2 groups. One group will undertake mindfulness only and the other group will complete exercise and mindfulness. Both groups will use a mobile application to complete these interventions over 8 weeks. The mobile app will be tailored to reflect the group the participants have drawn during randomisation. Self-reported questionnaire data will be assessed at baseline prior to commencing intervention and at post intervention. Feasibility will be assessed through recruitment, adherence, retention and attrition. Acceptability and participant perspective of participation (process evaluation), will be explored using focus groups. DISCUSSION This trial will hope to evidence and demonstrate that combination of two interventions such as mindfulness and exercise will further improve outcomes of fatigue and wellbeing in gynaecology cancer. The results of this study will be used to assess (i) the feasibility to deliver this type of intervention to this population of cancer patients using a digital platform; (ii) assist this group of women diagnosed with cancer to manage fatigue and other symptoms of sleep, mood and impact their quality of life. TRIAL REGISTRATION NCT05561413.
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Affiliation(s)
- Kairen McCloy
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, United Kingdom
| | - Ciara Hughes
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, United Kingdom
| | - Lynn Dunwoody
- Psychology Research Institute, Ulster University, Coleraine, United Kingdom
| | - Joanne Marley
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, United Kingdom
| | - Ian Cleland
- School of Computing, Ulster University, Newtownabbey, United Kingdom
| | - Federico Cruciani
- School of Computing, Ulster University, Newtownabbey, United Kingdom
| | | | - Jackie Gracey
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, United Kingdom
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3
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Kuballa L, Kessler CS, Kandil FI, von Scheidt C, Meinköhn M, Koch B, Wischnewsky M, Michalsen A, Jeitler M. Effects of an Integrative Day Care Clinic Program with a Focus on Nature Therapy in a Hospital Park Setting on Quality of Life in Oncological Patients-A Non-Randomized Controlled Study. Cancers (Basel) 2023; 15:4595. [PMID: 37760564 PMCID: PMC10527019 DOI: 10.3390/cancers15184595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Cancer often causes long-term physical and psychological impairments. Lifestyle modification and nature-based interventions (NBIs) can have a positive impact on patients' quality of life (QOL). This participants-blinded, non-randomized controlled study assessed parameters at weeks 0, 12, and 24, including, as a primary endpoint, QOL in cancer patients on the Functional Assessment of Cancer Therapy-General (FACT-G) at week 12. QOL in breast cancer patients, fatigue, well-being, stress, anxiety/depression, socio-psychological well-being, benefits of nature interaction, insomnia, self-efficacy, mindfulness, and self-compassion were assessed as secondary endpoints. N = 107 cancer patients (96.3% women; 52.5 ± 9.3 years, 80.4% breast cancer) were assigned to either a 12-week nature-based (NDC; n = 56) or conventional (DC; n = 51) oncology day care clinic program, whereby the assignment group was not known to the participants. There was no significant group difference for the primary endpoint. At week 24, QOL, fatigue, mindfulness and self-compassion scores were significantly higher, and at weeks 12 and 24, the insomnia score was significantly lower in NDC compared to DC. In conclusion, this study indicates positive and clinically relevant effects of the program on QOL, fatigue, and psychological parameters. NBIs seem to have a more pronounced effect.
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Affiliation(s)
- Lisa Kuballa
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (C.S.K.); (F.I.K.); (M.M.); (A.M.); (M.J.)
| | - Christian S. Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (C.S.K.); (F.I.K.); (M.M.); (A.M.); (M.J.)
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany; (C.v.S.); (B.K.)
| | - Farid I. Kandil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (C.S.K.); (F.I.K.); (M.M.); (A.M.); (M.J.)
| | - Christel von Scheidt
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany; (C.v.S.); (B.K.)
| | - Meline Meinköhn
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (C.S.K.); (F.I.K.); (M.M.); (A.M.); (M.J.)
| | - Barbara Koch
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany; (C.v.S.); (B.K.)
| | - Manfred Wischnewsky
- Department of Mathematics and Computer Science, University Bremen, 28359 Bremen, Germany;
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (C.S.K.); (F.I.K.); (M.M.); (A.M.); (M.J.)
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany; (C.v.S.); (B.K.)
| | - Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (C.S.K.); (F.I.K.); (M.M.); (A.M.); (M.J.)
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany; (C.v.S.); (B.K.)
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4
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Agbejule OA, Hart NH, Ekberg S, Crichton M, Chan RJ. Self-management support for cancer-related fatigue: a systematic review. Int J Nurs Stud 2022; 129:104206. [DOI: 10.1016/j.ijnurstu.2022.104206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/14/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022]
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Schröder ML, Stöckigt B, Binting S, Tissen-Diabaté T, Bangemann N, Goerling U, Kröz M, Blohmer JU, Ortiz M, Brinkhaus B. Feasibility and Possible Effects of Mindful Walking and Moderate Walking in Breast Cancer Survivors: A Randomized Controlled Pilot Study With a Nested Qualitative Study Part. Integr Cancer Ther 2022; 21:15347354211066067. [PMID: 35045736 PMCID: PMC8777370 DOI: 10.1177/15347354211066067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction: Breast cancer (BC) survivors often suffer from disease- and therapy-related
long-term side-effects. The study aim was to explore the feasibility,
adherence, and individual experiences as well as possible effects of 2
different walking interventions in BC patients. Methods: This randomized controlled, pragmatic pilot trial included a qualitative
study component. BC patients were randomized to either mindful walking (MFW)
with mindfulness exercises and walking or moderate walking (MW) alone in
weekly group sessions over 8 weeks. After 8 and 16 weeks, satisfaction, and
self-perceived effectiveness as well as different health-related outcomes
including health-related (WHOQOL-BREF) and disease-specific quality of life
(FACT-G), perceived stress (PSQ) and cancer-related fatigue (CFS-D) were
assessed. ANCOVA was used to evaluate differences in study outcomes.
Qualitative data included 4 focus group interviews including 20 patients and
were analyzed using a directed qualitative content analysis approach. Results: Altogether, 51 women (mean age 55.8 years (SD 10.9)) were randomized (n = 24
MFW; n = 27 MW). Both groups would recommend the course to other BC patients
(MFW 88.9%; MW 95.2%) and showed possible improvements from baseline to week
8, without statistically significant difference between groups: WHOQOL-BREF
(MFW: adjusted mean 65.4 (95% confidence interval (CI), 57.1-73.7); MW: 61.6
(53.6-69.6)); FACT-G (MFW: 76.0 (71.5-80.5); MW: 73.0 (68.5-77.4)); PSQ
(MFW: 45.3 (40.5-50.1); MW: 45.4 (40.8-50.0)); CFS-D (MFW: 24.3 (20.8-27.8);
MW: 25.5 (22.1-28.8)). Improvements lasted until the 16-weeks follow-up. The
qualitative analysis suggested that MFW primarily promoted mindfulness,
self-care, and acceptability in BC patients, whereas MW activated and
empowered the patients as a result of the physical exercise. Conclusion: Both study interventions were positively evaluated by patients and showed
possible pre-post effects in disease-specific health-related outcomes
without differences between groups. The qualitative analysis results
indicate that different resources and coping strategies were addressed by
the 2 study interventions. Trial registration: DKRS00011521; prospectively registered 21.12.2016; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011521.
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Affiliation(s)
| | | | | | | | | | - Ute Goerling
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Kröz
- Research Institute Havelhoehe, Berlin, Germany.,University Witten/Herdecke, Witten, Germany.,Hospital Arlesheim, Switzerland
| | | | - Miriam Ortiz
- Charité - Universitätsmedizin Berlin, Berlin, Germany
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6
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Mikolasek M, Witt CM, Barth J. Effects and Implementation of a Mindfulness and Relaxation App for Patients With Cancer: Mixed Methods Feasibility Study. JMIR Cancer 2021; 7:e16785. [PMID: 33439132 PMCID: PMC7840285 DOI: 10.2196/16785] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 03/13/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022] Open
Abstract
Background Cancer diagnosis and cancer treatment can cause high levels of distress, which is often not sufficiently addressed in standard medical care. Therefore, a variety of supportive nonpharmacological treatments have been suggested to reduce distress in patients with cancer. However, not all patients use these interventions because of limited access or lack of awareness. To overcome these barriers, mobile health may be a promising way to deliver the respective supportive treatments. Objective The aim of this study is to evaluate the effects and implementation of a mindfulness and relaxation app intervention for patients with cancer as well as patients’ adherence to such an intervention. Methods In this observational feasibility study with a mixed methods approach, patients with cancer were recruited through the web and through hospitals in Switzerland. All enrolled patients received access to a mindfulness and relaxation app. Patients completed self-reported outcomes (general health, health-related quality of life, anxiety, depression, distress, mindfulness, and fear of progression) at baseline and at weeks 4, 10, and 20. The frequency of app exercise usage was gathered directly through the app to assess the adherence of patients. In addition, we conducted interviews with 5 health professionals for their thoughts on the implementation of the app intervention in standard medical care. We analyzed patients’ self-reported outcomes using linear mixed models (LMMs) and qualitative data with content analysis. Results A total of 100 patients with cancer (74 female) with a mean age of 53.2 years (SD 11.6) participated in the study, of which 25 patients used the app regularly until week 20. LMM analyses revealed improvements in anxiety (P=.04), distress (P<.001), fatigue (P=.01), sleep disturbance (P=.02), quality of life (P=.03), and mindfulness (P<.001) over the course of 20 weeks. Further LMM analyses revealed a larger improvement in distress (P<.001), a moderate improvement in anxiety (P=.001), and a larger improvement in depression (P=.03) in patients with high levels of symptoms at baseline in the respective domains. The interviews revealed that the health professionals perceived the app as a helpful addition to standard care. They also made suggestions for improvements, which could facilitate the implementation of and adherence to such an app. Conclusions This study indicates that a mindfulness and relaxation app for patients with cancer can be a feasible and effective way to deliver a self-care intervention, especially for highly distressed patients. Future studies should investigate if the appeal of the app can be increased with more content, and the effectiveness of such an intervention needs to be tested in a randomized controlled trial.
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Affiliation(s)
- Michael Mikolasek
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Claudia Margitta Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin, Berlin, Germany.,Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Dennett AM, Sarkies M, Shields N, Peiris CL, Williams C, Taylor NF. Multidisciplinary, exercise-based oncology rehabilitation programs improve patient outcomes but their effects on healthcare service-level outcomes remain uncertain: a systematic review. J Physiother 2021; 67:12-26. [PMID: 33358544 DOI: 10.1016/j.jphys.2020.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 11/15/2020] [Accepted: 12/15/2020] [Indexed: 02/01/2023] Open
Abstract
QUESTION What is the effect of multidisciplinary, exercise-based, group oncology rehabilitation programs on healthcare service outcomes and patient-level outcomes, including quality of life and physical and psychosocial function? DESIGN Systematic review with meta-analysis of randomised controlled trials. PARTICIPANTS Adults diagnosed with cancer. INTERVENTION Multidisciplinary, group-based rehabilitation that includes exercise for cancer survivors. OUTCOME MEASURES Primary outcomes related to health service delivery, including costs, hospitalisations and healthcare service utilisation. Secondary outcomes were patient-level measures, including: the European Organisation for Research and Treatment of Cancer Quality-of-life Questionnaire, 30-second timed sit to stand and the Hospital Anxiety and Depression Scale. The evidence was evaluated using the PEDro Scale and the Grades of Research, Assessment, Development and Evaluation (GRADE) approach. RESULTS Seventeen trials (1,962 participants) were included. There was uncertainty about the effect of multidisciplinary, exercise-based rehabilitation on healthcare service outcomes, as only one trial reported length of stay and reported wide confidence intervals (MD 2.4 days, 95% CI -3.1 to 7.8). Multidisciplinary, exercise-based rehabilitation improved muscle strength (1RM chest press MD 3.6 kg, 95% CI 0.4 to 6.8; 1RM leg press MD 19.5 kg, 95% CI 12.3 to 26.8), functional strength (30-second sit to stand MD 6 repetitions, 95% CI 3 to 9) and reduced depression (MD -0.7 points, 95% CI -1.2 to -0.1) compared to usual care. There was uncertainty whether multidisciplinary rehabilitation programs are more effective when delivered early versus late or more effective than exercise alone. Adherence was typically high (mean weighted average 76% sessions attended) with no major and few minor adverse events reported. CONCLUSION Multidisciplinary, exercise-based oncology rehabilitation programs improve some patient-level outcomes compared with usual care. Further evidence from randomised trials to determine their effect at a healthcare service level are required if these programs are to become part of standard care. TRIAL REGISTRATION PROSPERO CRD42019130593.
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Affiliation(s)
- Amy M Dennett
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia; Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia.
| | - Mitchell Sarkies
- School of Public Health, Curtin University, Perth, Australia; School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Cylie Williams
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia; Department of Allied Health, Peninsula Health, Melbourne, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia; Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia
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8
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Cohen J, Rogers WA, Petruzzello S, Trinh L, Mullen SP. Acute effects of aerobic exercise and relaxation training on fatigue in breast cancer survivors: A feasibility trial. Psychooncology 2020; 30:252-259. [PMID: 33010183 DOI: 10.1002/pon.5561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/10/2020] [Accepted: 09/18/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This three-armed randomized controlled feasibility trial tested the acceptability and acute effects of aerobic exercise and technology-guided mindfulness training (relative to standalone interventions) on cancer-related fatigue among breast cancer survivors (BCS). METHODS BCS recruited from Central Illinois completed pre- and post-testing using established measures and were randomized to one of three groups (combined aerobic exercise with guided-mindfulness relaxation, aerobic exercise only, and relaxation only), conducted in three 90 min sessions over the course of 7 days in a fitness room and research office on a university campus. RESULTS We enrolled 40 BCS (Mage = 57.33 ± 8.75), MBMI = 27.38 ± 5.27, Mfatigue = 4.56 ± 1.81 as measured by the Piper Fatigue Scale. More favorable post-intervention evaluations were reported by the combined group, compared to aerobic exercise or relaxation only (p < 0.05). Reductions in fatigue favoring the combined group (p = 0.05) showed a modest effect size (Cohen's d = 0.91) compared to aerobic exercise only. CONCLUSIONS These findings provide preliminary evidence for the feasibility of combining evidence-based techniques to address fatigue among BCS. The combined approach, incorporating mobile health technology, presents an efficacious and well-received design. If replicated in longer trials, the approach could provide a promising opportunity to deliver broad-reaching interventions for improved outcomes in BCS. Preregistered-ClinicalTrials NCT03702712.
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Affiliation(s)
- Jason Cohen
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Wendy A Rogers
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Steven Petruzzello
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Sean P Mullen
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,Beckman Institute for Advanced Science & Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,Illinois Informatics Institute, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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9
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Abstract
Cancer-related fatigue (CRF) is a common symptom for which cancer patients often use integrative and integrative therapies; however, evidence supporting these therapies is limited. The aim of this review is to provide evidence-based recommendations for integrative interventions during and after cancer treatment for CRF. These recommendations are based on a systematic literature review from 1990 through 2019. Cognitive behavior therapy plus hypnosis and American ginseng can be considered during active treatment, and acupressure, mindfulness-based cognitive therapy, and qigong/tai chi easy can be considered during posttreatment. Coenzyme Q10 and L-carnitine are not recommended during active-treatment. All other integrative therapies for CRF had insufficient evidence to make a recommendation. While there is increasing evidence for integrative therapies for CRF, because of lack of rigorous trials and replication, no therapies could be definitively recommended. Further rigorously designed integrative therapy research is needed and should consider implementation and dissemination.
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10
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Mehl A, Reif M, Zerm R, Pranga D, Friemel D, Berger B, Brinkhaus B, Gutenbrunner C, Büssing A, Kröz M. Impact of a Multimodal and Combination Therapy on Self-Regulation and Internal Coherence in German Breast Cancer Survivors With Chronic Cancer-Related Fatigue: A Mixed-Method Comprehensive Cohort Design Study. Integr Cancer Ther 2020; 19:1534735420935618. [PMID: 32618207 PMCID: PMC7491213 DOI: 10.1177/1534735420935618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Recent studies have proved the relevance of salutogenetic variables for fatigue management in breast cancer survivors with cancer-related fatigue (CRF). This comprehensive cohort design study is the first to examine the impact of 2 multimodal therapies, multimodal therapy (MT) and combined therapy (CT), compared with standard aerobic training (AT) on salutogenetic variables (self-regulation and internal coherence) and distress in breast cancer survivors with CRF. Methods: A total of 105 patients started the therapies and n = 84 completed the Self-regulation Scale, the Internal Coherence Scale, the Cancer Fatigue Scale, and the Hospital Anxiety and Depression Scale at baseline, 10 weeks after treatment (T1) and n = 81 after 6 months (T2). Patient satisfaction and qualitative feedback regarding therapy quality was assessed at T1. A general linear model including allocation type, therapy arm (MT/CT/AT), and bias-adjusting propensity scores tested the superiority of both multimodal therapies versus AT for all questionnaires at T1 and T2. Results: MT and CT were superior to AT to improve self-regulation and patients' satisfaction at T1. Additionally, CT showed superiority for self-regulation at T2 (all P < .05). Compared with AT, internal coherence was significantly higher for patients in the MT arms at T2, respectively (all P < .01). Pearson's correlations between self-regulation, internal coherence, and CRF improved from baseline to T2 (Mean r = -0.60). Qualitative feedback confirmed patients' benefits in several health-related categories. Conclusions: Self-regulation and internal coherence are manipulable variables with relevant CRF associations. They can be positively affected by multimodal therapies. Alongside patients' satisfaction and qualitative feedback they help refine treatment.
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Affiliation(s)
| | - Marcus Reif
- Society for Clinical Research, Berlin, Germany
| | - Roland Zerm
- Research Institute Havelhöhe, Berlin, Germany.,Havelhöhe Hospital, Berlin, Germany
| | | | | | | | | | | | | | - Matthias Kröz
- Research Institute Havelhöhe, Berlin, Germany.,Witten/Herdecke University, Witten, Germany
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Grossert A, Meffert C, Hess V, Rochlitz C, Pless M, Hunziker S, Wössmer B, Geuter U, Meinlschmidt G, Schaefert R. A clinical trial of group-based body psychotherapy to improve bodily disturbances in post-treatment cancer patients in combination with randomized controlled smartphone-triggered bodily interventions (KPTK): study protocol. BMC Psychol 2019; 7:90. [PMID: 31888741 PMCID: PMC6936033 DOI: 10.1186/s40359-019-0357-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/28/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Disturbances in bodily well-being represent one key source of suffering and impairment related to cancer. There is growing evidence that body psychotherapy (BPT) is efficacious for the treatment of various mental disorders. However, with regard to cancer patients, evidence is scarce. The aims of this project are to evaluate whether bodily disturbances in post-treatment cancer patients can be improved by group BPT, and to estimate the efficacy of intermittent smartphone-triggered bodily interventions. METHODS The project is a bi-center study with two participating centers in Switzerland, applying a pre-post convergent parallel design of a weekly group BPT using a waiting-period comparator, including a nested RCT during the group BPT phase. During the BPT phase, either a smartphone-triggered bodily intervention or a smartphone-triggered control intervention is provided at random over 5 consecutive weeks, on 6 days weekly. Patients who had received curatively intended treatment for any malignant neoplasm (treatment being completed ≥3 months) and are suffering from bodily disturbances are screened to assess eligibility. Sample size estimation is based on an a priori power analysis. We plan to include a total of N = 88 subjects, aiming at at least 52 completers. Patients are surveyed three times (baseline assessment (T0), pre- (T1) and post-intervention assessment (T2)), and on a daily basis along BPT during five consecutive weeks. The primary outcome, bodily disturbances, is assessed using the 'Body Image Scale'(BIS). For the secondary outcomes standardized questionnaires are used to assess changes in experience of presence and vitality, mood, body mindfulness, somatic symptoms and somatic symptom disorder, quality of life, anxiety, and depression including suicidal tendency, vitality and mental health, as well as group cohesion. Using semi standardized interviews (at T0 and T2), we aim to explore the relation of BPT with bodily disturbances and body image in post-treatment cancer patients, as well as the acceptance and burden of the intervention. DISCUSSION The proposed study has strong potential benefits for cancer patients, as it may pave the way for new therapeutic approaches to treat bodily disturbances, which persist despite curative tumor therapy. These may considerably improve patients' biopsychosocial well-being and quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT03707548 (registered 9 October 2018; retrospectively registered).
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Affiliation(s)
- Astrid Grossert
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.,Department of Medical Oncology, University Hospital Basel, Basel, Switzerland.,Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
| | - Cornelia Meffert
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Viviane Hess
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Christoph Rochlitz
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Miklos Pless
- Department of Medical Oncology, Winterthur Cantonal Hospital, Winterthur, Switzerland
| | - Sabina Hunziker
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | - Ulfried Geuter
- Institute for Sports and Motology, University of Marburg, Marburg, Germany
| | - Gunther Meinlschmidt
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Berlin, Germany.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Rainer Schaefert
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland. .,Faculty of Medicine, University of Basel, Basel, Switzerland.
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Johannessen B, Syvertsen S, Kersten C, Berntsen S. Cancer-related fatigue: Patients' experiences of an intervention at a green care rehabilitation farm. Complement Ther Clin Pract 2019; 37:133-139. [PMID: 31582199 DOI: 10.1016/j.ctcp.2019.101062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 09/16/2019] [Accepted: 09/26/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Siri Syvertsen
- University of Agder, Faculty of Health and Sport Sciences, Norway
| | - Christian Kersten
- Center for Cancer Treatment, Sorlandet Hospital HF, Kristiansand, Norway
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13
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Lin WF, Zhong MF, Zhou QH, Zhang YR, Wang H, Zhao ZH, Cheng BB, Ling CQ. Efficacy of complementary and integrative medicine on health-related quality of life in cancer patients: a systematic review and meta-analysis. Cancer Manag Res 2019; 11:6663-6680. [PMID: 31413628 PMCID: PMC6661376 DOI: 10.2147/cmar.s195935] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 04/23/2019] [Indexed: 01/11/2023] Open
Abstract
Complementary and integrative medicine (CIM) has been used for improving health-related quality of life (HRQOL) in patients with cancer. The objective of this review is to evaluate the effects of CIMs on the HRQOL of cancer patients. We identified randomized controlled trials (RCTs) involving patients with cancer at any stage by retrieving electronic databases from the inception to February 14, 2018 (Systematic Review Registration: PROSPERO CRD42018091609). The main outcomes were HRQOL scores and related domains such as physical well-being scores. The standardized mean difference was used for the analysis and heterogeneity was assessed with the I 2 statistic. A Bayesian framework was used to estimate the ranking order of efficacy in HRQOL change. Finally, 34 RCTs with 3,010 patients were included. As a whole, the results showed clearly superior efficacy of CIM in improving HRQOL. For different domains of HRQOL, different CIM interventions may play different roles. The ranking order of efficacy in change HRQOL was qigong plus mindfulness, Chinese herbal medicine, multimodal complementary medicine, qigong, nutritional supplement, mindfulness, acupuncture, yoga, and massage, and it was different among different domains. There was no evidence of publication bias. In conclusion, CIM may improve the HRQOL of cancer patients. More studies, especially focusing on male cancer patients, are needed to increase the confidence level of our findings.
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Affiliation(s)
- Wan-Fu Lin
- Department of Traditional Chinese Medicine, Changhai Hospital, Naval Medical University, Shanghai 200433, People's Republic of China
| | - Mao-Feng Zhong
- Graduate School of Shanghai University of Chinese Medicine , Shanghai 201203, People's Republic of China
| | - Qing-Hui Zhou
- Department of Traditional Chinese Medicine, Changhai Hospital, Naval Medical University, Shanghai 200433, People's Republic of China
| | - Yu-Ren Zhang
- Department of Traditional Chinese Medicine, Changhai Hospital, Naval Medical University, Shanghai 200433, People's Republic of China
| | - Huan Wang
- Department of Traditional Chinese Medicine, Changhai Hospital, Naval Medical University, Shanghai 200433, People's Republic of China
| | - Zhi-Hao Zhao
- Department of Traditional Chinese Medicine, Changhai Hospital, Naval Medical University, Shanghai 200433, People's Republic of China
| | - Bin-Bin Cheng
- Department of Traditional Chinese Medicine, Changhai Hospital, Naval Medical University, Shanghai 200433, People's Republic of China
| | - Chang-Quan Ling
- Department of Traditional Chinese Medicine, Changhai Hospital, Naval Medical University, Shanghai 200433, People's Republic of China
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14
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Grossert A, Meinlschmidt G, Schaefert R. A case series report of cancer patients undergoing group body psychotherapy. F1000Res 2018; 6:1646. [PMID: 29067164 PMCID: PMC5635441 DOI: 10.12688/f1000research.12262.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2018] [Indexed: 12/30/2022] Open
Abstract
Background: Disturbances in bodily wellbeing represent a key source of psychosocial suffering and impairment related to cancer. Therefore, interventions to improve bodily wellbeing in post-treatment cancer patients are of paramount importance. Notably, body psychotherapy (BPT) has been shown to improve bodily wellbeing in subjects suffering from a variety of mental disorders. However, how post-treatment cancer patients perceive and subjectively react to group BPT aiming at improving bodily disturbances has, to the best of our knowledge, not yet been described. Methods: We report on six patients undergoing outpatient group BPT that followed oncological treatment for malignant neoplasms. The BPT consisted of six sessions based on a scientific embodiment approach, integrating body-oriented techniques to improve patients’ awareness, perception, acceptance, and expression regarding their body. Results: The BPT was well accepted by all patients. Despite having undergone different types of oncological treatment for different cancer types and locations, all subjects reported having appreciated BPT and improved how they perceived their bodies. However, individual descriptions of improvements showed substantial heterogeneity across subjects. Notably, most patients indicated that sensations, perceptions, and other mental activities related to their own body intensified when proceeding through the group BPT sessions. Conclusion: The findings from this case series encourage and inform future studies examining whether group BPT is efficacious in post-treatment cancer patients and investigating the related mechanisms of action. The observed heterogeneity in individual descriptions of perceived treatment effects point to the need for selecting comprehensive indicators of changes in disturbances of bodily wellbeing as the primary patient-reported outcome in future clinical trials. While increases in mental activities related to their own body are commonly interpreted as important mechanisms of therapeutic action in BPT, follow-up assessments are needed to evaluate intended and unintended consequences of these changes in cancer patients.
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Affiliation(s)
- Astrid Grossert
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland.,Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Gunther Meinlschmidt
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.,Faculty of Medicine, Ruhr-University Bochum, Bochum, Germany.,Faculty of Medicine, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Berlin, Germany
| | - Rainer Schaefert
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
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15
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Turner RR, Steed L, Quirk H, Greasley RU, Saxton JM, Taylor SJC, Rosario DJ, Thaha MA, Bourke L. Interventions for promoting habitual exercise in people living with and beyond cancer. Cochrane Database Syst Rev 2018; 9:CD010192. [PMID: 30229557 PMCID: PMC6513653 DOI: 10.1002/14651858.cd010192.pub3] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND This is an updated version of the original Cochrane Review published in the Cochrane Library 2013, Issue 9. Despite good evidence for the health benefits of regular exercise for people living with or beyond cancer, understanding how to promote sustainable exercise behaviour change in sedentary cancer survivors, particularly over the long term, is not as well understood. A large majority of people living with or recovering from cancer do not meet current exercise recommendations. Hence, reviewing the evidence on how to promote and sustain exercise behaviour is important for understanding the most effective strategies to ensure benefit in the patient population and identify research gaps. OBJECTIVES To assess the effects of interventions designed to promote exercise behaviour in sedentary people living with and beyond cancer and to address the following secondary questions: Which interventions are most effective in improving aerobic fitness and skeletal muscle strength and endurance? Which interventions are most effective in improving exercise behaviour amongst patients with different cancers? Which interventions are most likely to promote long-term (12 months or longer) exercise behaviour? What frequency of contact with exercise professionals and/or healthcare professionals is associated with increased exercise behaviour? What theoretical basis is most often associated with better behavioural outcomes? What behaviour change techniques (BCTs) are most often associated with increased exercise behaviour? What adverse effects are attributed to different exercise interventions? SEARCH METHODS We used standard methodological procedures expected by Cochrane. We updated our 2013 Cochrane systematic review by updating the searches of the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, Embase, AMED, CINAHL, PsycLIT/PsycINFO, SportDiscus and PEDro up to May 2018. We also searched the grey literature, trial registries, wrote to leading experts in the field and searched reference lists of included studies and other related recent systematic reviews. SELECTION CRITERIA We included only randomised controlled trials (RCTs) that compared an exercise intervention with usual care or 'waiting list' control in sedentary people over the age of 18 with a homogenous primary cancer diagnosis. DATA COLLECTION AND ANALYSIS In the update, review authors independently screened all titles and abstracts to identify studies that might meet the inclusion criteria, or that could not be safely excluded without assessment of the full text (e.g. when no abstract is available). We extracted data from all eligible papers with at least two members of the author team working independently (RT, LS and RG). We coded BCTs according to the CALO-RE taxonomy. Risk of bias was assessed using the Cochrane's tool for assessing risk of bias. When possible, and if appropriate, we performed a fixed-effect meta-analysis of study outcomes. If statistical heterogeneity was noted, a meta-analysis was performed using a random-effects model. For continuous outcomes (e.g. cardiorespiratory fitness), we extracted the final value, the standard deviation (SD) of the outcome of interest and the number of participants assessed at follow-up in each treatment arm, to estimate the standardised mean difference (SMD) between treatment arms. SMD was used, as investigators used heterogeneous methods to assess individual outcomes. If a meta-analysis was not possible or was not appropriate, we narratively synthesised studies. The quality of the evidence was assessed using the GRADE approach with the GRADE profiler. MAIN RESULTS We included 23 studies in this review, involving a total of 1372 participants (an addition of 10 studies, 724 participants from the original review); 227 full texts were screened in the update and 377 full texts were screened in the original review leaving 35 publications from a total of 23 unique studies included in the review. We planned to include all cancers, but only studies involving breast, prostate, colorectal and lung cancer met the inclusion criteria. Thirteen studies incorporated a target level of exercise that could meet current recommendations for moderate-intensity aerobic exercise (i.e.150 minutes per week); or resistance exercise (i.e. strength training exercises at least two days per week).Adherence to exercise interventions, which is crucial for understanding treatment dose, is still reported inconsistently. Eight studies reported intervention adherence of 75% or greater to an exercise prescription that met current guidelines. These studies all included a component of supervision: in our analysis of BCTs we designated these studies as 'Tier 1 trials'. Six studies reported intervention adherence of 75% or greater to an aerobic exercise goal that was less than the current guideline recommendations: in our analysis of BCTs we designated these studies as 'Tier 2 trials.' A hierarchy of BCTs was developed for Tier 1 and Tier 2 trials, with programme goal setting, setting of graded tasks and instruction of how to perform behaviour being amongst the most frequent BCTs. Despite the uncertainty surrounding adherence in some of the included studies, interventions resulted in improvements in aerobic exercise tolerance at eight to 12 weeks (SMD 0.54, 95% CI 0.37 to 0.70; 604 participants, 10 studies; low-quality evidence) versus usual care. At six months, aerobic exercise tolerance was also improved (SMD 0.56, 95% CI 0.39 to 0.72; 591 participants; 7 studies; low-quality evidence). AUTHORS' CONCLUSIONS Since the last version of this review, none of the new relevant studies have provided additional information to change the conclusions. We have found some improved understanding of how to encourage previously inactive cancer survivors to achieve international physical activity guidelines. Goal setting, setting of graded tasks and instruction of how to perform behaviour, feature in interventions that meet recommendations targets and report adherence of 75% or more. However, long-term follow-up data are still limited, and the majority of studies are in white women with breast cancer. There are still a considerable number of published studies with numerous and varied issues related to high risk of bias and poor reporting standards. Additionally, the meta-analyses were often graded as consisting of low- to very low-certainty evidence. A very small number of serious adverse effects were reported amongst the studies, providing reassurance exercise is safe for this population.
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Affiliation(s)
- Rebecca R Turner
- Sheffield Hallam UniversityCentre for Sport and Exercise ScienceA124 Collegiate Hall, Collegiate CrescentSheffieldSouth YorkshireUKS10 2BP
| | - Liz Steed
- Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonCentre for Primary Care and Public HealthBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Helen Quirk
- Sheffield Hallam UniversityCentre for Sport and Exercise ScienceA124 Collegiate Hall, Collegiate CrescentSheffieldSouth YorkshireUKS10 2BP
| | - Rosa U Greasley
- Sheffield Hallam UniversityCentre for Sport and Exercise ScienceA124 Collegiate Hall, Collegiate CrescentSheffieldSouth YorkshireUKS10 2BP
| | - John M Saxton
- Northumbria UniversityDepartment of Sport, Exercise, and RehabilitationNewcastle‐upon‐TyneUKNE1 8ST
| | - Stephanie JC Taylor
- Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonCentre for Primary Care and Public Health and Asthma UK Centre for Applied ResearchYvonne Carter Building58 Turner StreetLondonUKE1 2AB
| | - Derek J Rosario
- University of SheffieldDepartment of OncologyBeech Hill RoadRoyal Hallamshire HospitalSheffieldUKS010 2RX
| | - Mohamed A Thaha
- Barts & The London School of Medicine & Dentistry, Queen Mary University LondonAcademic Surgical Unit, National Centre for Bowel Research & Surgical Innovation, Centre for Digestive Diseases, Blizard Institute1st Floor, Abernethy Building, 2 Newark StreetThe Royal London Hospital, WhitechapelLondonEnglandUKE1 2AT
| | - Liam Bourke
- Sheffield Hallam UniversityHealth and Wellbeing Research InstituteSheffieldUKS10 2BP
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Tartavoulle TM, Karpinski AC, Aubin A, Kluger BM, Distler O, Saketkoo LA. Multidimensional fatigue in pulmonary hypertension: prevalence, severity and predictors. ERJ Open Res 2018; 4:00079-2017. [PMID: 29577043 PMCID: PMC5864970 DOI: 10.1183/23120541.00079-2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 01/18/2018] [Indexed: 01/21/2023] Open
Abstract
Pulmonary hypertension is a potentially fatal disease. Despite pharmacological advances in pulmonary hypertension, fatigue remains common in patients with pulmonary hypertension. A convenience sample of 120 participants at an international patient conference completed the Multidimensional Fatigue Inventory (MFI)-20 scale. Data on New York Heart Association Functional Class, body mass index, oxygen use and medication type/use were also collected. There was a high prevalence of “severe” to “very severe” fatigue for each dimension: General Fatigue (60%), Physical Fatigue (55.8%), Reduced Activity (41.7%), Reduced Motivation (32.5%) and Mental Fatigue (27.5%). The mean±sd overall MFI-20 score was 58±5.1. Dimensions with the highest averaged levels were General Fatigue (13.40±3.61), Physical Fatigue (13.23±3.67) and Reduced Activity (11.33±4.16). Body mass index correlated with higher fatigue scores. Phosphodiesterase inhibitor plus endothelin receptor antagonist combination negatively predicted General Fatigue, Physical Fatigue, Reduced Motivation and Reduced Activity. Triple therapy was a significant predictor of General Fatigue, Physical Fatigue and Reduced Activity. There were no significant predictors of Mental Fatigue. Multidimensional fatigue is common and severe in patients with pulmonary hypertension. Phosphodiesterase inhibitor plus endothelin receptor antagonist combination resulted in lower scores in most fatigue dimensions. Comprehensive assessment of fatigue should be considered in the clinical care of patients with pulmonary hypertension and clinical research to develop formal interventions that target this disabling symptom. Fatigue is common and severe in PH, and impacted by medications; targeted strategies to mitigate fatigue are neededhttp://ow.ly/EISN30i0WWU
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Affiliation(s)
- Todd M Tartavoulle
- School of Nursing, Louisiana State University Health Sciences Center - New Orleans, New Orleans, LA, USA
| | - Aryn C Karpinski
- Evaluation and Measurement, School of Foundations, Leadership and Administration, Kent State University, Kent, OH, USA
| | - Andrew Aubin
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Benzi M Kluger
- Dept of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Oliver Distler
- Dept of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, USA.,Tulane Lung Center, Tulane University School of Medicine, New Orleans, LA, USA.,University Medical Center, Comprehensive Pulmonary Hypertension Center, University Medical Center, New Orleans, LA, USA
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17
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Cormie P, Zopf EM, Zhang X, Schmitz KH. The Impact of Exercise on Cancer Mortality, Recurrence, and Treatment-Related Adverse Effects. Epidemiol Rev 2018; 39:71-92. [PMID: 28453622 DOI: 10.1093/epirev/mxx007] [Citation(s) in RCA: 356] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 02/16/2017] [Indexed: 12/15/2022] Open
Abstract
The combination of an increasing number of new cancer cases and improving survival rates has led to a large and rapidly growing population with unique health-care requirements. Exercise has been proposed as a strategy to help address the issues faced by cancer patients. Supported by a growing body of research, major health organizations commonly identify the importance of incorporating exercise in cancer care and advise patients to be physically active. This systematic review comprehensively summarizes the available epidemiologic and randomized controlled trial evidence investigating the role of exercise in the management of cancer. Literature searches focused on determining the potential impact of exercise on 1) cancer mortality and recurrence and 2) adverse effects of cancer and its treatment. A total of 100 studies were reviewed involving thousands of individual patients whose exercise behavior was assessed following the diagnosis of any type of cancer. Compared with patients who performed no/less exercise, patients who exercised following a diagnosis of cancer were observed to have a lower relative risk of cancer mortality and recurrence and experienced fewer/less severe adverse effects. The findings of this review support the view that exercise is an important adjunct therapy in the management of cancer. Implications on cancer care policy and practice are discussed.
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Abstract
To cope with cancer and its treatment-related side effects and toxicities, people are increasingly using complementary and alternative medicine (CAM). Consequently, integrative oncology, which combines conventional therapies and evidence-based CAM practices, is an emerging discipline in cancer care. The use of yoga as a CAM is proving to be beneficial and increasingly gaining popularity. An electronic database search (PubMed), through December 15, 2016, revealed 138 relevant clinical trials (single-armed, nonrandomized, and randomized controlled trials) on the use of yoga in cancer patients. A total of 10,660 cancer patients from 20 countries were recruited in these studies. Regardless of some methodological deficiencies, most of the studies reported that yoga improved the physical and psychological symptoms, quality of life, and markers of immunity of the patients, providing a strong support for yoga's integration into conventional cancer care. This review article presents the published clinical research on the prevalence of yoga's use in cancer patients so that oncologists, researchers, and the patients are aware of the evidence supporting the use of this relatively safe modality in cancer care.
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Affiliation(s)
- Ram P Agarwal
- Department of Medicine, Division of Oncology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Adi Maroko-Afek
- Department of Medicine, Division of Oncology, Miller School of Medicine, University of Miami, Miami, Florida, USA
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19
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Patsou ED, Alexias GD, Anagnostopoulos FG, Karamouzis MV. Effects of physical activity on depressive symptoms during breast cancer survivorship: a meta-analysis of randomised control trials. ESMO Open 2017; 2:e000271. [PMID: 29259819 PMCID: PMC5729305 DOI: 10.1136/esmoopen-2017-000271] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 01/18/2023] Open
Abstract
BackgroundBreast cancer is one of the most common cancers affecting women worldwide, and depressive symptoms are disturbing side effects of cancer diagnosis and treatment. Physical activity and exercise have emerged as an alternative treatment in handling psychological distress throughout breast cancer survivorship. AimThe aim of this review was to present the results of (1) physical activity and (2) exercise interventions in terms of type and duration regarding depressive symptoms among breast cancer survivors during and after treatment. The hypothesis was that cancer survivors who are engaged with physical activity will demonstrate statistically significant lower levels of depressive symptoms when compared with non-exercising control groups. MethodsWe searched PubMed, Elsevier and Google Scholar for recent articles published between January 2011 and November 2016. Fourteen randomised control trials with 1701 patients in total were assessed. ResultsSignificant differences in levels were found between exercise intervention groups and control groups, while moderate aerobic exercise interventions with an optimal duration of ≥135 min for up to 12 weeks are significantly more beneficial in depressive symptoms when it comes to patients under treatment than resistance, aerobicandresistance training and yoga interventions. ConclusionsIt is concluded that when progressive exercise programmes are prescribed according to the individual needs, capabilities and preferences of breast cancer survivors, they offer a valid alternative to depression mood management throughout the course of survivorship.
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Affiliation(s)
- Efrossini D Patsou
- Department of Psychology, Panteion University of Social and Political Sciences, Athens, Attika, Greece
| | - Georgios D Alexias
- Department of Psychology, Panteion University of Social and Political Sciences, Athens, Attika, Greece
| | - Fotios G Anagnostopoulos
- Department of Psychology, Panteion University of Social and Political Sciences, Athens, Attika, Greece
| | - Michalis V Karamouzis
- Molecular Oncology Unit, Department of Biological Chemistry and First Department of Internal medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Attika, Greece
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20
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Haller H, Winkler MM, Klose P, Dobos G, Kümmel S, Cramer H. Mindfulness-based interventions for women with breast cancer: an updated systematic review and meta-analysis. Acta Oncol 2017; 56:1665-1676. [PMID: 28686520 DOI: 10.1080/0284186x.2017.1342862] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The aim of this meta-analysis was to systematically update the evidence for mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) in women with breast cancer. MATERIAL AND METHODS In October 2016, PubMed, Scopus, and Central were searched for randomized controlled trials on MBSR/MBCT in breast cancer patients. The primary outcome was health-related quality of life. Secondary outcomes were fatigue, sleep stress, depression, anxiety, and safety. For each outcome, standardized mean differences (SMD/Hedges' g) and 95% confidence intervals (CI) were calculated. Risk of bias was assessed by the Cochrane risk of bias tool. RESULTS The Literature search identified 14 articles on 10 studies that included 1709 participants. The overall risk of bias was unclear, except for risk of low attrition bias and low other bias. Compared to usual care, significant post-intervention effects of MBSR/MBCT were found for health-related quality of life (SMD = .21; 95%CI = [.04-.39]), fatigue (SMD = -.28; 95%CI = [-.43 to -.14]), sleep (SMD = -.23; 95%CI = [-.40 to -.05]), stress (SMD = -.33; 95%CI = [-.61 to -.05]), anxiety (SMD = -.28; 95%CI = [-.39 to -.16]), and depression (SMD = -.34; 95%CI = [-.46 to -.21]). Up to 6 months after baseline effects were significant for: anxiety (SMD = -.28; 95%CI = [-.47 to -.09]) and depression (SMD = -.26; 95%CI = [-.47 to -.04]); and significant for anxiety (SMD = -.21; 95%CI = [-.40 to -.03]) up to 12 months after baseline. Compared to other active interventions, significant effects were only found post-intervention and only for anxiety (SMD = -.45; 95%CI = [-.71 to -.18]) and depression (SMD = -.39; 95%CI = [-.65 to -.14]). However, average effects were all below the threshold of minimal clinically important differences. Effects were robust against potential methodological bias. Adverse events were insufficiently reported. CONCLUSIONS This meta-analysis revealed evidence for the short-term effectiveness and safety of mindfulness-based interventions in women with breast cancer. However, their clinical relevance remains unclear. Further research is needed.
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Affiliation(s)
- Heidemarie Haller
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - María M. Winkler
- Department of Obstetrics and Gynecology, Robert Bosch Hospital, Stuttgart, Germany
| | - Petra Klose
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | | | - Holger Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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21
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Huether K, Abbott L, Cullen L, Cullen L, Gaarde A. Energy Through Motion©: An Evidence-Based Exercise Program to Reduce Cancer-Related Fatigue and Improve Quality of Life. Clin J Oncol Nurs 2017; 20:E60-70. [PMID: 27206306 DOI: 10.1188/16.cjon.e60-e70] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Evidence supports addressing cancer-related fatigue (CRF) with activity. Activity promotion is feasible during and following cancer treatment and improves patient outcomes. OBJECTIVES This project provided an evidence-based activity program for adult cancer survivors after treatment to reduce CRF and improve quality of life. METHODS The Iowa Model of Evidence-Based Practice to Promote Quality Care guided development of the activity promotion evidence-based practice project. This included evidence review, creation of an evidence-based activity intervention, and evaluation of the practice change. Two groups participated in the project; one group, the usual care group, provided baseline data and received "usual" instructions for activity, fatigue, and sleep, whereas the Energy Through Motion© (ETM) activity group received a three-month activity intervention with prepackaged ETM kits and follow-up phone calls. FINDINGS Patients in the ETM activity group had increased activity levels, whereas those in the usual care group had decreased activity levels. Fatigue levels in the ETM activity group decreased, and quality of life improved. This project supports nurse-led activity promotion as useful in addressing CRF and feasible for use in a busy clinical setting.
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Affiliation(s)
| | | | | | - Liz Cullen
- University of Iowa Hospitals and Clinics
| | - Ami Gaarde
- University of Iowa Hospitals and Clinics
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Cheng KKF, Lim YTE, Koh ZM, Tam WWS. Home-based multidimensional survivorship programmes for breast cancer survivors. Cochrane Database Syst Rev 2017; 8:CD011152. [PMID: 28836379 PMCID: PMC6483678 DOI: 10.1002/14651858.cd011152.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The prognosis and survival rate of women with breast cancer have significantly improved worldwide. Effective home-based multidimensional programmes for breast cancer survivors have gained an ever greater emphasis in survivorship care to maximise women's quality of life for their successful transition to rehabilitation and normal life. It is important to summarise the best available evidence to evaluate the effects of home-based multidimensional survivorship programmes on quality of life in women within 10 years of the completion of surgery or adjuvant cancer therapy for breast cancer, or both. OBJECTIVES To assess the effects of home-based, multidimensional survivorship (HBMS) programmes on maintaining or improving the quality of life in breast cancer survivors. SEARCH METHODS In April 2016 we searched the Cochrane Breast Cancer Specialised Register, CENTRAL, PubMed, Embase, CINAHL Plus, PsycINFO, Web of Science, and the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov. We also screened reference lists of all identified studies and contacted study authors. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs assessing the effects of HBMS programmes in maintaining or improving quality of life in women with stages 0 to 3 breast cancer who completed primary cancer treatment (surgery or adjuvant cancer therapy, or both) up to 10 years earlier. We considered studies where the interventions included more than one of the following listed components: educational (such as information provision and self-management advice), physical (such as exercise training and resistance training) and psychological (such as counselling and cognitive therapies), to constitute a multidimensional programme. Interventions had to be allowed to be carried out at home. DATA COLLECTION AND ANALYSIS Two authors independently assessed eligible studies for inclusion, and performed quality assessment and extracted relevant data of the included studies. Quality of life was the primary outcome of the review. MAIN RESULTS We included 22 RCTs and four quasi-RCTs on 2272 participants. We categorised the intervention components into four groups: educational and psychological; educational and physical; physical and psychological; and educational, physical and psychological. Most of the studies used usual care (routine medical follow-up services) as the comparator. A few studies used a lower level or different type of intervention (e.g. stress management or exercise) or attention control as the comparator.We used the Functional Assessment of Cancer Therapy-Breast (FACT B), European Organisation for Research and Treatment of Cancer Quality of Life C30 (EORTC C30), Quality of Life (QoL) Breast Cancer, and SF36 questionnaires to assess quality of life. HBMS programmes may increase breast cancer-specific quality of life and global quality of life immediately after the intervention, as measured by FACT-B and EORTC C30 (FACT-B: mean difference (MD) 4.55, 95% confidence interval (CI) 2.33 to 6.78, 7 studies, 764 participants; EORTC: MD 4.38, 95% CI 0.11 to 8.64, 6 studies; 299 participants; moderate-quality evidence). There was no evidence of a difference in quality of life as measured by QoL-Breast Cancer or SF-36 (QoL-Breast Cancer: MD 0.42, 95% CI -0.02 to 0.85, 2 studies, 111 participants, very low-quality evidence; physical composite score SF36: MD 0.55, 95% CI -3.52 to 4.63, 2 studies, 308 participants, low-quality evidence).We observed a similar pattern at one to three months after the intervention: FACT-B (MD 6.10, 95% CI 2.48 to 9.72, 2 studies, 426 participants), EORTC-C30 (MD 6.32, 95% CI 0.61 to 12.04, 2 studies; 172 participants) and QoL-Breast Cancer (MD 0.45, 95% CI -0.19 to 1.09, 1 study, 61 participants). At four to six months and 12 months, there was no evidence of a difference in quality of life between groups (four to six months: EORTC - MD 0.08, 95% CI -7.28 to 7.44, 2 studies; 117 participants; SF-36 - MD -1.05, 95% CI -5.60 to 3.51, 2 studies, 308 participants; 12 months: EORTC - MD 2.04, 95% CI -9.91 to 13.99, 1 study; 57 participants).Functional status was incorporated into the quality of life subscale findings. HBMS programmes may decrease anxiety (MD of Hospital Anxiety and Depression Scale (HADS) -1.01, 95% CI -1.94 to -0.08, 5 studies, 253 participants, low-quality evidence) compared to control immediately after the intervention but the effect did not persist at four to six months. There was no evidence of improvements in depression immediately after HBMS (MD of HADS -1.36, 95% CI -2.94 to 0.22, 4 studies, 213 participants, low-quality evidence) or at follow-up. HBMS programmes may also decrease fatigue (MD -1.11, 95% CI -1.78 to -0.45, 3 studies, 127 participants; low-quality evidence) and insomnia (MD -1.81, 95% CI -3.34 to -0.27, 3 studies, 185 participants, low-quality evidence).None of the included studies reported service needs and utilisation and cost of care, and therefore the effect of HBMS programmes on healthcare utilisation and cost is unknown. Due to the variations in assessment methods of adherence among the eight studies, we could not combine the results for meta-analysis. We synthesised the results narratively, with the reported adherence rates of 58% to 100%. AUTHORS' CONCLUSIONS The results of this systematic review and meta-analysis revealed that HBMS programmes in breast cancer survivors appear to have a short-term beneficial effect of improving breast cancer-specific quality of life and global quality of life as measured by FACT-B and EORTC-C30, respectively. In addition, HBMS programmes are associated with a reduction in anxiety, fatigue and insomnia immediately after the intervention. We assessed the quality of evidence across studies as moderate for some outcomes, meaning that we are fairly confident about the results, while we assessed other outcomes as being low-quality, meaning that we are uncertain about the result.
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Affiliation(s)
- Karis Kin Fong Cheng
- National University of Singapore, National University Health SystemAlice Lee Centre for Nursing StudiesSingaporeSingapore
| | - Yee Ting Ethel Lim
- National University of Singapore, National University Health SystemAlice Lee Centre for Nursing StudiesSingaporeSingapore
| | - Zhi Min Koh
- National University of Singapore, National University Health SystemAlice Lee Centre for Nursing StudiesSingaporeSingapore
| | - Wilson Wai San Tam
- National University of Singapore, National University Health SystemAlice Lee Centre for Nursing StudiesSingaporeSingapore
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Fulop JA, Grimone A, Victorson D. Restoring Balance for People with Cancer Through Integrative Oncology. Prim Care 2017; 44:323-335. [DOI: 10.1016/j.pop.2017.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Greenlee H, DuPont-Reyes MJ, Balneaves LG, Carlson LE, Cohen MR, Deng G, Johnson JA, Mumber M, Seely D, Zick SM, Boyce LM, Tripathy D. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin 2017; 67:194-232. [PMID: 28436999 PMCID: PMC5892208 DOI: 10.3322/caac.21397] [Citation(s) in RCA: 381] [Impact Index Per Article: 54.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Answer questions and earn CME/CNE Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. CA Cancer J Clin 2017;67:194-232. © 2017 American Cancer Society.
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Affiliation(s)
- Heather Greenlee
- Assistant Professor, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
- Member, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
| | - Melissa J DuPont-Reyes
- Doctoral Fellow, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Lynda G Balneaves
- Associate Professor, College of Nursing, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| | - Linda E Carlson
- Professor, Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Misha R Cohen
- Adjunct Professor, American College of Traditional Chinese Medicine at California Institute of Integral Studies, San Francisco, CA
- Clinic Director, Chicken Soup Chinese Medicine, San Francisco, CA
| | - Gary Deng
- Medical Director, Integrative Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jillian A Johnson
- Post-Doctoral Scholar, Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA
| | | | - Dugald Seely
- Executive Director, Ottawa Integrative Cancer Center, Ottawa, ON, Canada
- Executive Director of Research, Canadian College of Naturopathic Medicine, Toronto, ON, Canada
| | - Suzanna M Zick
- Research Associate Professor, Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI
- Research Associate Professor, Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Lindsay M Boyce
- Research Informationist, Memorial Sloan Kettering Library, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debu Tripathy
- Professor, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Jeitler M, Jaspers J, von Scheidt C, Koch B, Michalsen A, Steckhan N, Kessler CS. Mind-body medicine and lifestyle modification in supportive cancer care: A cohort study on a day care clinic program for cancer patients. Psychooncology 2017; 26:2127-2134. [PMID: 28370730 DOI: 10.1002/pon.4433] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We developed an integrative day care clinic program for cancer patients focusing on mind-body techniques and health-promoting lifestyle modification (7-hour once-per-week group sessions over 12 weeks). METHODS A cohort study design with a waiting group was implemented. Outcome parameters were assessed at the beginning, at the end of the active program, and at a 6-month follow-up. Patients waiting >4 and <12 weeks before treatment start were allocated to the waiting group and additionally assessed at the start of their day care program. Outcome measures included quality of life (FACT-G, FACT-B/C, WHO-5), fatigue (FACIT-F), depression/anxiety (HADS), and mood states (ASTS). A per protocol analysis using mixed linear models was performed. RESULTS One hundred patients were screened on-site for eligibility. Eighty-six cancer survivors (83% female; mean age 53.7 ± 9.7 years; 49% breast cancer) were included into the study. Sixty-two patients were allocated to the intervention group and 24 patients, to the waiting group (mean waiting time 5 ± 1 weeks). Sixty-six data sets were included in the final analysis. Significant improvements were observed in favor of the intervention group after 12 weeks compared with the waiting group at the end of the waiting period for quality of life, anxiety/depression, and fatigue. Results from the 6-month follow-up for the whole study population showed lasting improvement of quality of life. CONCLUSIONS The program can be considered as an effective means to improve quality of life, fatigue, and mental health of cancer patients. Moreover, it appears to have a sustainable effect, which has to be proved in randomized trials.
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Affiliation(s)
- Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Medical University, Berlin, Germany.,Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Jessica Jaspers
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Medical University, Berlin, Germany
| | - Christel von Scheidt
- Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Barbara Koch
- Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Medical University, Berlin, Germany.,Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Medical University, Berlin, Germany
| | - Christian S Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Medical University, Berlin, Germany.,Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
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Kröz M, Reif M, Glinz A, Berger B, Nikolaou A, Zerm R, Brinkhaus B, Girke M, Büssing A, Gutenbrunner C. Impact of a combined multimodal-aerobic and multimodal intervention compared to standard aerobic treatment in breast cancer survivors with chronic cancer-related fatigue - results of a three-armed pragmatic trial in a comprehensive cohort design. BMC Cancer 2017; 17:166. [PMID: 28253845 PMCID: PMC5335840 DOI: 10.1186/s12885-017-3142-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 02/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer-related fatigue (CRF) and insomnia are major complaints in breast cancer survivors (BC). Aerobic training (AT), the standard therapy for CRF in BC, shows only minor to moderate treatment effects. Other evidence-based treatments include cognitive behavioral therapy, e.g., sleep education/restriction (SE) and mindfulness-based therapies. We investigated the effectiveness of a 10-week multimodal program (MT) consisting of SE, psycho-education, eurythmy- and painting-therapy, administered separately or in combination with AT (CT) and compared both arms to AT alone. METHODS In a pragmatic comprehensive cohort study BC with chronic CRF were allocated randomly or by patient preference to (a) MT, (b) CT (MT + AT) or (c) AT alone. Primary endpoint was a composite score of the Pittsburgh Sleep Quality Index and the Cancer Fatigue Scale after 10 weeks of intervention (T1); a second endpoint was a follow-up assessment 6 months later (T2). The primary hypothesis stated superiority of CT and non-inferiority of MT vs. AT at T1. A closed testing procedure preserved the global α-level. The intention-to-treat analysis included propensity scores for the mode of allocation and for the preferred treatment, respectively. RESULTS Altogether 126 BC were recruited: 65 were randomized and 61 allocated by preference; 105 started the intervention. Socio-demographic parameters were generally balanced at baseline. Non-inferiority of MT to AT at T1 was confirmed (p < 0.05), yet the confirmative analysis stopped as it was not possible to confirm superiority of CT vs. AT (p = 0.119). In consecutive exploratory analyses MT and CT were superior to AT at T1 and T2 (MT) or T2 alone (CT), respectively. CONCLUSIONS The multimodal CRF-therapy was found to be confirmatively non-inferior to standard therapy and even yielded exploratively sustained superiority. A randomized controlled trial including a larger sample size and a longer follow-up to evaluate multimodal CRF-therapy is highly warranted. TRIAL REGISTER DRKS-ID: DRKS00003736 . Recruitment period June 2011 to March 2013. Date of registering 19 June 2012.
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Affiliation(s)
- Matthias Kröz
- Department of Internal Medicine, Havelhöhe Hospital, Kladower Damm 221, D-14089 Berlin, Germany
- Research Institute Havelhöhe, Kladower Damm 221, Berlin, D-14089 Germany
- Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Charité CCM, Berlin, 10098 Berlin Germany
- Institute for Integrative Medicine, University of Witten/Herdecke, Gerhard-Kienle-Weg 4, Herdecke, 58313 Germany
| | - Marcus Reif
- Society for Clinical Research, Hardenbergstraße 20, Berlin, 10623 Germany
| | - Augustina Glinz
- Research Institute Havelhöhe, Kladower Damm 221, Berlin, D-14089 Germany
| | - Bettina Berger
- Institute for Integrative Medicine, University of Witten/Herdecke, Gerhard-Kienle-Weg 4, Herdecke, 58313 Germany
| | - Andreas Nikolaou
- Clinic for Rehabilitative Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625 Germany
| | - Roland Zerm
- Department of Internal Medicine, Havelhöhe Hospital, Kladower Damm 221, D-14089 Berlin, Germany
- Research Institute Havelhöhe, Kladower Damm 221, Berlin, D-14089 Germany
| | - Benno Brinkhaus
- Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Charité CCM, Berlin, 10098 Berlin Germany
| | - Matthias Girke
- Department of Internal Medicine, Havelhöhe Hospital, Kladower Damm 221, D-14089 Berlin, Germany
- Research Institute Havelhöhe, Kladower Damm 221, Berlin, D-14089 Germany
| | - Arndt Büssing
- Institute for Integrative Medicine, University of Witten/Herdecke, Gerhard-Kienle-Weg 4, Herdecke, 58313 Germany
| | - Christoph Gutenbrunner
- Clinic for Rehabilitative Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625 Germany
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Roveda E, Vitale JA, Bruno E, Montaruli A, Pasanisi P, Villarini A, Gargano G, Galasso L, Berrino F, Caumo A, Carandente F. Protective Effect of Aerobic Physical Activity on Sleep Behavior in Breast Cancer Survivors. Integr Cancer Ther 2017; 16:21-31. [PMID: 27252076 PMCID: PMC5736068 DOI: 10.1177/1534735416651719] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/16/2022] Open
Abstract
HYPOTHESES Sleep disorders are associated with an increased risk of cancer, including breast cancer (BC). Physical activity (PA) can produce beneficial effects on sleep. STUDY DESIGN We designed a randomized controlled trial to test the effect of 3 months of physical activity on sleep and circadian rhythm activity level evaluated by actigraphy. METHODS 40 BC women, aged 35-70 years, were randomized into an intervention (IG) and a control group (CG). IG performed a 3 month of aerobic exercise. At baseline and after 3 months, the following parameters were evaluated both for IG and CG: anthropometric and body composition measurements, energy expenditure and motion level; sleep parameters (Actual Sleep Time-AST, Actual Wake Time-AWT, Sleep Efficiency-SE, Sleep Latency-SL, Mean Activity Score-MAS, Movement and Fragmentation Index-MFI and Immobility Time-IT) and activity level circadian rhythm using the Actigraph Actiwatch. RESULTS The CG showed a deterioration of sleep, whereas the IG showed a stable pattern. In the CG the SE, AST and IT decreased and the AWT, SL, MAS and MFI increased. In the IG, the SE, IT, AWT, SL, and MAS showed no changes and AST and MFI showed a less pronounced change in the IG than in the CG. The rhythmometric analysis revealed a significant circadian rhythm in two groups. After 3 months of PA, IG showed reduced fat mass %, while CG had improved weight and BMI. CONCLUSION Physical activity may be beneficial against sleep disruption. Indeed, PA prevented sleep worsening in IG. PA can represent an integrative intervention therapy able to modify sleep behaviour.
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Affiliation(s)
- Eliana Roveda
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Jacopo A. Vitale
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Eleonora Bruno
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Angela Montaruli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Anna Villarini
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Letizia Galasso
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Franco Berrino
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrea Caumo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- IRCCS Policlinico San Donato Milanese, Milan, Italy
| | - Franca Carandente
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Griffin KH, Johnson JR, Kitzmann JP, Kolste AK, Dusek JA. Outcomes of a Multimodal Resilience Training Program in an Outpatient Integrative Medicine Clinic. J Altern Complement Med 2015; 21:628-37. [DOI: 10.1089/acm.2015.0130] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kristen H. Griffin
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, MN
| | - Jill R. Johnson
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, MN
| | - Jennifer P. Kitzmann
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, MN
| | - Alison K. Kolste
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, MN
| | - Jeffery A. Dusek
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, MN
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Mitchell SA, Hoffman AJ, Clark JC, DeGennaro RM, Poirier P, Robinson CB, Weisbrod BL. Putting evidence into practice: an update of evidence-based interventions for cancer-related fatigue during and following treatment. Clin J Oncol Nurs 2015; 18 Suppl:38-58. [PMID: 25427608 DOI: 10.1188/14.cjon.s3.38-58] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cancer-related fatigue (CRF) has deleterious effects on physical, social, cognitive, and vocational functioning, and causes emotional and spiritual distress for patients and their families; however, it remains under-recognized and undertreated. This article critically reviews and integrates the available empirical evidence supporting the efficacy of pharmacologic and nonpharmacologic treatment approaches to CRF, highlighting new evidence since 2007 and 2009 Putting Evidence Into Practice publications. Interventions that are recommended for practice or likely to be effective in improving fatigue outcomes include exercise; screening for treatable risk factors; management of concurrent symptoms; yoga; structured rehabilitation; Wisconsin ginseng; cognitive-behavioral therapies for insomnia, pain, and depression; mindfulness-based stress reduction; and psychoeducational interventions such as anticipatory guidance, psychosocial support, and energy conservation and activity management. This information can be applied to improve the management of CRF, inform health policy and program development, shape the design of clinical trials of new therapies for CRF, and drive basic and translational research.
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Affiliation(s)
- Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Center, Bethesda, MD
| | - Amy J Hoffman
- College of Nursing, Michigan State University, East Lansing
| | - Jane C Clark
- Georgia Center for Oncology Research and Education in Atlanta
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Berger AM, Mitchell SA, Jacobsen PB, Pirl WF. Screening, evaluation, and management of cancer-related fatigue: Ready for implementation to practice? CA Cancer J Clin 2015; 65:190-211. [PMID: 25760293 DOI: 10.3322/caac.21268] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/05/2015] [Accepted: 02/06/2015] [Indexed: 12/13/2022] Open
Abstract
Answer questions and earn CME/CNE Evidence regarding cancer-related fatigue (fatigue) has accumulated sufficiently such that recommendations for screening, evaluation, and/or management have been released recently by 4 leading cancer organizations. These evidence-based fatigue recommendations are available for clinicians, and some have patient versions; but barriers at the patient, clinician, and system levels hinder dissemination and implementation into practice. The underlying biologic mechanisms for this debilitating symptom have not been elucidated completely, hindering the development of mechanistically driven interventions. However, significant progress has been made toward methods for screening and comprehensively evaluating fatigue and other common symptoms using reliable and valid self-report measures. Limited data exist to support the use of any pharmacologic agent; however, several nonpharmacologic interventions have been shown to be effective in reducing fatigue in adults. Never before have evidence-based recommendations for fatigue management been disseminated by 4 premier cancer organizations (the National Comprehensive Cancer, the Oncology Nursing Society, the Canadian Partnership Against Cancer/Canadian Association of Psychosocial Oncology, and the American Society of Clinical Oncology). Clinicians may ask: Are we ready for implementation into practice? The reply: A variety of approaches to screening, evaluation, and management are ready for implementation. To reduce fatigue severity and distress and its impact on functioning, intensified collaborations and close partnerships between clinicians and researchers are needed, with an emphasis on system-wide efforts to disseminate and implement these evidence-based recommendations.
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Affiliation(s)
- Ann M Berger
- University of Nebraska Medical Center College of Nursing, Fred and Pamela Buffett Cancer Center, Omaha, NE
| | - Sandra A Mitchell
- Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Paul B Jacobsen
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - William F Pirl
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
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Dobos G, Overhamm T, Büssing A, Ostermann T, Langhorst J, Kümmel S, Paul A, Cramer H. Integrating mindfulness in supportive cancer care: a cohort study on a mindfulness-based day care clinic for cancer survivors. Support Care Cancer 2015; 23:2945-55. [PMID: 25711654 DOI: 10.1007/s00520-015-2660-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 02/15/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to investigate the effects of a mindfulness-based day care clinic group program for cancer survivors on health-related quality of life and mental health; and to investigate which psychological variables are associated with changes in health variables. METHODS One hundred seventeen cancer survivors (91.0 % female; mean age 53.9 ± 10.7 years; 65.0 % breast cancer; mean time since diagnosis 27.2 ± 46.5 months) participated in an 11-week mindfulness-based day care clinic group program, 6 h per week. The intervention incorporated mindfulness-based meditation, yoga, cognitive-behavioral techniques, and lifestyle modification. Outcome measures including health-related quality of life (EORTC QLQ-C30), depression and anxiety (HADS); and psychological variables including life satisfaction (BMLSS), mindfulness (FMI), adaptive coping styles (AKU), spiritual/religious attitudes in dealing with illness (SpREUK), and interpretation of illness (IIQ) were assessed before, after, and 3 months after the intervention. RESULTS Using mixed linear models, significant improvements in global health status, physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning were found. Cancer-related symptoms, including fatigue, pain, insomnia, constipation, anxiety, and depression, also improved significantly. Mindfulness, life satisfaction, health satisfaction, all coping styles, all spiritual/religious attitudes, and interpretation of illness as something of value increased; interpretation of illness as punishment decreased significantly (all p < 0.05). Improved outcomes were associated with increases in psychological variables, mainly life satisfaction, health satisfaction, and trust in medical help (R (2) = 7.3-43.6 %). CONCLUSION Supportive mindfulness-based interventions can be considered as an effective means to improve cancer survivors' physical and mental health. Functional improvements are associated with improved satisfaction and coping styles.
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Affiliation(s)
- Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany
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Cramer H, Cohen L, Dobos G, Witt CM. Integrative oncology: best of both worlds-theoretical, practical, and research issues. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2013; 2013:383142. [PMID: 24371456 PMCID: PMC3863498 DOI: 10.1155/2013/383142] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 11/08/2013] [Accepted: 11/08/2013] [Indexed: 12/15/2022]
Abstract
More and more cancer patients use complementary therapies. As the majority of patients do not disclose their use of complementary therapies to their oncologists, they expose themselves to possible detrimental effects from the therapies due to drug interactions. To meet the needs of patients and health care professionals on valid information on complementary therapies, the collaborative research project "Competence Network Complementary Medicine in Oncology-KOKON", an interdisciplinary network for complementary medicine research in oncology, was established. Moreover, Integrative Oncology, a combination of conventional and evidenced-based complementary therapies delivered using a comprehensive approach, is now increasingly used in the United States and Europe. A variety of different Integrative Oncology models have been established worldwide including an expert-based model at the Kliniken Essen-Mitte, Essen, Germany and a patient-centered, evidenced-based approach at The University of Texas MD Anderson Cancer Center. Both models are briefly reviewed. More research is needed and Comparative Effectiveness Research that places strong emphasis on the comparison of different treatment options in usual care settings by including more heterogeneous patients, using less standardized treatment protocols, and measuring patient-centered outcomes would provide useful information for decision-making. To improve the quality of care and research in Integrative Oncology, sustainable financial models for Integrative Oncology and more funding for research are needed.
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Affiliation(s)
- Holger Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45276 Essen, Germany
| | - Lorenzo Cohen
- Department of General Oncology and the Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45276 Essen, Germany
| | - Claudia M. Witt
- Charité Universitätsmedizin Berlin, Institute for Social Medicine, Epidemiology and Health Economics, 10M7 Berlin, Germany
- University of Maryland School of Medicine, Center for Integrative Medicine, Baltimore, MD 21201, USA
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Esch T, Jose G, Gimpel C, von Scheidt C, Michalsen A. Die Flourishing Scale (FS) von Diener et al. liegt jetzt in einer autorisierten deutschen Fassung (FS-D) vor: Einsatz bei einer Mind-Body-medizinischen Fragestellung. ACTA ACUST UNITED AC 2013; 20:267-75. [DOI: 10.1159/000354414] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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