Change in physical activity and quality of life in endometrial cancer survivors receiving a physical activity intervention

The Use of Wearable Devices in Oncology Patients: A Systematic Review

INTRODUCTION

The aim of this systematic review was to summarize the current literature on wearable technologies in oncology patients for the purpose of prognostication, treatment monitoring, and rehabilitation planning.

METHODS

A search was conducted in Medline ALL, Cochrane Central Register of Controlled Trials, Embase, Emcare, CINAHL, Scopus, and Web of Science, up until February 2022. Articles were included if they reported on consumer grade and/or non-commercial wearable devices in the setting of either prognostication, treatment monitoring or rehabilitation.

RESULTS

We found 199 studies reporting on 18 513 patients suitable for inclusion. One hundred and eleven studies used wearable device data primarily for the purposes of rehabilitation, 68 for treatment monitoring, and 20 for prognostication. The most commonly-reported brands of wearable devices were ActiGraph (71 studies; 36%), Fitbit (37 studies; 19%), Garmin (13 studies; 7%), and ActivPAL (11 studies; 6%). Daily minutes of physical activity were measured in 121 studies (61%), and daily step counts were measured in 93 studies (47%). Adherence was reported in 86 studies, and ranged from 40% to 100%; of these, 63 (74%) reported adherence in excess of 80%.

CONCLUSION

Wearable devices may provide valuable data for the purposes of treatment monitoring, prognostication, and rehabilitation. Future studies should investigate live-time monitoring of collected data, which may facilitate directed interventions.

Socioeconomic Factors Predict Long-Term Quality of Life of Cancer Survivors: An International Survey

INTRODUCTION

Despite advances in cancer treatment, the quality of life (QOL) of survivors varies significantly. We assessed the correlation between socioeconomic factors and long-term QOL in a global cohort of cancer survivors.

MATERIALS AND METHODS

Patients were offered surveys via online support groups. Using the Short Form-12 validated questionnaire, physical QOL (PQOL) and mental QOL (MQOL) well-being were compared to the general population. Socioeconomic factors were assessed with regression analysis for impact on QOL.

RESULTS

Seven hundred eighty two survivors from six continents responded. They were 57 ± 13 y and 68% female, 90.8% White, with 43 distinct cancer diagnoses. All survivors had PQOL and MQOL scores lower than the general population. Lower education level, household income, and non-White race all correlated with reduced PQOL and/or MQOL. Age was negatively correlated with PQOL (r = -0.08, P = 0.03) and positively correlated with MQOL (r = 0.142, P < 0.001). Care at large regional/academic centers was associated with higher MQOL (42 ± 14 versus 38 ± 11, P = 0.005). Age (β = -0.1, P = 0.04), education (β = 1.1, P = 0.005), and income (β = 2.0, P < 0.001) were predictors of PQOL, while age (β = 0.2, P < 0.001), income (β = 1.7, P = 0.002), and community hospital care (β = -3.6, P = 0.013) were predictors of MQOL.

CONCLUSIONS

In a large international survey of cancer survivors, we identified socioeconomic factors and their associations with QOL. Further work should be directed to provide durable support across all socioeconomic classes.

Associations between modifiable lifestyle factors and health-related quality of life among endometrial carcinoma survivors - A cross-sectional study

OBJECTIVE

To explore possible associations between modifiable lifestyle factors and health-related quality of life (HRQoL) in endometrial carcinoma survivors by assessing differences in HRQoL between survivors meeting and not meeting the World Health Organization's (WHO) recommendations regarding physical activity, BMI, and smoking.

METHODS

This was a cross-sectional population-based study in women having undergone surgery for assumed early-stage endometrial carcinoma. Thresholds for clinical importance based on the EORTC QoL working group were used to interpret scores. Effect size (ES) was interpreted as small (d = 0.2-0.49), medium (d = 0.5-0.8), and large (d > 0.8).

RESULTS

In total, 1200 evaluable women were included. Meeting physical activity recommendations and BMI <25 kg/m2 was associated with significantly better global health status, (ES) = 0.18 and ES = -0.11, respectively. On multivariate analysis, women meeting physical activity recommendations had significantly higher scores on physical- (ES = 0.31), role- (ES = 0.15), and social functioning (ES = 0.15), and lower levels of fatigue (ES = -0.16), pain (ES = -0.10), and appetite loss (ES = -0.15) (all p < 0.05) compared to non-meeting survivors. Participants with BMI ≥25 kg/m2 had lower scores for social functioning (ES = -0.10), and higher levels of pain (ES = 0.13) and dyspnea (ES = 0.12) (all p < 0.05) compared to those with BMI <25 kg/m2. Smokers had lower scores for emotional functioning (ES = -0.09) and higher levels of diarrhea (ES = 0.10) (all p < 0.05) compared to non-smokers.

CONCLUSION

Meeting WHO recommendations for modifiable life-style factors is associated with better HRQoL among endometrial carcinoma survivors: Being sufficiently physical active and having a BMI <25 kg/m2 are significantly associated with better self-reported global health status. All modifiable factors are associated with better functioning, and reduced symptom-burden.

Trends in physical activity research for breast cancer - A bibliometric analysis of the past ten years

Introduction

Cancer, particularly breast cancer, is a significant cause of death worldwide, and physical activity has been shown to reduce the risk of developing cancer and improve the prognosis of patients diagnosed with cancer. However, there is a lack of detailed analysis of publications related to physical activity in breast cancer patients, hindering the provision of strong evidence in this area.

Materials and methods

The Core Collection database of Web of Science (WoS) was used as the source of the bibliography, with a search conducted on October 16, 2023. The search strategy used the terms "Physical Activity" and "Breast Cancer" or "Lymphedema," identifying articles published between 2012 and 2022. The bibliometric analysis focused on three dimensions, including scientific production and delivery, scientific collaboration, and bibliometric evaluation at the individual level. We performed the data analysis with Bibiometrix, an open-source tool integrated with R that allows a complete analysis of the behavior of the scientific literature.

Results

A total of 979 publications related to physical activity o exercise in breast cancer (974 article, 1 data paper, 2 article early access y 2 proceedings paper), with an increasing trend in the number of articles published over the years. The most common research topics included "quality of life", "woman", "survivors", and the impact of physical activity on the risk of cancer recurrence. The United States was the most productive country in this area, and the Journal "Supportive Care in Cancer" was the most common journal to publish on this topic.

Conclusion

This bibliometric analysis provides insight into publication trends and common research topics in the area of physical activity and breast cancer. The results can be beneficial in guiding future physical rehabilitation research inquiries and providing information to funding agencies on areas of greatest research opportunities.

Preoperative quality of life at time of gynecologic surgery: considerations for postoperative management

BACKGROUND

Patients presenting for gynecologic surgery are a heterogeneous group. Preoperative quality of life may be a useful tool to guide postoperative management.

OBJECTIVE

This study aimed to examine the key drivers of preoperative quality of life to improve counseling and postoperative management.

STUDY DESIGN

This study analyzed preoperative survey results from 154 participants using the following surveys: National Institutes of Health Toolbox Global Health v1.2, Gastrointestinal: Gas and Bloating v1.1 13a, Gastrointestinal: Diarrhea v1.0 6a, and Sexual Function and Satisfaction Brief Profile (Female) v2.0, Perceived Stress Scale, the Vaginal Assessment Scale, and the Vulvar Assessment Scale. Survey results in the form of T-scores were compared in patients with endometrial cancer and patients with benign gynecologic conditions using the Kruskal-Wallis test. The multivariate analysis was performed using linear regression to adjust the comparisons for age, body mass index, and comorbidity.

RESULTS

Of the 154 patients, preoperative diagnosis was benign in 66% (n=102) and endometrial cancer in 34% (n=52). Patients with endometrial cancer were more likely to be older, non-White, in lower income brackets, have higher body mass index, and be postmenopausal (P<.05). Although preoperative global health scores were similar between benign and malignant cases (P>.05), when adjusted for age, the differences in global health quality of life between patients with benign gynecologic conditions and those with endometrial cancer became significant, because the endometrial cancer group was older than the benign group (P<.05). However, when adjusting for age, body mass index, and comorbidities (hypertension and diabetes), the differences were no longer significant (P>.05). Sexual interest was decreased in the patients with endometrial cancer both in the unadjusted and adjusted model; and vulvar complaints became significantly different between the groups when controlling for body mass index, age, and comorbidities (P<.05).

CONCLUSION

Despite substantial differences in preoperative diagnosis, preoperative quality of life is highly influenced by age, body mass index, and comorbidities. Therefore, these factors should be explored in surgical outcomes and postoperative management trials.

Cost-utility analysis of a supervised exercise intervention for women with early-stage endometrial cancer

PURPOSE

Cardiovascular disease (CVD) is the leading cause of death after treatment for endometrial cancer (EC). There is clinical evidence that exercise significantly reduces the risks of CVD and cancer recurrence in this population; however, it is unclear whether there is value for money in integrating exercise into cancer recovery care for women treated for EC. This paper assesses the long-term cost-effectiveness of a 12-week supervised exercise intervention, as compared with standard care, for women diagnosed with early-stage EC.

METHOD

A cost-utility analysis was conducted from the Australian health system perspective for a time horizon of 5 years. A Markov cohort model was designed with six mutually exclusive health states: (i) no CVD, (ii) post-stroke, (iii) post-coronary heart disease (CHD), (iv) post-heart failure, (v) post-cancer recurrence, and (vi) death. The model was populated using the best available evidence. Costs and quality-adjusted life years (QALYs) were discounted at 5% annual rate. Uncertainty in the results was explored using one-way and probabilistic sensitivity analyses (PSA).

RESULT

The incremental cost of supervised exercise versus standard care was AUD $358, and the incremental QALY was 0.0789, resulting in an incremental cost-effectiveness ratio (ICER) of AUD $5184 per QALY gained. The likelihood that the supervised exercise intervention was cost-effective at a willingness-to-pay threshold of AUD $50,000 per QALY was 99.5%.

CONCLUSION

This is the first economic evaluation of exercise after treatment for EC. The results suggest that exercise is cost-effective for Australian EC survivors. Given the compelling evidence, efforts could now focus on the implementation of exercise as part of cancer recovery care in Australia.

Impact of Treatment Modality on Quality of Life Among Uterine Cancer Survivors

AIMS

Our understanding of the impact of adjuvant therapy on longitudinal quality of life (QoL) following surgery for patients with uterine cancer is limited. The purpose of this study was to compare QoL in patients who have undergone surgery with or without radiation therapy for uterine cancer.

MATERIALS AND METHODS

This was a cross-sectional cohort study that examined women treated for uterine cancer at MD Anderson Cancer Center from 2006 to 2017. Participants included those who underwent hysterectomy/bilateral salphingo-oophorectomy alone, with brachytherapy or external beam radiation therapy (EBRT). A non-cancer cohort of women who underwent a hysterectomy/bilateral salphingo-oophorectomy for benign indications was also identified (non-CA). To compare QoL we used the Functional Assessment of Cancer Therapy - Endometrial survey (FACT-En), a validated survey used to assess QoL. The survey has five subscales: physical, social, emotional, functional and an endometrial cancer-specific subscale. Cohorts were compared using ANOVA tests.

RESULTS

In total, 309 women responded to the questionnaire (hysterectomy/bilateral salphingo-oophorectomy 64, brachytherapy 77, EBRT 96, non-CA 72). The median time from surgery to survey completion was 6.7 years. The mean total FACT-En score for the entire cohort was 144 [standard deviation 22]. Overall QoL was different between cohorts, with the EBRT cohort reporting the lowest QoL (mean 139.4 [21.6]) and the brachytherapy cohort the highest (150.6 [18.2], P = 0.006). Among patients who had undergone cancer treatment, the EBRT cohort reported the worst endometrial-specific QoL (53.5 [8.6]), while again the brachytherapy group reported the highest score (57.5 [6.1], P = 0.007).

CONCLUSIONS

QoL differences in women who have undergone different treatments for uterine cancer may persist years after treatment. In women with endometrial cancer who require adjuvant therapy, brachytherapy does not appear to have any long-term detriments on QoL.

Feasibility and Effectiveness of the Exercise Program in Endometrial Cancer; Feasibility and Acceptability Survivorship Trial (EPEC-FAST)

To evaluate the feasibility of an individualized exercise program in the standard care for endometrial cancer patients aimed to improve quality of life and other health outcomes. This was a single-arm prospective intervention trial to assess the feasibility of an individualized exercise intervention in endometrial cancer patients after treatment. The exercise intervention consisted of weekly individualized training sessions, for 10 weeks, at a local gym facility. The program started six weeks post-operatively. Primary outcomes were feasibility aspects including number of eligible patients, recruitment and adherence rates. Secondary outcomes included quality of life outcomes and anthropometric measures. A total of 54 women were eligible for participation, of which 22 (41%) consented to the study. Overall attendance was 86%, and there were no adverse events. There was a significant improvement in quality of life outcomes, including role (p = 0.02), emotional (p = 0.02) and cognitive functioning (p = 0.04). In addition, there was a significant improvement in visceral fat percentage (p = 0.039) and physical fitness (six-minute walk test p < 0.001). The maximum weight loss achieved was 6.0 kg after 3 months and 8.4 kg after 6 months. An individualized one-to-one exercise intervention in endometrial cancer patients is feasible in terms of recruitment, adherence and safety.

Relationships among changes in physical activity, quality of life, and obesity-Status following a behavioral intervention for rural Appalachian adults

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Increasing weekly strength training was associated with reduced unhealthy days.

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No other physical activity and health-related quality of life (HRQoL) changes were linked.

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Baseline obesity did not moderate physical activity and HRQoL change relationships.

Improved health-related quality of life (HRQoL) is one benefit of physical activity. Yet, there is limited intervention research exploring (1) whether changes in physical activity influence changes in HRQoL among community-based populations and (2) if baseline obesity status influences the relationships. This exploratory analysis used secondary data from rural Appalachian adults who completed the MoveMore arm of a larger randomized control trial (n = 105, M_age = 41.8, 82 % female, 96 % White, M_income= $25,911). Specifically, this study examined associations among changes in physical activity and HRQOL and whether baseline obesity status moderated changes. Three HRQoL variables (self-rated health status, total unhealthy days, days poor health impacted activities) and two physical activity variables [weekly moderate-vigorous physical activity (MVPA) minutes, weekly strength training minutes] were collected at baseline and 6-months. Regression models, adjusted for age, gender, race, income, education, assessed associations between physical activity and HRQoL change variables. Moderation analyses explored the influence of baseline obesity status on these relationships. Participants reported significant improvements in self-rated health status (P = 0.001), weekly MVPA minutes (P = 0.008), and weekly strength training minutes (P < 0.001). Increasing weekly strength training minutes was associated with fewer days poor health impacted activities (B = -0.040, P = 0.013). Weekly minutes of MVPA was not associated with HRQoL variables. Baseline obesity status did not moderate relationships. Findings suggest increasing weekly strength training may reduce days poor health impacted activities and that relationships among changes in physical activity and HRQoL were not impacted by baseline obesity. Findings have implications for promoting strength activities in community-based physical activity interventions for rural populations.

A nationally representative study of aerobic activity and strength training in older cancer survivors and their psychological distress and sleep difficulties

OBJECTIVE

To examine the prevalence of different levels of aerobic activity and strength training in older cancer survivors and their associations with psychological distress and sleep difficulties.

METHODS

We used cross-sectional data from the 2016-2018 National Health Interview Survey on 3,425 survivors aged ≥ 65 years. Individuals were classified into active, insufficiently active, and inactive categories, and by whether they reported strength training at least twice per week. The outcome variables were self-reported psychological distress, trouble falling asleep, trouble staying asleep, and trouble waking up feeling rested. Multivariate logistic models were used to calculate the odds ratios (ORs) and the 95% confidence intervals (CIs).

RESULTS

Only 35.2% of older survivors reached the recommended aerobic activity guidelines, and 12% had strength training at least twice per week. A total of 626 (18.3%) reported at least moderate psychological distress, and 1,137 (33.2%) had trouble staying asleep. For survivors who reported strength training less than two times per week, being insufficiently active or inactive was associated with worse psychological distress (OR 1.52, 95% CI 1.17-1.97; OR 1.30, 95% CI 1.02-1.64) and more sleep difficulties (OR ranging from 1.33 to 2.07). Among active survivors, strength training two or more times per week was associated with more trouble staying asleep (OR 1.67, 95% CI 1.06-2.58).

CONCLUSIONS

Most older cancer survivors did not meet the recommended physical activity guidelines and suffered from psychological distress and sleep difficulties. Additional research may be needed to examine the effects of frequent muscle strength training on sleep quality.

Research Trends around Exercise Rehabilitation among Cancer Patients: A Bibliometrics and Visualized Knowledge Graph Analysis

This study analyzed the research hotspots and frontiers of exercise rehabilitation among cancer patients via CiteSpace. Relevant literature published in the core collection of the Web of Science (WoS) database from January 1, 2000, to February 6, 2022, was searched. Further, we used CiteSpace5.8R1 to generate a network map and identified top authors, institutions, countries, keywords, and research trends. A total of 2706 related literature were retrieved. The most prolific writer was found to be Kathryn H Schmitz (21 articles). The University of Toronto (64 articles) was found to be the leading institution, with the United States being the leading country. Further, “rehabilitation,” “exercise,” “quality of life,” “cancer,” and “physical activity” were the top 5 keywords based on frequency; next, “disability,” “survival,” “fatigue,” “cancer,” and “rehabilitation” were the top 5 keywords based on centrality. The keyword “fatigue” was ranked at the top of the most cited list. Finally, “rehabilitation medicine,” “activities of daily living,” “lung neoplasm,” “implementation,” “hospice,” “exercise oncology,” “mental health,” “telemedicine,” and “multidisciplinary” are potential topics for future research. Our results show that the research hotspots have changed from “quality of life,” “survival,” “rehabilitation,” “exercise,” “cancer,” “physical therapy,” “fatigue,” and “breast cancer” to “exercise oncology,” “COVID-19,” “rehabilitation medicine,” “inpatient rehabilitation,” “implementation,” “telemedicine,” “lung neoplasm,” “telehealth,” “multidisciplinary,” “psycho-oncology,” “hospice,” “adapted physical activity,” “cancer-related symptom,” “cognitive function,” and “behavior maintenance.” Future research should explore the recommended dosage and intensity of exercise in cancer patients. Further, following promotion of the concept of multidisciplinary cooperation and the rapid development of Internet medical care, a large amount of patient data has been accumulated; thus, how to effectively use this data to generate results of high clinical value is a question for future researchers.

Interactions between physical activity and type of cancer treatment received on associations with psychosocial outcomes among gynecologic cancer survivors

OBJECTIVE

Physical activity is associated with improved cancer outcomes; however, it is unclear which patients may benefit most from increased physical activity. We evaluated whether associations between meeting the American Cancer Society (ACS) physical activity recommendations and psychosocial outcomes in gynecologic cancer survivors varied by type of treatments received.

METHODS

We recruited English-speaking adult gynecologic cancer patients from an academic gynecologic oncology practice to participate in a prospective cohort study. Participants completed a survey at study entry regarding their psychosocial health-including distress, depression, anxiety, post-traumatic stress disorder, and quality of life (QoL)-and physical activity. Multivariate linear regression models for each psychosocial outcome tested for interactions between physical activity and each effect modifier (receipt of chemotherapy, radiation therapy, and/or minimally invasive surgery), adjusted for age, pain, body mass index, primary cancer diagnosis, cancer stage, time since diagnosis, and annual household income.

RESULTS

Among a total of 362 participants, 213 (59%) met ACS physical activity recommendations. We found evidence of interactions between physical activity and receipt of chemotherapy for depression, anxiety, and QoL scores; those who had received chemotherapy had a stronger association between physical activity and these psychosocial outcomes, compared to those who had not. We found no evidence of interactions between physical activity and receipt of radiation therapy or minimally invasive surgery for any of the outcomes.

CONCLUSIONS

Gynecologic cancer survivors who received chemotherapy had significant associations between psychosocial health and physical activity, suggesting they may derive greatest benefit from prescribed exercise.

Falls, walking or balance problems, and limitations in activities of daily living (ADLs) among older endometrial cancer survivors

PURPOSE

Functional status deficits are important quality of life concerns for older cancer survivors. We examined the prevalence of falls, walking/balance problems, and limitations in activities of daily living (ADLs) among older women with a history of endometrial cancer.

METHODS

Cancer registry records from the Surveillance, Epidemiology, and End Results (SEER) program linked with Medicare Health Outcomes Survey (MHOS) data were used to identify endometrial cancer survivors aged ≥ 65 years who completed a survey ≥ 1 year after their cancer diagnosis (N = 3766), as well as an age- and race-matched group of women without a cancer history (N = 3766). We estimated prevalence ratios (PRs) to compare the prevalence of falls, walking or balance problems, and limitations in ADLs (bathing, dressing, eating, getting in/out of chairs, walking, using the toilet) between groups.

RESULTS

Difficulty with walking or balance was more common among survivors than the noncancer group (43% vs 36%; PR = 1.19; 95% CI: 1.10-1.27). Fall prevalence was similar between groups (endometrial cancer: 25%; noncancer: 26%; PR = 0.98; 95% CI: 0.89-1.08). Nearly half of endometrial cancer survivors (47%) reported at least one ADL limitation, with several activities (getting in/out of a chair, walking, bathing, using the toilet) more often limited among survivors than among women without cancer.

CONCLUSION

Functional impairments, especially problems with walking and/or balance, are common among older endometrial cancer survivors. Our results highlight the importance of addressing functional problems during the ongoing survivorship care of women with a history of endometrial cancer, with referral to rehabilitation or other relevant services when indicated.

Chronic Fatigue in Cancer, Brain Connectivity and Reluctance to Engage in Physical Activity: A Mini-Review

A large amount of evidence shows that after a cancer diagnosis, patients significantly reduce their level of physical activity. Usually, this reduction is attributed to cancer-related fatigue. However, to our knowledge, no study has clearly demonstrated that fatigue alters effort-based decision-making in cancer. This mini-review aimed to provide evidence that chronic fatigue in cancer patients causes changes in brain connectivity that impact effort-based decision-making. Indeed, three patterns of activation to compensate for dysfunctional networks have been reported: greater variability in the executive network and hyperactivation in the executive network, which account for less efficient and costly processes in the frontal cortex, and reduced deactivation in the default mode network. Nevertheless, these activation patterns are also observed with other factors, such as anticipatory stressors (worry, rumination or sleep loss), that might also cause reluctance to engage in physical activity. Effort-based decision-making involving weighing costs against benefits and physical activity interventions should increase immediate benefits to facilitate engagement in effortful activities.

Clinical and Demographic Factors Associated With Follow-Up in a Hospital-Based Exercise Oncology Program

Objective:

Despite the numerous benefits of regular exercise participation for cancer survivors, nearly 60% of survivors do not meet current guidelines. Hospital-based exercise oncology programs may be one strategy to promote exercise engagement as survivors have expressed a preference for exercise programs associated with a cancer hospital. However, follow-up rates in hospital-based exercise oncology programs can be low. Follow-up assessments are a critical component of exercise oncology programs as they determine survivor progress, allow for revision of exercise prescriptions, and demonstrate the effectiveness of the exercise program. Therefore, the purpose of this study was to identify clinical and demographic factors associated with not attending a 12-week follow-up assessment in a hospital-based exercise oncology program.

Methods:

We analyzed data collected from 2016 to 2019 (n = 849) from the Huntsman Cancer Institute’s hospital-based exercise oncology program, the Personal Optimism with Exercise Recovery (POWER) program. Cancer survivors completed an assessment at the start of POWER and were encouraged to attend a 12-week follow-up assessment. Factors associated with not attending a 12-week follow-up assessment were identified using logistic regression.

Results:

Multiple myeloma cancer survivors were more likely (OR 2.33; 95% CI 1.09, 4.98) to not attend a 12-week follow-up assessment, whereas endometrial cancer survivors were less likely (OR 0.39; 95% CI 0.18, 0.87). Greater travel time (OR 2.69; 95% CI: 1.83, 3.96) and distance (OR 2.37; 95% CI: 1.61, 3.49) were associated with not attending a 12-week follow-up assessment. Immunotherapy (OR 1.66; 95% CI 1.02, 2.72), waist circumference (OR 1.01; 95% CI 1.00, 1.02), overweight status per body mass index (OR 1.62; 95% CI 1.11, 2.38), and male sex (OR 1.70; 95% CI 1.23, 2.35) were associated with an increased likelihood of not attending a 12-week follow-up assessment. Survivors with a higher baseline quality of life (OR 0.96; 95% CI 0.93, 0.99) and peak oxygen consumption (OR 0.97; 95% CI 0.95, 0.99) were less likely not to attend a 12-week follow-up assessment.

Conclusions:

Both clinical and demographic factors were associated with not attending a 12-week follow-up assessment in a hospital-based exercise oncology program. Understanding factors related to follow-up assessment attendance in exercise oncology programs can inform the development of targeted interventions to improve follow-up rate thus maximizing exercise support for cancer survivors.

Sleep deprivation and quality of life among uterine cancer survivors: systematic review

INTRODUCTION

While cancer survival might be a relief from a near-death health condition, the after-recovery period also predisposes the survivors to deteriorated quality of life as well as sleep deprivation. Patients with cancer may experience post-traumatic stress disorder (PTSD) throughout the diagnostic process and even after diagnosis is completed, especially when facing the possibility of tumor recurrence. Survivors, in particular, are frequently in a condition of uncertainty due to the 15 to 20% chance of recurrence within 3 years of the main treatment. Despite the high rate of cancer survival, which is believed to be around 83%, assessing quality of life after a cancer diagnosis can help to improve such results.

PURPOSE

This article aimed to describe the sleep patterns among uterine cancer survivors and verify psychological and physical factors affecting their general qualities of life. According to the qualitative study, uterine cancer survivors who receive treatment, whether pharmaceutical or therapeutic, have a higher quality of life than those who do not.

METHOD

PRISMA reporting was used for this systematic review. Electronic databases that were searched include PubMed, Cochrane Trial Register, and ScienceDirect for studies evaluating the sleep deprivation and quality of life among uterine cancer survivors. Ten publications were chosen based on inclusion criteria that included uterine cancer survivors who had finished their treatments and addressed sleep quality or overall quality of life.

RESULTS

The main finding of the systematic review is that 61% of uterine cancer survivors had poor sleep quality, and 81% have a decreased quality of life.

CONCLUSION

According to the most recent research, uterine cancer survivors suffer from sleep deprivation, which leads to a lower quality of life. However, the same study reveals that uterine cancer survivors suffering with sleep loss use a variety of cognitive behavioral therapy to improve their quality of life. Maintaining a healthy diet, incorporating physical activity into daily routines, receiving cognitive behavior therapy, participating in relevant training programs, and obtaining frequent depression and sexual health screenings are just a few of the CBT mechanisms mentioned.

Quality of life in patients with endometrial carcinoma: A Longitudinal Study

AIM

To investigate the quality of life in patients with endometrial carcinoma and provide theoretical basis for nursing care.

DESIGN

In this study, 69 patients diagnosed with endometrial carcinoma from 2016-2018 were included in the cohort.

METHODS

Sixty-nine patients from our hospital who underwent endometrial cancer surgeries were selected. The SF-36 was used to investigate and analyse the patients' quality of life in the first, second and third months after their operations. Questionnaires were administered to analyse the factors affecting postoperative quality of life.

RESULTS

Quality of life for the second and third months was obviously better than that for the first month after the operation (p < .05). Based on multivariate regression analysis, we found that patients with higher family income had better quality of life after surgery(p < .05). These results can provide some guidance for daily nursing work after endometrial cancer operation.

Towards a better understanding of physical activity in people with COPD: predicting physical activity after pulmonary rehabilitation using an integrative competence model

The integrative Physical Activity-related Health Competence (PAHCO) model specifies competences (movement competence, control competence, and self-regulation competence) that enable people to lead a physically active lifestyle. This longitudinal study analyses the predictive quality of a multidimensional PAHCO assessment for levels of physical activity (PA) and their relevance for quality of life in COPD patients after pulmonary rehabilitation. At the end of an inpatient pulmonary rehabilitation (T2), 350 COPD patients participating in the Stay Active after Rehabilitation (STAR) study underwent assessments, including a six-factor measurement of PAHCO. PA (triaxial accelerometry) and quality of life (Saint George's Respiratory Questionnaire) were recorded 6 weeks (T3) and 6 months (T4) after rehabilitation. Structural equation modelling (SEM) was used to regress the PAHCO assessment on PA, which should, in turn, influence quality of life. In univariable analysis, five and six factors of the PAHCO model were related to PA and quality of life, respectively. Multivariate modelling showed that the predictive analyses for the PA level were dominated by the 6-minute walking test representing movement competence (0.562 ≤ |β| ≤ 0.599). Affect regulation as an indicator of control competence co-predicted quality of life at T3 and levels of PA at T4. The PA level was, in turn, significantly associated with patients' quality of life (0.306 ≤ |β| ≤ 0.388). The integrative PAHCO model may be used as a theoretical framework for predicting PA in COPD patients following pulmonary rehabilitation. The results improve our understanding of PA behaviour in COPD patients and bear implications for person-oriented PA promotion.

Patient-reported outcomes of non-pharmacological interventions for endometrial cancer survivors: a systematic review

PURPOSE

The objective of this review was to assess the efficacy of non-pharmacological interventions on endometrial cancer (EC) survivors' QOL, and their use of patient-reported outcome measures (PROMs).

METHODS

We conducted a systematic review of randomized controlled trials (RCTs) of non-pharmacological interventions that assessed the impact of intervention on EC survivors' general and domain-specific QOL (i.e., physical, psychological, and social well-being) using PROMs.

RESULTS

Of the 3178 studies identified, 28 full-text articles were reviewed, and 10 were included in the review. Nine RCTs assessed at least one PROM as a primary outcome and six assessed a PROM as a secondary outcome, but few studies used validated PROMs. Significant improvements in general QOL were found in two studies, domain-specific QOL in three studies, and both general and domain-specific QOL in three studies; however, effect sizes ranged from small to large and no significant effects were found for social well-being and few were found for psychological well-being.

CONCLUSIONS

Few non-pharmacological interventions for EC survivors targeted QOL, even though QOL was assessed as either a primary or secondary outcome of the RCT. Despite this, findings suggest that non-pharmacological interventions for EC survivors hold promise for improving general and domain-specific QOL. Use of validated PROMs would greatly enhance outcome reporting and facilitate comparisons across studies. More interventions are also needed that address social and psychological functioning in this population.

IMPLICATIONS FOR CANCER SURVIVORS

Our review highlights a need to (1) expand non-pharmacological RCTs for EC survivors, (2) increase the use of validated PROMs measuring QOL, and (3) address psychosocial domains of QOL when developing interventions for this population.

Effect of a technology-supported physical activity intervention on health-related quality of life, sleep, and processes of behavior change in cancer survivors: A randomized controlled trial

OBJECTIVES

This pilot trial tested the effect of adding a multi-level, technology-based physical activity intervention module to a standard survivorship care plan for breast and colorectal cancer survivors. The objective of this analysis was to determine whether the physical activity module improved health-related quality of life, sleep, and factors key to lasting behavior change (eg, social support, self-efficacy).

METHODS

Breast and colorectal cancer survivors (n = 50) were enrolled alongside a support partner. Survivors were assigned to receive a standard survivorship care plan either alone or augmented by a 12-week multi-component physical activity module. The module included a Fitbit tracker (with the physical activity data integrated into the electronic health record for clinician review) and customized email feedback. Physical activity was measured using the ActiGraph GT3X+. Psychosocial outcomes included the SF-36, FACT, ISEL, PROMIS sleep measures, and physical activity beliefs. Data were analyzed using linear mixed modeling.

RESULTS

Cancer survivors were aged 54.4 ± 11.2 years and were 2.0 ± 1.5 years from diagnosis. Relative to comparison, the intervention was associated with moderate-to-large improvements in physical health (effect size: d = 0.39, 95% CI = 0.0, 0.78), mental health (d = 0.59, 95% CI = 0.19, 0.99), sleep impairment (d = 0.62, 95% CI = -1.02, -0.22), and exercise self-efficacy (d = 0.60, 95% CI = 0.20, 1.0).

CONCLUSIONS

The intervention delivered meaningful improvements in survivors' quality of life, social support, and sleep impairment. If replicated in a larger sample, adding a technology-supported physical activity module to survivorship care plans may be a practical strategy for supporting healthy survivorship.

TRIAL REGISTRATION

ClinicalTrials.gov#: NCT02677389.

Longitudinal assessment of post-surgical physical activity in endometrial and ovarian cancer patients

OBJECTIVE

Physical activity plays a key role in cancer survivorship. The purpose of this investigation was to (a) describe the post-surgical physical activity trajectories of endometrial (n = 65) and ovarian (n = 31) cancer patients and (b) identify clinical and demographic predictors of physical activity over time.

METHODS

96 participants wore an Actiwatch accelerometer for three days at each of three time points (one week, one month and four months) after surgical intervention for their endometrial or ovarian cancer diagnosis. Analyses were conducted using linear mixed effects regression modeling in SAS 9.4.

RESULTS

For both tumor types, although physical activity levels increased with time after surgery, even at four months patients were performing only a small fraction of the 150 minutes of recommended weekly moderate to vigorous physical activity. At 1 week, subjects were completing on average 14 minutes/week (SD = 4) of moderate-to-vigorous physical activity, compared to 14 minutes/week (SD = 2) of moderate-to-vigorous physical activity at four months post-surgery (p < .05). Better self-rated health was associated with higher physical activity (p = 0.02) in endometrial cancer survivors only. BMI, age, surgery type and use of neoadjuvant chemotherapy were not associated with activity over time.

CONCLUSIONS

Our findings suggest that physical activity levels are different for those with better self-rated health, but those individuals are still insufficiently active. This study adds new information describing the trajectories and variables that influence physical activity in gynecologic cancer survivors after surgery and highlights the need for health promotion interventions in this population.