Incorporating Exercise Into the Cancer Treatment Paradigm

Temporal Trends in the Incidence and Mortality of Major Reproductive-Related Cancers in Women in Guangzhou From 2010 to 2020: A Joinpoint and Age-Period-Cohort Study

Objective: To understand the temporal trends of cancer incidence and mortality in women in Guangzhou during the past 11 years and provide clues for future research. Methods: Data were obtained from the Guangzhou Cancer and Death Registry. Average annual percentage changes (AAPCs) in age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) were obtained by joinpoint regression. The age-period-cohort (APC) model was generated to quantify the effects of age, period, and cohort. Results: The ASIRs for cervical (AAPC = -4.3%) and ovarian (AAPC = -3.2%) cancers showed a downward trend during 2010-2020, and that for uterine cancer showed an upward trend. The ASMRs of breast (APC = 5.0%) and cervical (APC = 8.8%) cancers increased. The APC model highlights different age, period, and birth cohort effects depending on the cancer site. Conclusion: The ASIRs for cervical and ovarian cancers among women in Guangzhou showed a decreasing trend during the period. The APC model showed mortality for 4 cancers increased with age. Incidence and mortality decreased with increasing birth cohort. Annual reproductive cancer screening is recommended for women of appropriate age to reduce the disease burden.

Community-Based Exercise Programs for Cancer Survivors: A Scoping Review of Program Characteristics Using the Consolidated Framework for Implementation Research

OBJECTIVE

To describe the characteristics of exercise programs for survivors of cancer conducted outside of a research laboratory (ie, home-based or community-based settings).

DATA SOURCES

A systematic search of published literature was conducted using Medline, Pubmed, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, SPORTdiscus, and Embase from 1980 to January 2021. Where conference abstracts were identified, authors were contacted for other articles.

STUDY SELECTION

Two independent reviewers screened titles and abstracts and full texts of potentially relevant studies to determine eligibility, with discrepancies resolved by discussion. Included studies were reports of exercise programs or interventions in which participants exercise at home or in a community-based setting and including individuals diagnosed with cancer either undergoing treatment or who had completed treatment.

DATA EXTRACTION

Data were extracted using the Oxford Implementation Index and coded under the 5 domains of the Consolidated Framework for Implementation Research (CFIR). Extraction and coding were completed by 2 independent reviewers, with discrepancies resolved through discussion. Data were synthesized narratively according to CFIR.

DATA SYNTHESIS

A total of 58 publications describing 34 individual programs from around the world were included. Of these, only 14 publications had the specific goal of reporting on program implementation and development. A variety of intervention characteristics and characteristics of individuals involved in the intervention were described. Reporting of factors related to the CFIR domains of inner setting, outer setting, and implementation process were minimal.

CONCLUSIONS

This review summarizes the characteristics of existing programs that have been reported in the literature and finds that partnerships and collaboration occur in the inner and outer settings and as part of the process of implementation. This review highlights key knowledge gaps to be answered to support the development of future community-based interventions.

Reduced Cancer-Related Fatigue after Tablet-Based Exercise Education for Patients

AIM

Exercise can be an effective treatment for cancer-related fatigue, but exercise is not prescribed for many cancer patients. Our specific aim was to compare usual care and a tablet-based fatigue education and prescription program for effects on level of fatigue (primary outcome) and satisfaction with fatigue and amount of exercise (secondary outcomes).

METHODS

In a four-week pretest/posttest randomized study, 279 patients with cancer completed a touch screen fatigue assessment and daily paper-based activity logs. The experimental group also had access to FatigueUCope, a tablet-based multimedia education intervention focused on exercise as therapy for fatigue.

RESULTS

In total, 94% of intervention group accessed FatigueUCope. Controlling for baseline fatigue, compared to the usual-care group, the experimental group reported lower fatigue scores (P = .02). Neither satisfaction with fatigue nor exercise level was significantly different between groups, but not all activity logs were returned. None of the patients reported adverse effects.

CONCLUSION

Objective indicators of exercise are warranted in future studies to examine whether exercise is indeed the mechanism of the FatigueUCope effect and determine the clinical utility of this intervention. This brief, engaging tablet-based multimedia education and prescription program has promise to help patients recognize the benefits of exercise to manage cancer-related fatigue.

Quality of Life: A Nurse-Led Physical Activity Coaching Program to Improve the Quality of Life of Patients With Cancer During the COVID-19 Pandemic

BACKGROUND

Physical activity has been shown to mitigate many of the effects of cancer treatment, yet it often is not embraced by the patient or made part of the nursing standard of care.

OBJECTIVES

This pilot study evaluates the impact of the Oncology Nursing Society's Get Up, Get Moving program, a personalized, home-based, nurse-led physical activity coaching program.

METHODS

Patients with cancer in the intervention and control groups completed the SF-36® and the Godin Leisure-Time Exercise Questionnaire at weeks 1 and 12. All patients were initially counseled on exercise. A nurse called each member of the intervention group weekly to encourage physical activity and asked about fatigue, nausea, and step count. The control group was contacted at 6 weeks and 12 weeks only.

FINDINGS

The program, coupled with nurse telephone calls, increased steps, decreased fatigue, and maintained health-related quality of life among patients in the intervention group. The control group had a decrease in steps, a decline in their SF-36 general health score, and an increase in fatigue. Nurse coaching positively affects physical activity, which may help to decrease cancer treatment side effects.

A Randomized Controlled Trial of a Physical Activity Intervention for Self-management of Fatigue in Adolescents and Young Adults With Cancer

BACKGROUND

Fatigue remains a persistent and troubling symptom for adolescents and young adults (AYAs) with cancer. Physical activity (PA) is recommended as a strategy for self-management of fatigue.

OBJECTIVE

The aim of the study was to examine a PA intervention to improve the self-management of fatigue in AYAs during chemotherapy.

METHODS

This randomized controlled trial enrolled AYAs (18-39 years) receiving chemotherapy. Adolescents and young adults in the intervention group received a 12-week PA intervention integrated into 5 clinic visits that included education, PA tracking, and collaboration. Physical activity was measured with an accelerometer, and participants completed measures of fatigue severity, self-efficacy for PA, and self-regulation at baseline and end of study.

RESULTS

Forty-four AYAs completed the study. At baseline, AYAs averaged 4290 (SD, 2423) steps/day and 14.4 (SD, 20.6) minutes/day of moderate- to vigorous-intensity PA; their average Patient-Reported Outcomes Measurement Information System fatigue score was 55.0 (SD, 9.2). At end of study, there were no significant differences between groups in fatigue, self-efficacy, self-regulation, or PA, but trends in the desired direction were observed for each of the variables in the intervention group.

CONCLUSION

During chemotherapy, AYAs had variable levels of PA and engaged in mostly light-intensity PA. Their average fatigue level was slightly worse than a national comparison group.

IMPLICATIONS FOR PRACTICE

Tailored interventions are needed to promote PA in AYAs as a self-management strategy for fatigue. Enhancing self-efficacy and self-regulation may be important approaches to promote PA.

Exercise Intervention: A Pilot Study to Assess the Feasibility and Impact on Cancer-Related Fatigue and Quality of Life Among Patients With High-Grade Glioma

BACKGROUND

Cancer-related fatigue (CRF) is a challenging symptom, often compromising quality of life (QOL) and hindering physical activity among patients with cancer.

OBJECTIVES

This 18-month pilot study assessed the feasibility to recruit and retain participants with high-grade glioma into a 10-week exercise intervention and evaluated the effects on CRF and QOL.

METHODS

Participants were enrolled into the usual care, education, or exercise group based on time of enrollment and radiation treatment location. Feasibility was determined by accrual and retention rates. Fatigue and QOL were assessed at weeks 0, 3, and 10. Descriptive statistics and percentage change were used for pre-/post-test differences.

FINDINGS

Exercise participants experienced less fatigue and improved QOL as compared to the usual care and education groups, suggesting that exercise favorably affects clinical outcomes and is feasible among patients with high-grade glioma.

Exercise Intervention: Attrition, Compliance, Adherence, and Progression Following Hematopoietic Stem Cell Transplantation

BACKGROUND

Exercise is widely touted as an effective intervention to optimize health and well-being after high-dose chemotherapy and hematopoietic stem cell transplantation. 
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OBJECTIVES

This article reports attrition, compliance, adherence, and progression from the strength training arm of the single-blind randomized, controlled trial Strength Training to Enhance Early Recovery (STEER). 
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METHODS

37 patients were randomized to the intervention and participated in a structured strength training program introduced during hospitalization and continued for six weeks after release. Research staff and patients maintained exercise logs to document compliance, adherence, and progression. 
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FINDINGS

No patients left the study because of burden. Patients were compliant with completion of exercise sessions, and their adherence was high; they also progressed on their exercise prescription. Because STEER balances intervention effectiveness with patient burden, the findings support the likelihood of successful translation into clinical practice.