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Cantwell M, Moyna N, McCaffrey N, Skelly F, Loughney L, Woods C, Walsh D, Dowd K, McCarren A, Kehoe B. A two-arm non-randomised trial of MedEx IMPACT: a community-based, physical activity behaviour change intervention for survivors of cancer. Support Care Cancer 2024; 32:95. [PMID: 38198017 DOI: 10.1007/s00520-023-08263-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 12/16/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE This two-arm non-randomised trial examined the short- and long-term effects of a usual care (UC) community-based exercise programme (MedEx Move On (MMO)), and UC combined with a physical activity (PA) behaviour change (BC) intervention (MedEx IMproved PA after Cancer Treatement (MedEx IMPACT)) on PA levels, cardiorespiratory fitness (CRF) and quality of life (QoL) among survivors of cancer. METHODS Cancer survivors referred to MMO were recruited (n = 191; mean age (± SD) 56 (± 10y), 73% female). Eighty-seven participants were assigned to UC, and 104 participants were assigned to the MedEx IMPACT intervention group (MI). UC and MI both received twice-weekly supervised exercise classes for 12-weeks. MI also received an independent PA programme, 4 PA information sessions and a 1:1 exercise consultation during the 12-week programme. Assessments of physical and psycho-social health, including 6-day accelerometry, the 6-min time trial and the Functional Assessment of Cancer Therapy-General QoL questionnaire, were conducted at baseline (T1), post-intervention (T2) and 3 months following programme completion (T3). RESULTS Linear mixed-model analyses of variance demonstrated significant main effects for time for both groups from T1 to T2 with increases in objectively measured daily steps (p < 0.05), CRF (p < .001) and QoL (p < .01), which were maintained for CRF (p < .001) at T3. MI participants also maintained increases achieved at T2, in steps and QoL, at T3 (p < 0.01). CONCLUSION Twelve weeks of twice-weekly supervised exercise was effective in increasing PA, CRF and QoL among survivors of cancer. MI resulted in the maintenance of all improvements achieved 3 months following programme completion.
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Affiliation(s)
- Mairéad Cantwell
- Department of Sport and Health Sciences, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, Co. Westmeath, Ireland.
- School of Health and Human Performance, Dublin City University, Dublin, Ireland.
- Irish Cancer Society, Dublin, Ireland.
| | - Niall Moyna
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Noel McCaffrey
- MedEx Wellness, School of Health & Human Performance, Dublin City University; ExWell Medical, Dublin, Ireland
| | - Fiona Skelly
- Department of Sport and Health Sciences, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, Co. Westmeath, Ireland
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- MedEx Wellness, School of Health & Human Performance, Dublin City University; ExWell Medical, Dublin, Ireland
| | - Lisa Loughney
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Catherine Woods
- Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Deirdre Walsh
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Department of Social Sciences, Technological University of the Shannon: Midlands Midwest, Athlone, Ireland
| | - Kieran Dowd
- Department of Sport and Health Sciences, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, Co. Westmeath, Ireland
| | - Andrew McCarren
- School of Computing, Dublin City University, Dublin, Ireland
| | - Bróna Kehoe
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Department of Sport and Exercise Science, South East Technological University, Waterford, Ireland
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Dissemination and implementation strategies for physical activity guidelines among adults with disability, chronic conditions, and pregnancy: a systematic scoping review. BMC Public Health 2022; 22:1034. [PMID: 35606712 PMCID: PMC9126633 DOI: 10.1186/s12889-022-13317-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity guidelines for adults with disability, chronic conditions, and pregnancy (i.e., specific populations) have been developed to provide guidance for engaging in physical activity. However, specific populations remain considerably less physically active compared to the general population, presenting a knowledge-practice gap. PURPOSE The purpose of this systematic scoping review was to identify and evaluate strategies for disseminating and implementing physical activity guidelines among specific populations and/or stakeholders (e.g., healthcare professionals) in Canada. METHODS Five search approaches (peer-reviewed literature databases, grey literature database, custom Google search engines, targeted web-based searches, and content expert consultation) identified records documenting and/or evaluating strategies that had been used to disseminate or implement guidelines from a predetermined list. Systematic and scoping review protocols were followed. Risk of bias assessments were conducted for all studies that evaluated strategies. RESULTS Eighty-one records reported dissemination strategies (n = 42), implementation strategies (n = 28), or both (n = 11). Twenty-two studies reporting on 29 evaluated strategies were deemed "serious" or "high" risk of bias. Common guideline dissemination and implementation strategies are deliberated and recommendations for future practice are made. CONCLUSIONS Findings may inform future dissemination and implementation efforts for physical activity guidelines in Canada or similar countries.
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Czosnek L, Richards J, Zopf E, Cormie P, Rosenbaum S, Rankin NM. Exercise interventions for people diagnosed with cancer: a systematic review of implementation outcomes. BMC Cancer 2021; 21:643. [PMID: 34053445 PMCID: PMC8166065 DOI: 10.1186/s12885-021-08196-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/14/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Exercise is efficacious for people living after a cancer diagnosis. However, implementation of exercise interventions in real-world settings is challenging. Implementation outcomes are defined as 'the effects of deliberate and purposive actions to implement new treatments, practices, and services'. Measuring implementation outcomes is a practical way of evaluating implementation success. This systematic review explores the implementation outcomes of exercise interventions evaluated under real-world conditions for cancer care. METHODS Using PRISMA guidelines, an electronic database search of Medline, PsycInfo, CINAHL, Web of Science, SportsDiscus, Scopus and Cochrane Central Registry of Controlled Trials was conducted for studies published between January 2000 and February 2020. The Moving through Cancer registry was hand searched. The Implementation Outcomes Framework guided data extraction. Inclusion criteria were adult populations with a cancer diagnosis. Efficacy studies were excluded. RESULTS Thirty-seven articles that described 31 unique programs met the inclusion criteria. Implementation outcomes commonly evaluated were feasibility (unique programs n = 17, 54.8%) and adoption (unique programs n = 14, 45.2%). Interventions were typically delivered in the community (unique programs n = 17, 58.6%), in groups (unique programs n = 14, 48.3%) and supervised by a qualified health professional (unique programs n = 14, 48.3%). Implementation outcomes infrequently evaluated were penetration (unique programs n = 1, 3.2%) and sustainability (unique programs n = 1, 3.2%). CONCLUSIONS Exercise studies need to measure and evaluate implementation outcomes under real-world conditions. Robust measurement and reporting of implementation outcomes can help to identify what strategies are essential for successful implementation of exercise interventions. IMPLICATIONS FOR CANCER SURVIVORS Understanding how exercise interventions can be successful implemented is important so that people living after a cancer diagnosis can derive the benefits of exercise.
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Affiliation(s)
- Louise Czosnek
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, 3000, Australia.
| | - Justin Richards
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Eva Zopf
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, 3000, Australia
| | - Prue Cormie
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, 3000, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Simon Rosenbaum
- School of Psychiatry, University of New South Wales, Sydney, Australia
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Nicole M Rankin
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Covington KR, Marshall T, Campbell G, Williams GR, Fu JB, Kendig TD, Howe N, Alfano CM, Pergolotti M. Development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm. Support Care Cancer 2021; 29:6469-6480. [PMID: 33900458 DOI: 10.1007/s00520-021-06208-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Participation in exercise or rehabilitation services is recommended to optimize health, functioning, and well-being across the cancer continuum of care. However, limited knowledge of individual needs and complex decision-making are barriers to connect the right survivor to the right exercise/rehabilitation service at the right time. In this article, we define the levels of exercise/rehabilitation services, provide a conceptual model to improve understanding of individual needs, and describe the development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm. METHODS From literature review, we synthesized defining characteristics of exercise/rehabilitation services and individual characteristics associated with safety and efficacy for each service. We developed a visual model to conceptualize the need for each level of specialized care, then organized individual characteristics into a risk-stratified algorithm. Iterative review with a multidisciplinary expert panel was conducted until consensus was reached on algorithm content and format. RESULTS We identified eight defining features of the four levels of exercise/rehabilitation services and provide a conceptual model of to guide individualized navigation for each service across the continuum of care. The EXCEEDS algorithm includes a risk-stratified series of eleven dichotomous questions, organized in two sections and ten domains. CONCLUSIONS The EXCEEDS algorithm is an evidence-based decision support tool that provides a common language to describe exercise/rehabilitation services, a practical model to understand individualized needs, and step-by-step decision support guidance. The EXCEEDS algorithm is designed to be used at point of care or point of need by multidisciplinary users, including survivors. Thus, implementation may improve care coordination for cancer exercise/rehabilitation services.
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Affiliation(s)
- Kelley R Covington
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA, USA. .,Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA.
| | | | - Grace Campbell
- Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.,Department of Occupational Therapy, University of Pittsburgh School of Health & Rehabilitation Sciences, Pittsburgh, PA, USA.,UPMC Hillman Cancer Center at UPMC Magee Women's Hospital, Pittsburgh, PA, USA
| | - Grant R Williams
- Department of Medicine, Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jack B Fu
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tiffany D Kendig
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA, USA.,Kessler Institute of Rehabilitation, West Orange, NJ, USA
| | - Nancy Howe
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | | | - Mackenzi Pergolotti
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA, USA.,Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA
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Truant TLO, Lambert LK, Thorne S. Barriers to Equity in Cancer Survivorship Care: Perspectives of Cancer Survivors and System Stakeholders. Glob Qual Nurs Res 2021; 8:23333936211006703. [PMID: 33912623 PMCID: PMC8050754 DOI: 10.1177/23333936211006703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/16/2022] Open
Abstract
As more cancer patients survive into post-treatment, the challenge of managing their survivorship care is confronting health care systems globally. In striving to deliver high quality survivorship care, equity constitutes a particularly troublesome challenge. We analyzed accounts from both cancer survivors and stakeholders within care system management to uncover insights with respect to barriers to equitable cancer survivorship services. Beyond the social determinants of health that shape inequities across all of our systems, the cancer care system involves a pattern of prioritizing biomedicine, evidence-based options, and care standardization. We learned that these lead to system rigidities that not only compromise the individualization essential to person-centered care but also obscure the attention to group differences that becomes indispensable to responsiveness to inequities. On the basis of these insights, we reflect on what may be required to begin to redress the current and projected inequities with respect to access to appropriate cancer survivorship supports and services.
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Affiliation(s)
| | - Leah K Lambert
- BC Cancer, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | - Sally Thorne
- University of British Columbia, Vancouver, Canada
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Community-based exercise programs and cancer-related fatigue: a systematic review and meta-analysis. Support Care Cancer 2021; 29:4921-4929. [PMID: 33751225 DOI: 10.1007/s00520-021-06135-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To explore the prevalence of cancer-related fatigue (CRF) within community-based exercise programs and to determine the overall impact that participation in community-based exercise programs have on CRF. METHODS Literature searches were performed in March and updated in April of 2020. Studies that were community-based in adult cancer populations and reported CRF outcomes were included. Mean and standard deviations for CRF from 12 studies were extracted in order to compute a pooled effect size via a random effects model. An overall percentage was computed to discern how many community-based exercise programs reported CRF. RESULTS Sample sizes varied among studies with most patients being middle-aged with breast cancer in the post-treatment setting. Most programs implemented aerobic + resistance exercise training interventions (~77%). Only ~42% of programs identified in the review reported CRF outcomes. The random effects model produced a pooled effect size of 0.30 (p < 0.001). CONCLUSIONS Fewer than half of the identified community-based exercise programs reported CRF outcomes (~42%). Of those that did, the random effects model revealed a small yet significant impact on improving CRF after exercise participation, though more research is certainly needed in this area. This review produced promising preliminary evidence for the impact of community-based exercise programs on CRF. As exercise interventions transition to community-based facilities, patients should feel confident that these programs will continue to assist in managing CRF that is commonly experienced across the cancer continuum.
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Adams SC, Petrella A, Sabiston CM, Vani MF, Gupta A, Trinh L, Matthew AG, Hamilton RJ, Mina DS. Preferences for exercise and physical activity support in adolescent and young adult cancer survivors: a cross-sectional survey. Support Care Cancer 2021; 29:4113-4127. [PMID: 33409722 PMCID: PMC7787126 DOI: 10.1007/s00520-020-05897-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/16/2020] [Indexed: 02/05/2023]
Abstract
Purpose Exercise and physical activity (hereafter, collectively referred to as PA) preferences and benefits are becoming increasingly well characterised in cancer survivors, yet evidence from adolescent and young adult cancer survivors (AYAs) is scant. We describe the overall PA behaviour and support preferences of AYAs and explore subgroup differences to inform AYA-specific research and support. Methods AYAs diagnosed with cancer between the ages of 18–39 years, irrespective of current age, were approached in clinic at a large cancer centre for this cross-sectional survey that assessed self-reported demographics, medical history, PA behaviour and PA support preferences. Results A total of 318 AYAs completed the survey. Approximately 40% of AYAs were not meeting PA guidelines, and only 5% reported engagement with cancer PA support services. Most AYAs wanted PA support (78%), to increase PA levels (70%), and were interested in engaging in PA interventions that were individually supervised (82%), home-based (79%), performed ≥ 3 days/week (75%) and for ≥ 30 minutes/session (78%), offered following treatment (63%), restricted by age (63%), and involved strength (83%), walking (78%), and flexibility (75%) exercise. PA preferences most often differed according to sex, treatment status, current PA behaviour and PA support setting. Conclusion AYAs have a great capacity and interest in specific types of PA support. Poor engagement with existing PA support services highlights the need for further AYA-specific research. Better understanding of AYAs' unique PA behaviour and support preferences can inform the development of urgently needed research and support services for this understudied and rapidly growing population. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-020-05897-w.
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Affiliation(s)
- Scott C Adams
- Department of Cardiology, Toronto General Hospital Research Institute, Toronto, ON, M5G 2C4, Canada.
- Ted Rogers Cardiotoxicity Prevention Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, M5S2W6, Canada.
- Faculty of Kinesiology & Physical Education, University of Toronto, M5S2W6, Toronto, ON, Canada.
| | - Anika Petrella
- Faculty of Kinesiology & Physical Education, University of Toronto, M5S2W6, Toronto, ON, Canada
| | - Catherine M Sabiston
- Faculty of Kinesiology & Physical Education, University of Toronto, M5S2W6, Toronto, ON, Canada
| | - Madison F Vani
- Faculty of Kinesiology & Physical Education, University of Toronto, M5S2W6, Toronto, ON, Canada
| | - Abha Gupta
- Department of Supportive Care, Princess Margaret Cancer Centre, M5G2C1, Toronto, ON, Canada
- Hospital for Sick Children, M5G1X8, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, M5S1A8, Toronto, ON, Canada
| | - Linda Trinh
- Faculty of Kinesiology & Physical Education, University of Toronto, M5S2W6, Toronto, ON, Canada
| | - Andrew G Matthew
- Department of Supportive Care, Princess Margaret Cancer Centre, M5G2C1, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, M5S1A8, Toronto, ON, Canada
| | - Robert J Hamilton
- Faculty of Medicine, University of Toronto, M5S1A8, Toronto, ON, Canada
- Division of Urology, Department of Surgery, University Health Network, M5G1L7, Toronto, ON, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology & Physical Education, University of Toronto, M5S2W6, Toronto, ON, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, M5G2C1, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, M5S1A8, Toronto, ON, Canada
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Malam S, Lawrence B, Bradley C, McBride KM, Clement A, Conrad T, Noronha MC, Wong JK, Woo RA, Kassam Z. Integrating Survivorship Care Into a Radiation Medicine Program. Cureus 2020; 12:e8013. [PMID: 32528754 PMCID: PMC7279678 DOI: 10.7759/cureus.8013] [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: 11/21/2022] Open
Abstract
Introduction An important but often overlooked component of caring for cancer patients is survivorship care, provided after the completion of active treatment in order to facilitate transition into the next surveillance phase. A survivorship program was developed to deliver a one-on-one education session on healthy lifestyle behaviours and available resources to help patients transition to their post-treatment life. This study reports the outcome of this pilot survivorship care program provided to breast cancer patients completing radiation therapy. Program delivery format and content were evaluated for effectiveness, applicability, and feasibility. Methods and materials Between March 2017 and August 2018, 124 breast cancer patients, nearing completion of their curative intent radiation treatments, participated in this centre-specific survivorship program. The survivorship program entailed a one on one education session delivered to breast cancer patients within the last two weeks of their radiation treatment. Participants were provided a Microsoft PowerPoint presentation, information pamphlet, and evaluation form to provide feedback on materials and presentation. Survivorship education sessions were delivered by study staff or staff scheduled in the Pre-Radiotherapy Patient Assessment role. Follow-up phone calls were conducted post-session delivery to determine the ongoing applicability of survivorship material. Staff was also given an evaluation form upon completion of the trial to measure the session feasibility. Results Of the 124 participants in the study, 69 (56%) provided feedback. Results showed that 98% of participants felt the information provided either confirmed what they were already doing (44%) or encouraged them to consider a lifestyle change (54%). Additionally, 70% reported feeling more confident after completing the session. Staff survey results reported that 87.5% agreed or strongly agreed that these sessions were beneficial and valuable to patients Conclusions Delivering one-on-one education sessions to individual participants focusing on healthy lifestyle measures garnered a positive response from participants, increasing their confidence and knowledge for making lifestyle changes. While staff survey results pointed strongly in favour of continuing with the survivorship sessions, it was shown that the methods of delivery trialed in this study were not feasible to be implemented on a larger scale. With some workflow modification, implementing a survivorship care program in our cancer centre is a possible and important aspect of a patient’s treatment journey.
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Affiliation(s)
- Shaziya Malam
- Radiation Oncology, Southlake Regional Health Centre, Newmarket, CAN
| | - Belinda Lawrence
- Radiation Oncology, Southlake Regional Health Centre, Newmarket, CAN
| | - Cari Bradley
- Radiation Oncology, Southlake Regional Health Centre, Newmarket, CAN
| | | | - Ashley Clement
- Radiation Oncology, Southlake Regional Health Centre, Newmarket, CAN
| | - Tatiana Conrad
- Radiation Oncology, Southlake Regional Health Centre, Newmarket, CAN
| | - M Cheryl Noronha
- Radiation Oncology, Southlake Regional Health Centre, Newmarket, CAN
| | - Jeanette K Wong
- Radiation Oncology, Southlake Regional Health Centre, Newmarket, CAN
| | - Rachel A Woo
- Radiation Oncology, Southlake Regional Health Centre, Newmarket, CAN
| | - Zahra Kassam
- Radiation Oncology, Southlake Regional Health Centre, Newmarket, CAN
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Team triathlon effects on physiological, psychological, and immunological measures in women breast cancer survivors. Support Care Cancer 2020; 28:6095-6104. [PMID: 32314053 DOI: 10.1007/s00520-020-05457-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Exercise after breast cancer diagnosis and treatment improves cancer-related outcomes, although the mechanisms involved are not clear. This study evaluated the impact of exercise on body composition, strength, endurance, quality of life (QOL), fatigue, and endocrine and inflammatory biomarkers in breast cancer survivors participating in a highly monitored, clinically supervised, moderate-intensity exercise program. The association of hormonal and inflammatory biomarkers with the observed physiological changes was assessed. METHODS Female breast cancer survivors (BCS; n = 46) who engaged in a goal-oriented 14-week triathlon exercise training program were compared to an untrained control group of female BCS (n = 16). Psychosocial metrics, QOL, cancer-related fatigue, and exercise self-efficacy were evaluated via pre- and post-exercise intervention questionnaires. Serum estradiol and inflammatory biomarkers (C-reactive protein (CRP), sTNFR1a, estradiol, leptin, and adiponectin) were measured prior to the exercise training program start and after the completion of the goal triathlon. RESULTS After exercise training, the exercise group had lower BMI and arm circumferences. Greater positive change was noted in the trained group for QOL, fatigue, and self-efficacy questionnaires. Functional endurance improved in the trained but not the control group. Knee and elbow strength were not different between the groups, except that knee flexion at 180 degrees∙sec-1 was higher in trained. The only significantly different biomarker was adiponectin, which decreased in the trained group. CONCLUSIONS Group triathlon exercise training may be beneficial to BCS by significantly improving their psychosocial measures, functional endurance, and BMI.
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Covington KR, Hidde MC, Pergolotti M, Leach HJ. Community-based exercise programs for cancer survivors: a scoping review of practice-based evidence. Support Care Cancer 2019; 27:4435-4450. [PMID: 31418074 DOI: 10.1007/s00520-019-05022-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/30/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Based on randomized controlled trials, exercise is an efficacious strategy to improve quality of life (QOL) among cancer survivors. However, the effectiveness of exercise programs to improve QOL in real-world settings is unknown, as are factors related to external validity. This hinders dissemination and scalability. This scoping review synthesized published research on community-based exercise programs for cancer survivors and reported on the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM). METHODS A systematic literature search identified community-based exercise programs for adult cancer survivors (1980-March 2018), that met the following inclusion criteria: at least one face-to-face exercise session, the primary aim of program evaluation (i.e., feasibility/effectiveness), and pre/post measure of QOL. Data were coded using the RE-AIM framework. The effect size was calculated for overall QOL. RESULTS Electronic database search yielded 553 articles; 31 studies describing unique programs were included for review. All studies described at least one element of implementation and most (80.6%) reported a significant (p < .05) improvement in at least one subscale, or total QOL. Few studies reported on indicators of reach (16.1%), adoption (6.5%), individual (16.1%), or system-level maintenance (32.3%). CONCLUSIONS Community-based exercise programs are effective for improving QOL in adult cancer survivors. Recommendations are provided to improve reporting across RE-AIM dimensions, which is an important step to enhance the scalability of programs and thus, the potential for exercise to be fully integrated into system-level standard care for cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Community-based exercise programs are a resource to improve QOL for adult cancer survivors.
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Affiliation(s)
- Kelley R Covington
- Department of Occupational Therapy, Colorado State University, Occupational Therapy Building, 1573 Campus Delivery, Fort Collins, CO, 80523-1573, USA.
- ReVital Cancer Rehabilitation, Select Medical, 4714, Gettysburg Road, Mechanicsburg, PA, 17055, USA.
| | - Mary C Hidde
- Department of Health and Exercise Science, Colorado State University, 220 Moby Complex B, 1592 Campus Delivery, Fort Collins, CO, 80523-1582, USA
| | - Mackenzi Pergolotti
- Department of Occupational Therapy, Colorado State University, Occupational Therapy Building, 1573 Campus Delivery, Fort Collins, CO, 80523-1573, USA
- ReVital Cancer Rehabilitation, Select Medical, 4714, Gettysburg Road, Mechanicsburg, PA, 17055, USA
| | - Heather J Leach
- Department of Health and Exercise Science, Colorado State University, 220 Moby Complex B, 1592 Campus Delivery, Fort Collins, CO, 80523-1582, USA
- Colorado School of Public Health, 13001 E. 17th Place, Mail Stop B119, Aurora, CO, 80045, USA
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McNeely ML, Sellar C, Williamson T, Shea-Budgell M, Joy AA, Lau HY, Easaw JC, Murtha AD, Vallance J, Courneya K, Mackey JR, Parliament M, Culos-Reed N. Community-based exercise for health promotion and secondary cancer prevention in Canada: protocol for a hybrid effectiveness-implementation study. BMJ Open 2019; 9:e029975. [PMID: 31519676 PMCID: PMC6747880 DOI: 10.1136/bmjopen-2019-029975] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/15/2019] [Accepted: 08/30/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cancer care has expanded from a disease-focused, survival-oriented model to an approach that now considers how survivors can live well in the aftermath of intensive therapy, where they may deal with significant changes to their bodies, mental health or emotional well-being. Research evidence supports the benefit of exercise during and following cancer treatments for cancer-related symptoms, physical functioning and fitness, and health-related quality of life. To move this efficacy evidence into practice, we designed and launched a 5-year study to evaluate the relative benefit from implementing a clinic-to-community-based cancer and exercise model of care. METHODS AND ANALYSIS A hybrid effectiveness and implementation trial design is being used to evaluate the effectiveness of delivery of community-based exercise and to collect data on implementation of the programme. The study opened in January 2017, with estimated completion by January 2022. The programme will be delivered in seven cities across the province of Alberta, Canada, with sites including three academic institutions, six YMCA locations, Wellspring Edmonton and Calgary, and six municipal fitness centres. Participants are adult cancer survivors (n=2500) from all tumour groups and stages and at any time point along their cancer treatment trajectory, up to 3 years post treatment completion. Survivors take part in a minimum of 60 min of mild-to-moderate intensity full body exercise twice weekly for a 12-week period. The primary effectiveness outcome is the proportion of participants meeting or exceeding 150 min of moderate intensity exercise per week at 1-year follow-up. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework will be utilised to capture individual-level and organizational-level impact of the exercise programme at 12 and 24 weeks and 1-year follow-up. The cohort of survivors participating in the study will allow for long-term (>5-year) evaluation of rates of cancer recurrence and secondary cancers beyond the funding period. ETHICS AND DISSEMINATION The study was approved by the Health Research Ethics Board of Alberta. The study is funded by Alberta Innovates and the Alberta Cancer Foundation. The study will help to answer critical questions on the effectiveness of cancer-specific community-based exercise programming in both the short-term and the long-term. Collectively, the findings will help to inform the acceptability, adoption, feasibility, reach and sustainability of community-based exercise. TRIAL REGISTRATION NUMBER NCT02984163; Pre-results.
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Affiliation(s)
- Margaret L McNeely
- Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
- Rehabilitation Medicine, Cross Cancer Institute, Edmonton, Alberta, Canada
| | | | | | - Melissa Shea-Budgell
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Anil Abraham Joy
- Division of Medical Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Harold Y Lau
- Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Jacob C Easaw
- Medical Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Albert D Murtha
- Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Jeffrey Vallance
- Faculty of Health Disciplines, Athabasca University, Medicine Hat, Alberta, Canada
| | - Kerry Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - John R Mackey
- Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew Parliament
- Radiation Oncology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
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12
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Sabiston CM, Fong AJ, O'Loughlin EK, Meterissian S. A mixed-methods evaluation of a community physical activity program for breast cancer survivors. J Transl Med 2019; 17:206. [PMID: 31217021 PMCID: PMC6585098 DOI: 10.1186/s12967-019-1958-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/14/2019] [Indexed: 12/17/2022] Open
Abstract
Background Given the benefits of physical activity for health and survival, clinicians are seeking opportunities for cancer patients to become more active independent of rehabilitation programs that are small, time-limited, and location specific. This proof-of-concept study evaluated a community-based physical activity program (Curves™) for increasing physical activity among women diagnosed and treated for breast cancer. Methods Women were recruited from a breast cancer clinic through physician chart review. In study 1, women (n = 14) received the community physical activity memberships (Curves™), guidelines, and a pedometer. This group was compared to women (n = 16) who received physical activity guidelines and a pedometer on changes in physical activity. In study 2, women (n = 66) completed self-report questionnaires after Curves™ memberships expired to evaluate the program. Study 3 was a qualitative study exploring the benefits and barriers of the physical activity program among women (n = 6) who attended Curves™ regularly. Results Provision of memberships to a community-based physical activity program did not improve physical activity levels beyond educational and information resources. However, there are a number of advantages to community-based physical activity programs, and the women offer a number of suggestions for improvements for community physical activity opportunities aimed at breast cancer survivors. Conclusions Women-only community-based physical activity programs may be a viable option to help introduce women to get active after treatment. Trial registration ISRCTN, ISRCTN14747810. Registered on 18 October 2017—Retrospectively registered, 10.1186/ISRCTN14747810
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Affiliation(s)
- Catherine M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada.
| | - Angela J Fong
- School of Kinesiology and Health Studies, Queen's University, Kingston, Canada
| | - Erin K O'Loughlin
- Centre Hospitalier de L'université de Montréal & Individualized Program Department, Concordia University Montreal, Montreal, Canada
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13
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Maindet C, Burnod A, Minello C, George B, Allano G, Lemaire A. Strategies of complementary and integrative therapies in cancer-related pain-attaining exhaustive cancer pain management. Support Care Cancer 2019; 27:3119-3132. [PMID: 31076901 DOI: 10.1007/s00520-019-04829-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 04/23/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Complementary integrative therapies (CITs) correspond to growing demand in patients with cancer-related pain. This demand needs to be considered alongside pharmaceutical and/or interventional therapies. CITs can be used to cover certain specific pain-related characteristics. The objective of this review is to present the options for CITs that could be used within dynamic, multidisciplinary, and personalized management, leading to an integrative oncology approach. METHODS Critical reflection based on literature analysis and clinical practice. RESULTS Most CITs only showed trends in efficacy as cancer pain was mainly a secondary endpoint, or populations were restricted. Physical therapy has demonstrated efficacy in motion and pain, in some specific cancers (head and neck or breast cancers) or in treatments sequelae (lymphedema). In cancer survivors, higher levels of physical activity decrease pain intensity. Due to the multimorphism of cancer pain, certain mind-body therapies acting on anxiety, stress, depression, or mood disturbances (such as massage, acupuncture, healing touch, hypnosis, and music therapy) are efficient on cancer pain. Other mind-body therapies have shown trends in reducing the severity of cancer pain and improving other parameters, and they include education (with coping skills training), yoga, tai chi/qigong, guided imagery, virtual reality, and cognitive-behavioral therapy alone or combined. The outcome sustainability of most CITs is still questioned. CONCLUSIONS High-quality clinical trials should be conducted with CITs, as their efficacy on pain is mainly based on efficacy trends in pain severity, professional judgment, and patient preferences. Finally, the implementation of CITs requires an interdisciplinary team approach to offer optimal, personalized, cancer pain management.
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Affiliation(s)
- Caroline Maindet
- Pain management centre, Grenoble-Alpes University Hospital, Grenoble, France
| | - Alexis Burnod
- Department of supportive care, Institut Curie, PSL Research University, Paris, France
| | - Christian Minello
- Anaesthesia-intensive care department, Cancer Centre Georges François Leclerc, Dijon, France
| | | | - Gilles Allano
- Pain management unit, Mutualist Clinic of la Porte-de-l'Orient, Lorient, France
| | - Antoine Lemaire
- Oncology and medical specialties department, Valenciennes General Hospital, Valenciennes, France.
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Hsieh KL, Wood TA, An R, Trinh L, Sosnoff JJ. Gait and Balance Impairments in Breast Cancer Survivors: A Systematic Review and Meta-analysis of Observational Studies. Arch Rehabil Res Clin Transl 2019; 1:100001. [PMID: 33570512 PMCID: PMC7853379 DOI: 10.1016/j.arrct.2018.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objective To systematically review and quantitatively synthesize gait and balance impairments in breast cancer survivors compared with age-matched controls or normative values for adults who never had breast cancer. Data Sources PubMed, Cumulative Index of Nursing and Allied Health, and Web of Science was searched using terms associated with breast cancer, mobility, and adult until November 2018. Study Selection Studies were included if they were randomized control trials, cross-sectional, prospective, pre-post, or case-control by design, included adult breast cancer survivors, reported gait and/or balance metrics as primary or secondary outcomes, were peer-reviewed publications, and were written in English. The search yielded 2117 results with 29 studies meeting the inclusion criteria. Data Extraction Two reviewers assessed study quality by the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies to determine the strength of evidence for each study that met the inclusion criteria. Basic descriptors of each study, study protocol, and balance and gait measures were extracted. Meta-analysis was performed for the single leg stance, functional reach, center of pressure velocity, gait speed, and timed up and go. Data Synthesis For quality assessment, 3 studies were rated good, 16 fair, and 10 poor. The meta-analysis indicated that there were no significant differences in single leg stance between breast cancer survivors and those who never had breast cancer (P=.33). Pooled values of the functional reach task (22.16cm; 95% CI, 8.98-35.33) and center of pressure velocity (1.2cm/s; 95% CI, 0.87-1.55) suggest balance impairment in breast cancer survivors when compared with normative values. Breast cancer survivors also performed worse than those who never had breast cancer in challenging balance conditions that reduced sensory information or altered base of support. Pooled gait speed at a usual speed (0.91m/s; 95% CI, 0.2-1.6), fast speed across a short distance (1.2m/s; 95% CI, 0.31-2.1), and fast gait speed across a long distance (1.65m/s; 95% CI, 1.64-1.66) suggest gait impairments when compared with normative values. Conclusions Breast cancer survivors may demonstrate gait and balance impairments compared with normative values. Clinicians should consider assessing changes in balance and gait in breast cancer survivors to improve functional independence and prevent fall-related injuries.
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Affiliation(s)
- Katherine L Hsieh
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Urbana, IL
| | - Tyler A Wood
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Urbana, IL
| | - Ruopeng An
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Urbana, IL
| | - Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Jacob J Sosnoff
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Urbana, IL
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