Associations of leisure-time physical activity with quality of life in a large,population-based sample of colorectal cancer survivors

Objective To examine the associations between physical activity and quality of life for colorectal cancer survivors; and to describe the associations of medical and sociodemographic attributes with overall quality of life, and their moderating effects on the relationships between physical activity and quality of life. Methods Telephone interviews were conducted with 1,996 colorectal cancer survivors recruited through the Queensland Cancer Registry. Data were collected on current quality of life; leisure-time physical activity pre- and post-diagnosis; cancer treatment and side-effects; and general sociodemographic attributes. Hierarchical generalized linear models identified variables significantly associated with quality of life. Results After controlling for sociodemographic variables, disease-specific variables, treatment side-effects, and pre-diagnosis leisure-time physical activity, there were significant differences in quality of life scores by post-diagnosis physical activity category. Compared to participants who were inactive after their diagnosis, those who were sufficiently active had a 17.0% higher total quality of life score. Physical activity also had a significant independent positive association with the physical well-being, functional well-being, and additional concerns subscales of the FACT-C. Conclusions Our findings demonstrate that quite modest changes in leisure-time physical activity are associated with quality of life. Colorectal cancer survivors may benefit from a more active lifestyle.     

Quality of life in survivors of oropharyngeal cancer: A systematic review and meta-analysis of 1366 patients

Human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) is rapidly increasing in incidence and has a favourable prognosis compared with HPV-negative disease. Current combined therapies include significant risks of morbidity for the growing group of survivors. This systematic review and meta-analysis investigates how treatment affects quality of life (QoL) in survivors of oropharyngeal cancer. PubMed, EMBASE and the Cochrane Library were systematically searched for all studies reporting patient-assessed QoL at least 1 year after treatment for OPC. In a meta-analysis, weighted average QoL scores from the four most commonly utilised QoL instruments were compared with baseline and reference group scores using the concept of minimal clinically important difference. The meta-analysis included data from 1366 patients from 25 studies and 12 countries. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) was answered by 704 patients, 644 patients answered the EORTC QLQ Head and Neck-35 (H&N-35), 474 patients answered the University of Washington Quality of Life Questionnaire, and 381 patients answered the M. D. Anderson Dysphagia Inventory. Moderate to large clinically important deteriorations in QoL were found in the domains dry mouth and sticky saliva for the EORTC QLQ-H&N35, saliva, chewing, swallowing, speech, taste, appearance and shoulder for the University of Washington Quality of Life Questionnaire, and the global, physical and emotional subscales for the M. D. Anderson Dysphagia Inventory. In conclusion, survivors of OPC face clinically important deteriorations in QoL that most markedly centre on xerostomia, dysphagia and chewing. These ailments indicate a potential for improvement in patient management.     

Association between physical activity and quality of life among Western Australian breast cancer survivors

Previous research has shown that physical activity (PA) may be beneficial to quality of life (QoL) in breast cancer survivors. Few studies however, have focused on the time period soon after the completion of adjuvant therapy or examined exercise issues separately for rural/urban or healthy weight/obese breast cancer survivors. Our study addressed these issues. Breast cancer survivors (N = 558) from the Western Australia Cancer Registry completed a survey that included the Godin Leisure Time Exercise Questionnaire (GLTEQ) and the Functional Assessment of Cancer Therapy-Breast (FACT-B) scale. Results showed that only 31% of breast cancer survivors were meeting the recommended PA guidelines post-treatment. Analysis of variance revealed that survivors meeting these guidelines reported higher scores on the FACT-B (mean difference 8.6; 95% CI = 5.0-12.1; p<0.001), the FACT-General (mean difference 6.3; 95% CI = 3.5-9.0; p<0.001), the trial outcome index (TOI; p<0.001), and several of the FACT-B subscales. Furthermore, healthy weight participants also reported higher scores than obese participants on the FACT-B (p = 0.058) and the breast cancer subscale (p = 0.033). There were no differences based on geographic location. We conclude that physically active and healthy weight breast cancer survivors report better QoL than their inactive and obese counterparts soon after completing adjuvant therapy.     

Dimensions of physical activity and their relationship to physical and emotional symptoms in breast cancer survivors

Background  Many breast cancer survivors experience long term sequelae, including fatigue, decreased physical functioning, pain, and psychological distress. Physical activity can ameliorate these problems, but there is little research on how activity should be performed to be most beneficial. This study explores how dimensions of physical activity (total energy expenditure, frequency, and duration) are associated with symptoms among breast cancer survivors. Methods  We conducted a secondary analysis of data on physical activity behavior and symptoms in a cross-sectional study (n = 148) of breast cancer survivors who were off treatment and had been diagnosed within the past 5 years. Results  Multivariate analyses showed that total energy expenditure was associated with better general health (p = 0.006) and fewer depressive symptoms (p = 0.014), while frequency of activity was linearly related to physical functioning (p = 0.047), pain (0.057), general health (p < 0.001), and depressive symptoms (p < 0.001). Duration was related to physical functioning, pain, and general health, but the worst outcomes were reported by the participants with the shortest and longest duration of activity (quadratic trend p values = 0.002, 0.003, 0.008, respectively). Discussion/Conclusions  Greater total energy expenditure, higher physical activity frequency, and moderate duration were associated with better outcomes for most symptoms, although there was no relationship between any of the dimensions of physical activity and fatigue. Implications for cancer survivors  The association of better outcomes with higher energy expenditure, higher frequency of activity, and moderate duration indicates that increasing activity through multiple short bouts may be the most beneficial for breast cancer survivors. However, randomized studies are needed to confirm this finding.     

Health-related quality of life in long-term breast cancer survivors: nationwide survey in Denmark

Aim To investigate health-related quality of life (HRQOL) in a nationally representative sample of long-term breast cancer survivors (BCS) in Denmark. Participants and methods An age-stratified random sample of 2,000 female BCS ≥ 5 years after primary surgery without recurrence was drawn from the Danish Breast Cancer Cooperative Group register, which is representative regarding long-term BCS in Denmark, and compared with 3,104 women of the nationally representative Danish Health and Morbidity Survey 2000. The Short Form-36 questionnaire assessed HRQOL and its association with BCS’ sociodemography, type of surgery, systemic therapy, radiotherapy, time since operation, receptor status, and low/high risk protocol. Results The response rate was 79%. BCS tended to rate HRQOL better than the general female population. BCS reported significantly less “bodily pain” (P < 0.0001), better “general health” (P < 0.0001), but worse “mental health” (P < 0.0001). Age interacted significantly with four other subscales (P < 0.05): Younger BCS reported worse HRQOL than equally aged women of the general population, while older BCS reported better HRQOL. Poor HRQOL was significantly associated with being single (all subscales: P < 0.05), short education (all subscales: P < 0.05, except “social function”), and high body mass index (“physical function”, “role physical”: P < 0.05). Breast cancer (low/high risk, receptor status) and treatment did not affect HRQOL. Conclusion HRQOL was similar between BCS and women of the general population. Potential long-term effects of breast cancer (low/high risk, receptor status) and treatment did not seem to impact HRQOL. However, predictors for worse HRQOL in BCS were being single, and having a short education.     

Surgery and health-related quality of life – A prospective follow up study on breast cancer patients in Finland

IntroductionThe influence of different surgical approaches on breast cancer patients’ Health-related Quality of life (HRQoL) is an important determinant when making decisions on the choice of treatment. Knowledge on how patients actually perceive different surgical treatments regarding long-term HRQoL is still scarce.Materials & methods1065 patients with primary breast cancer operated on from 2008 to 2015 at Helsinki University Hospital, Finland were prospectively followed-up for two years. They filled in two HRQoL questionnaires, the EORTC QLQ C30 – BR 23 and the 15D, at baseline and at 3, 6, 12 and 24 months after surgery. Clinical data on treatments given and the course of recovery were collected from patient records. Patients were divided into four mutually exclusive groups according to surgical method: breast resection (n = 415), oncoplastic resection (n = 248), mastectomy (n = 351) and immediate reconstruction (n = 51). Clinical data were combined with HRQoL scores and analysed as multivariate modelling.ResultsAll groups experienced initially worsening overall HRQoL after baseline. Oncoplastic resection patients had the best body image and their HRQoL reached the highest level after treatments at 12 months whereas the reconstruction patients reached the highest HRQoL level first at 24 months. Mastectomy patients had the lowest scores throughout the 24-month follow-up.ConclusionExtensive surgery, in terms of immediate reconstruction, led to slower HRQoL recovery than oncoplastic techniques. Mastectomy patients are at risk of having the lowest HRQoL scores throughout their recovery after surgery.     

Complementary and alternative therapies among very long-term breast cancer survivors

Breast cancer patients may have different complementary and alternative medicine (CAM) usage rates and may turn to CAM for different reasons than healthy adults. CAM has mostly been studied in recently diagnosed women; no studies have included survivors 10 years post-diagnosis. We examined very long-term breast cancer survivors to determine whether CAM users had dissimilar patterns of association with survivorship factors. Interviews of 374 breast cancer case patients from a population-based case–control breast cancer study of young women from Los Angeles County, California, during the 1980s occurred at follow-up; 371 patients with complete information were included. CAM represented 28 herbal remedies. Quality-of-life originated from the Medical Outcomes Study Short Form 36 questionnaire (SF-36). Higher rates of CAM (59%) usage occurred compared to nationwide estimates. CAM users resembled non-users on follow-up age, exercise, original disease, treatment, smoking, body-mass index, alcohol, and fear of recurrence. CAM users had a higher prevalence of medical co-morbidities (P = 0.0005), and scored significantly lower on the SF-36 emotional well-being subscale than non-CAM users (P = 0.01). CAM users and non-users did not differ on the SF-36 physical sub-scale. Very long-term breast cancer survivors who use CAM may have poorer emotional functioning and more medical problems than non-users.     

The health-related quality of life of long-term survivors of melanoma treated with isolated limb perfusion.

AIMS: To evaluate the generic and condition-specific health-related quality of life (HRQL) of long-term survivors of extremity melanoma treated with isolated limb perfusion (ILP). METHODS: Between 1978 and 2001, 292 patients with melanoma of the limbs underwent ILP in our institution. Of these patients, 59 were alive and disease-free for at least six months prior to study entry. Fifty-one of these 59 patients completed a mailed questionnaire assessing generic HRQL (SF-36), condition-specific HRQL (limb function, cosmetic results, fear of recurrence), and problems regarding work and insurance. An age- and gender-matched, normative sample of the Dutch general population was available for comparison of SF-36 scores. RESULTS: Mean age of patients was 57 years, 90% female, with a median time since ILP of 14 years (range 3-25 years). The SF-36 scores of the patient group were equal to or better than that of the general population, significantly for bodily pain, general health perceptions, and the physical and mental health component scores. Nevertheless, the patients reported a number of specific problems: complaints of limb function were reported by 49-55%, cosmetic problems by 31-38% and fear of local disease recurrence and distant metastases by 77 and 63% of the patients, respectively. Less than 10% of patients reported problems in obtaining a mortgage or life insurance. CONCLUSIONS: The HRQL of long-term survivors of melanoma treated with ILP appears comparable to, and sometimes better than that of healthy peers within the general population. Nevertheless, this survivor group reports a number of specific problems that impact on daily life. Although these findings need to be confirmed with larger, prospective studies, they suggest that rehabilitation should focus on improving limb functionality, and addressing chronic fear of disease recurrence.     

Physical activity and survival in breast cancer

PurposeKnowledge about lifestyle factors possibly influencing survival after breast cancer (BC) is paramount. We examined associations between two types of postdiagnosis physical activity (PA) and overall survival after BC.Patients and methodsWe used prospective data on 959 BC survivors from the Diet, Cancer, and Health cohort, all enrolled before diagnosis. Self-reported PA was measured as time per activity, and estimated metabolic equivalent task (MET)–hours per week were summed for each activity. We constructed measures for household, exercise, and total PA. The association between postdiagnosis PA and all-cause mortality was estimated as hazard ratio (HRs) based on Cox proportional hazards model, with time since diagnosis as the underlying time scale. Prediagnosis PA, body mass index (BMI), and receptor status were examined as potential effect modifiers.ResultsWe identified 144 deaths from all causes during the study period. In adjusted analyses, exercise PA above eight MET h/week compared to lower levels of activity was significantly associated with improved overall survival (HR, 0.68; confidence interval [CI]: 0.47–0.99). When comparing participation in exercise to non-participation, we found a 44% risk reduction in overall survival (HR, 0.56; CI: 0.33–0.95). Neither between household nor total PA and overall survival did, we find significant associations. Prediagnosis PA, BMI, and receptor status did not modify the effect significantly.ConclusionExercise PA corresponding to 2.5 h or more of brisk weekly walking after BC diagnosis may reduce mortality by up to 32% compared to low-level exercise. Participation in exercise PA may reduce mortality by 44% compared to non-participation.     

Physical activity and breast cancer outcome: A brief review of evidence,current practice and future direction

There have been several publications of large scale studies with long-term follow up addressing the role of physical activity in the management of breast cancer. Of the twelve studies specifically addressing the effect of physical activity on breast cancer survival, eight showed a statistically significant 50% risk reduction in breast cancer mortality in women who engaged in moderate intensity physical activity before and after their diagnosis of breast cancer. Four smaller studies demonstrated no benefit. Almost all of these observational studies predominantly involved white, professional women from North America and Europe. The positive effects of physical activity were seen for all stages of cancer, with the greatest benefit in steroid receptor positive breast tumours. These studies relied on self-reported questionnaires for recording the levels of physical activity. Despite including thousands of patients, published studies offer no data related to the optimum type, duration and timing of physical activity. Only a few studies provided objective data on physical activity, cardio-respiratory and general fitness. Thus, potential role of physical activity in the management of breast cancer remains far from established. If the beneficial effect of physical activity as demonstrated in the observational studies can be replicated in robust, well designed and well-executed prospective randomised controlled trials, this would provide a tremendous opportunity to enhance adjuvant treatment of breast cancer. By adding physical activity to the spectrum of adjuvant therapies offered to women survival from breast cancer may be enhanced.     

A comparison of the clinical determinants of health-related quality of life and subjective well-being in long-term breast cancer survivors

Research concerning long-term breast cancer survivors (BCS) has primarily analysed their health-related quality of life (HRQoL). However, other dimensions of life considered important by patients might be affected by cancer treatments as well. The aim of this paper is thus to compare the clinical determinants of HRQoL and of overall quality of life as described by measures of subjective well-being (SWB) in long-term BCS. SWB represents a person's own evaluation of their overall situation. A total of 321 French BCS diagnosed 5 to 15 years ago participated in a cross-sectional mailed survey. Outcome measures were the physical and mental health scores of the 36-item Short-Form survey and measures of SWB (happiness, life satisfaction and the positive and negative affect scales). Multivariate regression analyses suggest that HRQoL and SWB measures provide different pictures of the experience of breast cancer. Treatment type has no impact on HRQoL but is correlated with all our SWB measures while time since diagnosis positively affects physical health but not SWB. We conclude that it could be fruitful to analyse SWB, alongside the traditional study of HRQoL, in order to enhance our understanding of the various long-lasting consequences of breast cancer.     

Associations among physical activity, body mass index, and health-related quality of life by race/ethnicity in a diverse sample of breast cancer survivors

BACKGROUND:

Health‐related quality of life (HRQOL), body mass index (BMI), and physical activity (PA) levels have all been associated with prognosis following breast cancer and may explain partially the higher mortality for breast cancer in certain racial/ethnic subgroups. In this study, associations between PA, BMI, and HRQOL by race were examined in a sample of breast cancer survivors.

METHODS:

Measures of PA, BMI, and HRQOL as well as demographic and medical characteristics of women (N = 3013, 13% nonwhite) who participated in the Women's Healthy Eating and Living Study were assessed at baseline. Analysis of covariance was used to examine the relationship between PA and obesity with HRQOL outcomes. Statistical tests were 2‐sided.

RESULTS:

African American women were less likely to meet guidelines for PA and more likely to be obese than women from other ethnic groups (P < .05). In adjusted models, women who met guidelines for PA reported significantly higher physical health composite (point differences ranged from 10.5 to 21.2 points, all P < .05) and vitality (point differences ranged from 9.9 to 16.5 points, all P < .05) scores than those who did not, regardless of race/ethnicity. Associations between obesity and HRQOL were mixed with fewer associations for Asian American and African American women and stronger associations for whites.

CONCLUSIONS:

Breast cancer survivors from racially and ethnically diverse populations have lower levels of PA and higher rates of obesity that are generally associated with poorer HRQOL. Culturally sensitive PA and weight loss interventions may improve these lifestyle characteristics and result in improved HRQOL. Cancer 2012. © 2012 American Cancer Society.     

Applying a conceptual model for examining health-related quality of life in long-term breast cancer survivors: CALGB study 79804

Objectives: The Survivor's Health and Reaction study used a quality‐of‐life model adapted for cancer survivors by Dow and colleagues to identify factors related to global health‐related quality of life (HRQL) and to document the prevalence of problems and health‐oriented behaviors in a follow‐up study of breast cancer patients who participated in CALGB 8541. Methods: A total of 245 survivors (78% of those invited) who were 9.4–16.5 years post‐diagnosis completed surveys that inquired about current HRQL, economic, spiritual, physical and psychosocial concerns, and health‐oriented behaviors (e.g. smoking, exercise, and supplement use). A regression model was developed to examine factors related to global HRQL across all domains. Results: The regression model revealed that decreased energy levels (odds ratio (OR)=1.05, 95% confidence interval (CI): 1.03, 1.07), having heart disease (OR=5.01, 95% CI: 1.39, 18.1), having two or more co‐morbidities (OR=2.39, 95% CI: 1.10, 5.19), and lower social support (OR=1.03, 95% CI: 1.02, 1.05) were associated with lower global HRQL. Factors related to psychological, spiritual, and economic domains were not predictive of global HRQL. Regarding lifestyle changes, some women reported engaging in health‐oriented behaviors since their cancer diagnosis, such as improving eating habits (54%), increasing exercise (32%), and reducing/quitting smoking (20%). The most prevalent problems reported by women at follow‐up were menopausal symptoms (64%), such as hot flashes and vaginal dryness, osteoporosis (25%), and lymphedema (23%). Conclusion: Suggestions are provided to target interventions, such as provider‐based strategies, in order to improve HRQL in long‐term breast cancer survivors. Copyright © 2008 John Wiley & Sons, Ltd.     

Objectively measured breast symmetry has no influence on quality of life in breast cancer patients

Aims

This study investigates how quality of life (QoL) of breast cancer patients is related to breast symmetry.

Methods

We objectively measured breast symmetry using the breast analyzing tool (BAT) in 101 patients after breast conserving surgery for breast cancer at different time points during follow up. We correlated the results with the quality of life measured at the same time using the breast image scale (BIS), the EORTC QLQ-BR23 scale and a not validated sexual score scale. Age, tumour size, tumour/breast relation and the use of oncoplastic surgery were also correlated with symmetry and quality of life scales. Using multivariate analyses, independent parameters for an improved quality of life were identified.

Results

Mean age was 56 (±11.6), and 75.2% of patients had T1 or T2 tumours. Patient age (p = 0.03) and tumour size (p = 0.01) significantly influenced objectively measured breast symmetry. The cosmetic result was important for 53% of patients while 48% found it not important. Independent from this, neither overall quality of life nor breast self esteem was influenced by breast symmetry in our patients.

Conclusions

After breast cancer surgery, breast symmetry is not a major factor for patients’ quality of life and breast self esteem. Cosmetic result seems to be less important than oncologic outcome in patients with breast cancer.     

Physical activity among breast cancer survivors: regular exercisers vs participants in a physical activity intervention

BACKGROUND: Secondary prevention is of great importance in the cancer survivor population, given the substantial medical risks survivors face. Consequently, researchers have begun developing interventions that target behavioral risk factors, such as sedentary lifestyle, among survivors. This study represents a novel approach for evaluating the efficacy of a physical activity intervention for breast cancer survivors. METHODS: Repeated measures analyses were used to compare a group of previously sedentary breast cancer survivors offered a physical activity intervention (n=43) with a group of regularly active survivors (n=40). These two groups were compared on select behavioral and psychosocial measures associated with physical activity. RESULTS: Results indicated significant time x group effects on the following: behavioral processes of change, minutes of moderate-intensity activity/week, and time to complete the one-mile walk test (a measure of fitness). There was also a borderline significant interaction for self-efficacy. Contrasts indicated that, for each interaction, previously sedentary and regularly active survivors differed at baseline, but were not significantly different postintervention. CONCLUSIONS: Thus, after completing a 12-week physical activity intervention, previously sedentary breast cancer survivors became similar to regularly active survivors on select behavioral and psychosocial measures associated with physical activity.     

Health-related quality of life before and after a breast cancer diagnosis

While many reports describe health-related quality of life (QOL) among breast cancer survivors, few compare QOL before and after diagnosis and whether changes in QOL substantially differ from changes experienced by all women during aging. QOL was examined in a cohort of female residents of Beaver Dam, Wisconsin, aged 43-86 years at the time of a 1988-1990 baseline examination (N = 2,762; 83% of eligible). Participants were re-contacted four times through 2002 to ascertain QOL using the 36-item Short Form Health Survey (SF-36). QOL data for 114 incident breast cancer cases identified by data linkage with the statewide cancer registry were compared with data for 2,527 women without breast cancer. Women with breast cancer averaged 4.5 (95% CI: 1.6, 7.3) points lower than control women on the SF-36 Physical Component Summary (PCS) scale, regardless of time since diagnosis (up to 13 years). Women with breast cancer also reported lower scores on the SF-36 Mental Component Summary (MCS) scale within two years after diagnosis, but not at more distant times. In longitudinal analyses, 26 women who completed the SF-36 before and after breast cancer diagnosis experienced larger declines than age-matched controls in seven of the eight SF-36 health domains (all but role-emotional) and reported relative declines of -7.0 (95% CI: -11.5, -2.6) and -2.9 (95% CI: -6.3, 0.6) on the PCS and MCS scales, respectively. These results suggest that breast cancer survivors experience relative declines in health-related QOL across a broad spectrum of domains, even many years after diagnosis.