Exercise Training for Improving Patient-Reported Outcomes in Patients With Advanced-Stage Cancer: A Systematic Review and Meta-Analysis

ContextPatients with advanced-stage cancer often suffer many physical and psychological symptoms. Exercise has been shown to improve quality of life (QoL), decrease cancer-related symptoms, and maintain or improve functional status in cancer survivors or patients with early stage cancer. However, the effect of exercise on these outcomes in patients with advanced-stage cancer is unclear.ObjectivesThis meta-analysis aimed to assess the effectiveness of exercise interventions for patients with advanced-stage cancer in improving cancer-related symptoms and functional status outcomes.MethodsWe conducted a comprehensive literature search in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science from their inception to February 3, 2019, to include randomized controlled trials (RCTs) comparing exercise and usual care for improving outcomes in patients with advanced-stage cancer. Two reviewers independently screened the studies, extracted data of interest, and assessed the risk of bias of individual RCTs using the Cochrane Handbook, Version 5.1.0.ResultsAbout 15 RCTs enrolling 1208 patients were included. Compared with usual care, exercise showed a significant improvement in QoL (standardized mean difference [SMD] 0.22; 95% CI 0.06–0.38; P = 0.009), fatigue (SMD −0.25; 95% CI −0.45 to −0.04; P = 0.02), insomnia (SMD −0.36; 95% CI −0.56 to −0.17; P = 0.0002), physical function (SMD 0.22; 95% CI 0.05–0.38; P = 0.009), social function (SMD 0.18; 95% CI 0.02–0.34; P = 0.03), and dyspnea reduction (SMD −0.18; 95% CI −0.34 to −0.01; P = 0.03).ConclusionExercise serves as an effective intervention to improve QoL and alleviate fatigue, insomnia, dyspnea, and physical and social functions for patients with advanced-stage cancer.     

Impact of Self-Reported Exercise on Recounted Levels of Fatigue and Anxiety in Early-Stage Breast Cancer Radiation Therapy Patients

PurposeExercise may be an alternative strategy to helping early-stage breast cancer (ESBC) patients manage their cancer-related fatigue and anxiety during radiation therapy. This observational study aims to investigate the impact of self-reported exercise on fatigue and anxiety levels pre (T0), mid (T1), and post (T2) radiation therapy in patients with ESBC.MethodsFollowing informed consent, subjects completed three standardized questionnaires measuring physical activity, fatigue/quality of life, and anxiety at T0, T1, and T2.ResultsA total of 58 female patients (57 ± 9 years) completed this study. Mean activity level at T0 was 2548 (3292) metabolic equivalent units (METs), T1 was 3072 (3974) METs, and T2 was 2963 (2442) METs. There was no significant change between the three time points with measures of physical activity. Many patients moved from the moderately active group at T0 to the active group at T1. The mean T0 score using the quality of life questionnaire was 38.97 (11.30), T1 was 36.93 (11.69), and T2 was 35.36 (11.18). There was no significant change between the three time points with measures of quality of life (P = .211). There was statistical significance at P = .025 at T1 for lower quality of life compared to T0 across all exercise types. There was also statistical significance at P = .026 at T1 for the active group with higher quality of life compared to the inactive one. All three physical activity categories showed a decline in quality of life scores over time. Anxiety decreased between the three time point measurements. Mean T0 score for anxiety was 47.33 (5.95), T1 was 43.16 (6.49), and T2 was 38.48 (8.46). The interaction of exercise level and time is not significant for anxiety (P = .91). There was statistical significance (P = .015) for anxiety at T2 compared to T1 across exercise types.DiscussionThis study demonstrated that ESBC patients showed signs of fatigue and anxiety while undergoing radiation therapy regardless of self-reported exercise measured by a physical activity questionnaire. Several trends were observed that showed improved outcomes for patients consistent with previously published studies. The present study highlights a nonsignificant change in fatigue. As fatigue is one of the main side effects from radiation, it may be difficult to demonstrate significance. There are some studies in the field that demonstrate significance between fatigue and exercise with larger sample sizes. The results also highlight a decrease in anxiety from the baseline to the end of treatment. It is postulated that patients become less anxious as treatment progresses due to familiarity of a routine. The present study is limited by several factors including sample size and the study not being a randomized controlled one.ConclusionsExercise may reduce anxiety during radiation treatment for ESBC patients. Further investigation is required to assess the impact of fatigue.     

Effects of Exercise Training on Restless Legs Syndrome,Depression, Sleep Quality,and Fatigue Among Hemodialysis Patients: A Systematic Review and Meta-analysis

Context

Hemodialysis (HD) patients experience a heavy symptom burden that leads to a decreased quality of life. Pharmacological treatment is effective but costly and has adverse effects. Exercise is a promising approach for symptom management, but the effect of exercise on restless legs syndrome (RLS), depression, sleep quality, and fatigue in HD patients is still uncertain.

The Relationship Between Fatigue and Quality of Life in Children With Chronic Health Problems: A Systematic Review

PURPOSE: This systematic review synthesized the literature regarding fatigue in children with chronic health problems and examined the relationship to quality of life. CONCLUSIONS: Most studies that have examined fatigue and its relationship to quality of life in children with chronic health problems have focused on children with cancer. Studies found that children often reported fatigue and that it decreased quality of life. PRACTICE IMPLICATIONS: Quantifying fatigue in children with chronic illnesses and disabilities is critical for pediatric nursing assessment. Understanding the impact of fatigue on children with chronic health problems is a first step in improving their quality of life.     

Template-based Intensity-Modulated Radiation Therapy: A Cost-effective Intensity-Modulated Radiation Therapy Planning Procedure for Prostate Cancer

IntroductionIntensity-modulated radiation therapy (IMRT) has been widely accepted for the treatment of prostate cancer. In comparison with traditional three-dimensional conformal radiation therapy (3D-CRT), it improves local control while minimizing side effects. However, IMRT comes at a significantly higher cost. In this report, we describe the development of template-based IMRT (TB-IMRT) planning for prostate cancer that does not require additional resources above 3D-CRT.MethodsTwenty patients previously treated using 3D-CRT were retrospectively planned using the TB-IMRT planning technique. Planning target volume coverage, dose to organs at risk, and resource usage were compared between 3D-CRT and TB-IMRT techniques.ResultsAll 3D-CRT and TB-IMRT plans met the planning guidelines. TB-IMRT compared better than 3D-CRT in terms of the homogeneity index (0.039 ± 0.007 vs. 0.052 ± 0.008) and conformity index (0.866 ± 0.024 vs. 0.752 ± 0.054). TB-IMRT also provided better sparing of organs at risk. Planning times were significantly less for TB-IMRT (average 13.43 ± 2.18 minutes) compared with conventional plans (45.4 ± 17.0 minutes). Times required for patient-specific quality assurance were similar between TB-IMRT and 3D-CRT.ConclusionsThe TB-IMRT technique for prostate allows for all the potential benefits of IMRT without any additional resources above conventional 3D-CRT.     

健康教育干预对胃癌患者癌因性疲乏及生活质量的影响

目的探讨健康教育干预对胃癌患者癌因性疲乏（cancer related fatigue，CRF）及生活质量（quality of life，QOL）的影响。方法将80例进展期胃癌术前化疗的患者随机分为观察组和对照组各40例。对照组采用一般护理干预，观察组在此基础上增加癌因性疲乏的健康教育。利用疲乏简易量表（brief fatigue inventory，BFI）及生活质量评估问卷（EORTC QLQ—C30），于化疗前、后评价两组患者的CRF程度及QOL，观察组在化疗后进行满意度评价。结果护理干预后，观察组CRF程度较干预前及对照组干预后均显著减轻（P〈0．05或0．01）；观察组QOL各维度得分均高于对照组（P〈0．05）；干预组患者满意度评分为（8．47±0．83）分。结论健康教育干预可有效缓解胃癌患者的CRF，提高患者的生活质量。     

妇科恶性肿瘤患者应对方式、癌因性疲乏与生活质量的结构方程模型

目的探讨妇科恶性肿瘤患者应对方式、癌因性疲乏与生活质量的关系。方法选取2012年5—11月4所三级甲等医院住院的妇科恶性肿瘤患者(宫颈癌、卵巢癌和子宫内膜癌)共608例,应用医学应对问卷、癌症疲乏量表和癌症治疗功能评价系统的一般量表进行测评,并用结构方程模型软件进行分析。结果医学应对方式中,面对维度得分为(19.55±3.83)分,回避维度得分为(16.33±2.79)分,屈服维度得分为(8.61±2.76)分;癌因性疲乏总分为(25.20±8.49)分;生活质量总分为(70.17±13.39)分。面对维度对癌因性疲乏总分有直接(正向)效应(β=0.08,P0.05);屈服维度对癌因性疲乏总分有直接(正向)效应(β=0.52,P0.01),对生活质量直接(负向)效应(β=-0.39,P0.01);癌因性疲乏总分对生活质量直接(负向)效应(β=-0.61,P0.01);面对和屈服的应对方式均可通过癌因性疲乏总分间接影响生活质量。结论应对方式对妇科恶性肿瘤患者的生活质量有直接和间接影响:癌因性疲乏作为中介变量调节应对方式与生活质量的关系。     

认知行为治疗对妇科癌症患者化疗间歇期生活质量的影响

目的探讨认知行为治疗对妇科癌症患者化疗间歇期生活质量的影响。方法采用类实验性研究方法，进行方便取样，对35名研究对象进行系统的、有计划的、有针对性的认知行为治疗的系统护理下预，措施内容包括健康教育、心理指导、应对技巧训练和社会支持运用。研究工具包括中国癌症化疗患者生活质量量表（QLQCCC）、Zung焦虑自评量表（SAS）、Beck抑郁问卷（BDI）、社会支持评定量表、医学应对问卷（MCMQ）。研究者分别于患者入组后第1个化疗周期、第3个化疗周期、第4个化疗周期的第1天与患者进行访谈，并填写问卷。结果通过认知行为治疗，患者的整体生活质量以及躯体健康、心理健康、总体感觉等维度均有不同程度的提高，社会健康维度没有显著性变化。结论认知行为治疗通过影响妇科癌症患者的心理状况、社会支持和应对方式，可以改善其化疗间歇期的生活质量。     

Side Effects Associated with the Use of Intensity-Modulated Radiation Therapy in Breast Cancer Patients Undergoing Adjuvant Radiation Therapy: A Systematic Review and Meta-Analysis

PurposeThe purpose of the study was to establish the efficacy and safety of breast intensity-modulated radiation therapy (IMRT) compared with non-IMRT standard wedge radiation therapy (RT) for the treatment of adjuvant breast cancer.MethodsA systematic review and meta-analysis were completed using STATA and a random effects model. A total of 1,499 citations were identified from the literature search. Of those, 1,475 were excluded based on abstract review. Full texts of 24 remaining articles were reviewed and 11 articles were included in the final analysis. Side effects were analysed as the primary outcomes of interest. We calculated individual odds ratios and 95% confidence intervals for 17 classifications of side effects reported. The data for eight classifications of side effects were then pooled for meta-analyses to obtain more precise estimates of the relationships between adjuvant RT and a particular side effect.ResultsThe pooled analyses revealed potential protective associations between adjuvant IMRT and two acute side effects: dermatitis and moist desquamation. The remaining pooled estimates suggest that the odds of developing edema, hyperpigmentation, fat necrosis, pain, induration were no worse, nor better among those treated with IMRT compared with those treated with non-IMRT standard wedge RT.ConclusionThe pooled estimates from this meta-analysis are in line with the existing evidence. When the outcome of interest is reduction of the acute side effects: dermatitis and moist desquamation IMRT is a viable treatment option for women undergoing external beam RT after breast-conserving surgery.     

Proteomic Serum Profile of Fatigued Men Receiving Localized External Beam Radiation Therapy for Non-Metastatic Prostate Cancer

ContextFatigue is the most distressing side effect of radiation therapy, and its progression etiology is unknown.ObjectivesThis study describes proteome changes from sera of fatigued men with non-metastatic prostate cancer receiving external beam radiation therapy (EBRT).MethodsFatigue scores, measured by the Functional Assessment of Chronic Illness Therapy-Fatigue, and serum were collected from 12 subjects at baseline (before EBRT) and at midpoint (Day 21) of EBRT. Depleted sera from both time points were analyzed using two-dimensional difference gel electrophoresis, and up/down regulated proteins were identified using liquid chromatography-tandem mass spectrometry. Western blot analyses confirmed the protein changes observed.ResultsResults showed that apolipoprotein (Apo)A1, ApoE, and transthyretin (TTR) consistently changed from baseline (Day 0) to midpoint (Day 21). The mean ApoE level of subjects with high change in fatigue (HF: n = 9) increased significantly from baseline to midpoint and were higher than in subjects with no change in fatigue. The mean ApoA1 level was higher in HF subjects at baseline and at midpoint than in no fatigue subjects at both time points. The mean TTR level of no fatigue subjects was higher at baseline and midpoint than in HF subjects.ConclusionThese ApoE, ApoA1, and TTR results may assist in understanding pathways that can explain fatigue progression etiology in this clinical population.     

Prevalence of Fatigue in Patients With Cancer: A Systematic Review and Meta-Analysis

ContextFatigue is a particularly common and troubling symptom that has a negative impact on quality of life throughout all phases of treatment and stages of the illness among patients with cancer.ObjectivesThe objective of this meta-analysis is to examine the present status of fatigue prevalence in patients with cancer.MethodsThe following databases were searched: PubMed, MEDLINE, EMBASE, PsycINFO, Cochrane Library, from inception up to February 2020. Prevalence rates were pooled with meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I²) statistics.ResultsA total of 129 studies (N = 71,568) published between 1993 and 2020 met the inclusion criteria. The overall prevalence of fatigue was 49% (34,947 of 71,656 participants, 95% CI = 45–53) with significant heterogeneity between studies (P < 0.000; τ² = 0.0000; I² = 98.88%). Subgroup analyses show that the prevalence of fatigue related to type of cancer ranged from 26.2% in patients with gynecological cancer to 56.3% in studies that included mixed types of cancer. In advanced cancer stage patients, the highest prevalence of fatigue (60.6%) was reported. Fatigue prevalence rates were 62% during treatment and 51% during mixed treatment status. The prevalence of fatigue decreased from 64% in studies published from 1996 to 2000 to 43% in studies published from 2016 to 2020. Metaregression identified female gender as a significant moderator for higher prevalence of fatigue, whereas mean age is not associated with fatigue.ConclusionThis meta-analysis highlights the importance of developing optimal monitoring strategies to reduce fatigue and improve the quality of life of patients with cancer.     

Effectiveness of Therapeutic Exercise on Forward Head Posture: A Systematic Review and Meta-analysis

Objective

The purpose of this systematic review and meta-analysis was to summarize the results related to the effects of corrective exercises on postural variables in individuals with forward head posture (FHP).

Association Between the Overall Risk of Prostate Cancer and Use of Calcium Channel Blockers: A Systematic Review and Meta-analysis

PurposeAlthough calcium channel blockers (CCBs) are now commonly prescribed to treat hypertension as a first-line drug therapy, their impact on prostate cancer (PCa) is unclear. This systematic review and meta-analysis was conducted to determine the association between CCB use and the overall risk of PCa.MethodsPubMed, EMBASE, and Cochrane were searched up to December 26, 2019, stratified according to statistical method of outcome [odd ratios (ORs), relative ratios (RRs), hazard ratios (HRs)] and cumulative duration of CCB use. The quality assessment of included studies was evaluated by using the Newcastle–Ottawa Scale. Fixed effects models were used to study the association between CCB use and the risk of PCa. Between-study heterogeneity was quantified by using Cochran's Q-statistic and I² statistics. Sensitivity analysis was performed by excluding the studies one by one, and publication bias was analyzed by using funnel plots.FindingsNineteen studies with 1,418,407 patients were identified for inclusion in the meta-analysis, which was based on the comparison of cohort studies, nested case–control studies, and case–control studies. Pooled estimates showed a RR of 1.08 (95% CI, 1.05–1.11; P < 0.00001) and a HR of 1.07 (95% CI, 1.02–1.13; P = 0.008) for association between CCB use and the risk of PCa. In addition, the results of subgroup analysis showed that CCB users of <5 years had an 8% increased overall risk of PCa (RR, 1.08; 95% CI, 1.04–1.12; P = 0.0001), and CCB users of 5–10 years had a 13% increased overall risk of PCa (RR, 1.13; 95% CI, 1.04–1.23; P = 0.003).ImplicationsCCB use had a tendency to increase the overall risk of PCa, and cumulative duration of CCB use might also be positively correlated with the overall risk of PCa.     

癌症患者生活质量调查研究

目的 :了解肿瘤患者的生活质量。方法 :选择本院肿瘤中心肿瘤患者共 116例 ,如实填写WHOQOL -10 0调查问卷及自行设计的一般情况调查问卷 (包括性别、年龄、婚姻、学历等 ) ,收集的资料应用SPSS11 0统计软件包进行统计处理 ,运用t检验比较肿瘤患者WHOQOL - 10 0与常模之间差异的显著性 ;运用t检验比较不同一般情况肿瘤患者WHOQOL - 10 0差异的显著性。结果 :肿瘤患者除了自尊、医疗服务和社会保障、精神支柱个人信仰 3个方面与常模没有显著性差异外 ,其余 6个领域 2 1个方面均有显著性差异 ,且总的生活质量与常模有显著性差异 ;此外 ,不同一般情况的肿瘤患者其生活质量也有显著差异。结论 :肿瘤患者的生活质量较常模显著降低 ,应对肿瘤患者 ,尤其是中青年、未婚、农村、外地及低学历患者给予躯体、心理和健康知识宣教等全方面的关心、支持和帮助。     

The Hot Flash Related Daily Interference Scale: A Tool for Assessing the Impact of Hot Flashes on Quality of Life Following Breast Cancer

To assess the psychometric properties of the Hot Flash Related Daily Interference Scale (HFRDIS), a sample of breast cancer survivors and an age-matched comparison group completed a questionnaire packet and 2-day prospective hot flash diary at an initial time point and again 6 months later. There were 71 breast cancer survivors and 63 comparators at Time 1, and 54 survivors and 46 comparators at Time 2. The HFRDIS was internally consistent, with alphas of 0.96 at times 1 and 2. Validity was supported through 1) correlations with other hot flash variables, 2) correlations with measures of affect and mood, 3) significant differences between women with hot flashes and those without, and 4) demonstrated sensitivity to change over time. The HFRDIS is a psychometrically sound measure for assessing the impact of hot flashes on daily activities and overall quality of life in clinical practice or research protocols.     

前列腺癌患者经济毒性在自我效能与生活质量间的中介效应研究

目的 探讨前列腺癌患者经济毒性在自我效能与生活质量间的中介效应.方法 采取便利抽样法,选择2021年1-9月上海市某三级甲等医院诊治的404例前列腺癌患者,采用一般资料调查表、一般自我效能感量表、患者报告结局的经济毒性综合评分量表和癌症患者生存质量量表对其进行问卷调查.结果 前列腺癌患者生活质量总分为95.0(80.0...     

Combined Low Dose Rate Brachytherapy and External Beam Radiation Therapy for Intermediate-Risk Prostate Cancer

Introduction

This is a retrospective study conducted to report the tumor control and late toxicity outcomes of patients with intermediate-risk prostate cancer undergoing combination external beam radiation therapy and low dose rate brachytherapy (LDR-PB).