Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy.

BACKGROUND: Few exercise trials in cancer patients have reported longer-term follow-up. Here, we report a 6-month follow-up of exercise behavior and patient-rated outcomes from an exercise trial in breast cancer patients. METHODS: Breast cancer patients initiating adjuvant chemotherapy (n = 242) were randomly assigned to usual care (n = 82), resistance exercise training (RET; n = 82), or aerobic exercise training (AET; n = 78) for the duration of their chemotherapy. At 6-month follow-up, participants were mailed a questionnaire that assessed quality of life, self-esteem, fatigue, anxiety, depression, and exercise behavior. RESULTS: Two hundred one (83.1%) participants provided 6-month follow-up data. Adjusted linear mixed-model analyses showed that, at 6-month follow-up, the RET group reported higher self-esteem [adjusted mean difference, 1.6; 95% confidence interval (95% CI), 0.1-3.2; P = 0.032] and the AET group reported lower anxiety (adjusted mean difference, -4.7; 95% CI, -0.0 to -9.3; P = 0.049) compared with the usual care group. Moreover, compared with participants reporting no regular exercise during the follow-up period, those reporting regular aerobic and resistance exercise also reported better patient-rated outcomes, including quality of life (adjusted mean difference, 9.5; 95% CI, 1.2-17.8; P = 0.025). CONCLUSIONS: Improvements in self-esteem observed with RET during breast cancer chemotherapy were maintained at 6-month follow-up whereas reductions in anxiety not observed with AET during breast cancer chemotherapy emerged at 6-month follow-up. Moreover, adopting a combined aerobic and resistance exercise program after breast cancer chemotherapy was associated with further improvements in patient-rated outcomes. Exercise training during breast cancer chemotherapy may result in some longer-term and late effects for selected patient-rated outcomes.     

Polymorphisms in three base excision repair genes and breast cancer risk in Thai women

Few randomized controlled trials have examined the effects of combined aerobic and resistance training in breast cancer survivors soon after completing adjuvant therapy. Breast cancer survivors (N = 58) within 2 years of completing adjuvant therapy were randomly assigned to an immediate exercise group (IEG; n = 29) or a delayed exercise group (DEG; n = 29). The IEG completed 12 weeks of supervised aerobic and resistance exercise, three times per week. The DEG completed the program during the next 12 weeks. Participants completed patient-rated outcomes at baseline, 6, 12, 18 and 24 weeks. The primary endpoint was overall quality of life (QoL) measured by the Functional Assessment of Cancer Therapy-Breast scale. Secondary endpoints were fatigue, social physique anxiety, and physical fitness. Follow-up data was obtained on 97% of participants and exercise adherence was 61.3%. Repeated measures analyses of variance revealed a significant group by time interaction for overall QoL (P < 0.001). Specifically, QoL increased in the IEG from baseline to 12 weeks by 20.8 points compared to a decrease in the DEG of 5.3 points (mean group difference = 26.1; 95% CI = 18.3–32.7; P < 0.001). From 12 to 24 weeks, QoL increased in the DEG by 29.5 points compared to an increase of 6.5 points in the IEG (mean group difference = 23.0; 95% CI = 16.3–29.1; P < 0.001). Similar results were obtained for the secondary endpoints. Combined aerobic and resistance exercise soon after the completion of breast cancer therapy produces large and rapid improvements in health-related outcomes.     

Subgroup effects in a randomised trial of different types and doses of exercise during breast cancer chemotherapy

Background:

The Combined Aerobic and Resistance Exercise Trial tested different types and doses of exercise in breast cancer patients receiving chemotherapy. Here, we explore potential moderators of the exercise training responses.

Methods:

Breast cancer patients initiating chemotherapy (N=301) were randomly assigned to three times a week, supervised exercise of a standard dose of 25–30 min of aerobic exercise, a higher dose of 50–60 min of aerobic exercise, or a higher dose of 50–60 min of combined aerobic and resistance exercise. Outcomes were patient-reported symptoms and health-related fitness. Moderators were baseline demographic, exercise/fitness, and cancer variables.

Results:

Body mass index moderated the effects of the exercise interventions on bodily pain (P for interaction=0.038), endocrine symptoms (P for interaction=0.029), taxane/neuropathy symptoms (P for interaction=0.013), aerobic fitness (P for interaction=0.041), muscular strength (P for interaction=0.007), and fat mass (P for interaction=0.005). In general, healthy weight patients responded better to the higher-dose exercise interventions than overweight/obese patients. Menopausal status, age, and baseline fitness moderated the effects on patient-reported symptoms. Premenopausal, younger, and fitter patients achieved greater benefits from the higher-dose exercise interventions.

Conclusions:

Healthy weight, fitter, and premenopausal/younger breast cancer patients receiving chemotherapy are more likely to benefit from higher-dose exercise interventions.     

Predictors of follow-up exercise behavior 6 months after a randomized trial of exercise training during breast cancer chemotherapy

Purpose Exercise during breast cancer chemotherapy is beneficial but it needs to be maintained into survivorship to optimize long-term benefits. Here, we report the predictors of follow-up exercise behavior 6 months after a randomized exercise trial in breast cancer patients. Methods Breast cancer patients (N = 242) initiating adjuvant chemotherapy were randomly assigned to usual care (n = 82), supervised resistance exercise (n = 82), or supervised aerobic exercise (n = 78) for the duration of their chemotherapy. At baseline and postintervention, data were collected on demographic, medical, behavioral, fitness, psychosocial, and motivational variables. At 6-month follow-up, participants were mailed a questionnaire that assessed exercise behavior over the past 6 months and were categorized as either meeting both aerobic and resistance exercise guidelines, either exercise guideline, or neither exercise guideline. Results Two hundred one (83.1%) participants provided 6-month follow-up data with 85 (42.3%) meeting neither exercise guideline, 74 (36.8%) meeting either exercise guideline, and 42 (20.9%) meeting both exercise guidelines. In multivariate regression analysis, seven variables independently predicted the likelihood of meeting exercise guidelines at follow-up including higher pretrial exercise (β = 0.23; P = 0.002), younger age (β = −0.15; P = 0.028), breast conserving surgery (β = 0.15; P = 0.033), strength improvements (β = 0.15; P = 0.028), lower postintervention fatigue (β = 0.13; P = 0.067), a more positive attitude (β = 0.12; P = 0.086), and lower postintervention body mass index (β = −0.11; P = 0.105). Conclusion Exercise behavior 6 months after a randomized trial was predicted by a wide range of demographic, medical, behavioral, fitness, psychosocial, and motivational variables. These findings may help facilitate the uptake of exercise behavior during the transition from breast cancer patient to survivor.     

Feasibility and efficacy of a supervised exercise intervention in de-conditioned cancer survivors during the early survivorship phase: the PEACH trial

Purpose

This study aims to evaluate the feasibility and efficacy of an 8-week supervised exercise program in de-conditioned cancer survivors within 2–6 months of chemotherapy completion.

Methods

Participants were randomly assigned to an 8-week, twice-weekly, supervised aerobic exercise training regime (n?=?23) or a usual care group (n?=?20). Feasibility was assessed by recruitment rate, program adherence and participant feedback. The primary outcome was aerobic fitness assessed by the Modified Bruce fitness test at baseline (0 weeks), post-intervention (8 weeks) and at 3-month follow-up. Secondary outcomes included physical activity, waist circumference, fatigue and quality of life.

Results

The recruitment rate was 81 % and adherence to the supervised exercise was 78.3 %. Meaningful differences in aerobic fitness between the exercise and usual care groups at both the 8-week [mean 3.0 mL kg^?1 min^?1 (95 % CI ?1.1–7.0)] and 3-month follow-up [2.1 mL kg^?1 min^?1 (?2.3–6.6)] were found, although these differences did not achieve statistical significance (p values >0.14). Self-reported physical activity increased in the exercise group (EG) compared to the usual care group at both 8-week (p?=?0.01) and 3-month follow-up (p?=?0.03) and significant differences in favour of the EG were found for physical well-being at both the 8-week (p?=?0.03) and 3-month follow-up (p?=?0.04). Improvements in fatigue (p?=?0.01), total quality of life plus fatigue (p?=?0.04), and a composite physical functioning score (p?=?0.01) at the 3-month follow-up were also found.

Conclusion

The PEACH trial suggests that 8 weeks of supervised aerobic exercise training was feasible and may improve aerobic fitness, fatigue and quality of life in de-conditioned cancer survivors during the early survivorship phase.

Implications for Cancer Survivors

Exercise interventions commenced in the early survivorship phase appear safe, feasible and may lead to improvements in QOL and fatigue.     

The implementation of an oncologist referred, exercise self-management program for older breast cancer survivors

BACKGROUND: With increased breast cancer survivor rates among older women, the negative outcomes of breast cancer treatment may linger for years. METHOD: We designed and implemented an oncologist referred, exercise self-management program to increase physical activity and health-related quality of life using a pretest-posttest, single group design. We recruited 34 breast cancer survivors seen for a follow-up oncology visit at two university cancer treatment centers. Women with a mean age of 59.6 years (S.D.=66) comprised the sample. Average time since diagnosed was 3.1 years; 45% had stage I breast cancer and 55% had stage II; 62% received chemotherapy and 59% received a mastectomy. Following a baseline assessment on exercise support, self-efficacy, barriers and benefits; quality of life; and a functional performance test, subjects participated in self-management classes and received telephone support. Participants (n=30) repeated the assessment at 6-months. We compared scores between time periods using t-tests. RESULTS: Older women increased frequency of weekly, moderate physical activities (p相似文献   

An Individualized Exercise Intervention for People with Multiple Myeloma—Study Protocol of a Randomized Waitlist-Controlled Trial

People with multiple myeloma (MM) are second only to people with lung cancer for the poorest reported health-related quality of life (HRQoL) of all cancer types. Whether exercise can improve HRQoL in MM, where bone pain and lesions are common, requires investigation. This trial aims to evaluate the efficacy of an exercise intervention compared with control on HRQoL in people with MM. Following baseline testing, people with MM (n = 60) will be randomized to an exercise (EX) or waitlist control (WT) group. EX will complete 12-weeks of supervised (24 sessions) and unsupervised (12 sessions) individualized, modular multimodal exercise training. From weeks 12–52, EX continue unsupervised training thrice weekly, with one optional supervised group-based session weekly from weeks 12–24. The WT will be asked to maintain their current activity levels for the first 12-weeks, before completing the same protocol as EX for the following 52 weeks. Primary (patient-reported HRQoL) and secondary (bone health and pain, fatigue, cardiorespiratory fitness, muscle strength, body composition, disease response, and blood biomarkers) outcomes will be assessed at baseline, 12-, 24- and 52-weeks. Adverse events, attendance, and adherence will be recorded and cost-effectiveness analysis performed. The findings will inform whether exercise should be included as part of standard myeloma care to improve the health of this unique population.     

Impact of a walking intervention on cardiorespiratory fitness,self‐reported physical function,and pain in patients undergoing treatment for solid tumors

BACKGROUND:

Cancer treatment is associated with decline in measured and self‐reported physical function and increased pain. In the current study, the authors evaluated the impact of a walking intervention on these outcomes during chemotherapy/radiation.

METHODS:

Patients with breast, prostate, and other cancers (N=126) were randomized to a home‐based walking intervention (exercise) or usual care (control). Exercise dose during the intervention was assessed using a 5‐item Physical Activity Questionnaire. Outcome measures were cardiorespiratory fitness, expressed as peak oxygen uptake (VO₂) measured during treadmill testing (n = 85) or estimated by 12‐minute walk (n = 27), and self‐reported physical function, role limitations, and pain derived from Medical Outcomes Study Short Form 36. Linear regression was used to evaluate pre‐to‐post intervention change outcomes between groups.

RESULTS:

The mean (standard deviation) age of the patients was 60.2 (10.6) years. Diagnoses included prostate (55.6%) and breast (32.5%) cancer. Treatment included external beam radiotherapy (52.3%) and chemotherapy (34.9%). Exercise patients reported worsening Medical Outcomes Study physical function role limitations by the end of cancer treatment (P = .037). Younger age was associated with improved Medical Outcomes Study physical function (P = .048). In all patients, increased exercise dose was associated with decreased Medical Outcomes Study pain (P = .046), regardless of diagnosis. The percent change of VO₂ between prostate and nonprostate cancer patients when adjusted for baseline VO₂ and Physical Activity Questionnaire values was 17.45% (P = .008), with better VO₂ maintenance in the prostate group.

CONCLUSIONS:

Exercise during cancer treatment improves cardiorespiratory fitness and self‐reported physical function in prostate cancer patients and in younger patients, regardless of diagnosis, and may attenuate loss of those capacities in patients undergoing chemotherapy. Exercise also reduces the pain experience. Cancer 2009. © 2009 American Cancer Society.     

Moderators of the effects of exercise training in breast cancer patients receiving chemotherapy: a randomized controlled trial

BACKGROUND: Exercise training improves supportive care outcomes in patients with breast cancer who are receiving adjuvant therapy, but the responses are heterogeneous. In this study, the authors examined personal and clinical factors that may predict exercise training responses. METHODS: Breast cancer patients who were initiating adjuvant chemotherapy (N=242) were assigned randomly to receive usual care (UC) (n=82), resistance exercise training (RET) (n=82), or aerobic exercise training (AET) (n=78) for the duration of chemotherapy. Endpoints were quality of life (QoL), aerobic fitness, muscular strength, lean body mass, and body fat. Moderators were patient preference for group assignment, marital status, age, disease stage, and chemotherapy regimen. RESULTS: Adjusted linear mixed-model analyses demonstrated that patient preference moderated QoL response (P= .005). Patients who preferred RET improved QoL when they were assigned to receive RET compared with UC (mean difference, 16.5; 95% confidence interval [95% CI], 4.3-28.7; P= .008) or AET (mean difference, 11; 95% CI, -1.1-23.4; P= .076). Patients who had no preference had improved QoL when they were assigned to receive AET compared with RET (mean difference, 23; 95% CI, 4.9-41; P= .014). Marital status also moderated QoL response (P= .026), age moderated aerobic fitness response (P= .029), chemotherapy regimen moderated strength gain (P= .009), and disease stage moderated both lean body mass gain (P< .001) and fat loss (P= .059). Unmarried, younger patients who were receiving nontaxane-based therapies and had more advanced disease stage experienced better outcomes. The findings were not explained by differences in adherence. CONCLUSIONS: Patient preference, demographic variables, and medical variables moderated the effects of exercise training in breast cancer patients who were receiving chemotherapy. If replicated, these results may inform clinical practice.     

Effect of Exercise on Taxane Chemotherapy–Induced Peripheral Neuropathy in Women With Breast Cancer: A Randomized Controlled Trial

BackgroundChemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting adverse effect of taxanes. We sought to evaluate the effect of exercise on taxane CIPN in women with breast cancer.Patients and MethodsWomen (n = 27) were randomized to immediate exercise (IE, during taxane chemotherapy) or delayed exercise (DE, after chemotherapy). Supervised aerobic, resistance, and balance training was offered 3 days a week for 8-12 weeks. CIPN symptoms and quality of life were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30 and CIPN20 (scored from 0 to 100). The percentage of participants reporting moderate to severe sensory symptoms (‘3/4’ or ‘4/4’ for CIPN20 sensory items) was also evaluated, along with clinical sensory testing at the lower limb (vibration sense and pinprick). Taxane treatment adherence, including relative dose intensity, was extracted from patient medical records. Assessments occurred at: baseline (before taxane chemotherapy), pre-cycle 4 (before the final taxane cycle), the end of chemotherapy, and follow-up (10-15 weeks after chemotherapy).ResultsNo differences in the EORTC QLQ CIPN20 symptom scores were detected between groups at any time point. At pre-cycle 4, there was a significant difference between groups in patient-reported moderate to severe numbness in the toes or feet (IE: n = 1, 9%, DE: n = 7, 50%, P = .04) and impaired vibration sense in the feet (IE: n = 2, 18%, DE: n = 10, 83%, P < .01). Overall global health status/quality of life was higher in IE compared to DE at the end of chemotherapy (P = .05), yet both groups had worse CIPN20 sensory (Δ24.3 ± 4.6, P < .01) and motor symptom scores (Δ10.5 ± 1.9, P < .01) relative to baseline. By the end of chemotherapy, no differences between groups were found for moderate to severe numbness in the toes or feet (P = 1.0) or impaired vibration sense in the feet (P = .71). More IE participants received ≥ 85% relative dose intensity (IE: n = 12, 100%, DE: n = 10, 67%, P < .05).ConclusionExercise may attenuate CIPN over the course of taxane chemotherapy and possibly improve taxane adherence in women with breast cancer. These findings, as well as whether exercise can attenuate CIPN by the end of taxane chemotherapy, should be confirmed in larger trials.     

Efficacy of multimodal exercise-based rehabilitation on physical activity,cardiorespiratory fitness,and patient-reported outcomes in cancer survivors: a randomized,controlled trial

BackgroundSedentary behavior and impaired cardiovascular reserve capacity are common late effects of cancer therapy emphasizing the need for effective strategies to increase physical activity (PA) in cancer survivors. We examined the efficacy of a 12-month exercise-based rehabilitation program on self-reported PA, cardiorespiratory fitness (VO_2peak), strength, and patient-reported outcomes.Patients and methodsTwo hundred fourteen post-treatment cancer survivors were randomly assigned to a 12-month rehabilitation program consisting of individual (x3) and group-based (x6) counseling in combination with once weekly high-intensity group-based exercise training (the Copenhagen Physical Activity after Cancer Treatment, PACT; n = 108) or to a health evaluation program (HE, n = 106). Study outcomes were assessed at baseline, 6 months, and 12 months.ResultsAfter 12 months, the percentage of patients reporting meeting PA goal behavior (≥3 h/week) was significantly increased in the PACT group versus the HE group (70.4% versus 43.4%, P = 0.001). Repeated measures analyses indicated a statistically significant improvement in VO_2peak (l min^-1) in favour of PACT (treatment effect ratio = 1.04; 95% confidence interval 1.00–1.07; P = 0.032). Significant between group differences were also observed for strength (P < 0.001), depression (P = 0.020) and mental health (P = 0.040).ConclusionA 12-month exercise-based rehabilitation program is an effective strategy to promote PA and improve VO_2peak in cancer survivors.     

No reduction in C-reactive protein following a 12-month randomized controlled trial of exercise in men and women

Low-grade systemic inflammation is suggested to play a role in the development of several chronic diseases including cancer. Higher levels of physical activity and lower adiposity have been associated with reduced levels of markers of systemic inflammation, such as C-reactive protein (CRP); however, reductions in CRP have not been consistently observed in randomized controlled trials of exercise. PURPOSE: To examine the effect of a 12-month aerobic exercise intervention on CRP levels in men and women. METHODS: One hundred two men and 100 women, sedentary and of ages 40 to 75 years, with mean body mass index (BMI) of 29.9 and 28.7 kg/m(2), respectively, were randomly assigned to a 12-month moderate-to-vigorous aerobic exercise intervention (6 d/wk, 60 min/d, 60-85% maximum heart rate) or control group. Fasting blood samples were collected at baseline and at 12 months. CRP levels were measured by high-sensitivity latex-enhanced nephelometry. RESULTS: At baseline, CRP was 1.16 and 2.11 mg/L for men and women, respectively, and CRP was correlated with percent body fat (r = 0.48, P < or =0.001), BMI (r = 0.37, P < or = 0.001), and aerobic fitness (r = -0.49, P < or = 0.001). No intervention effects were observed for CRP in men or women, or when stratified by baseline BMI (<30 versus > or =30 kg/m(2)), baseline CRP (<3 versus > or =3 mg/L), or change in body weight, body composition, or aerobic fitness. CONCLUSION: A 12-month moderate-to-vigorous aerobic exercise intervention did not affect CRP levels in previously sedentary men or women with average-risk CRP values at baseline.     

The Impact of Rehabilitation Support Services on Health-related Quality of Life for Women with Breast Cancer

As the number of women surviving breast cancer increases, with implications for the health system, research into the physical and psychosocial sequelae of the cancer and its treatment is a priority. This research estimated self-reported health-related quality of life (HRQoL) associated with two rehabilitation interventions for breast cancer survivors, compared to a non-intervention group. Women were selected if they received an early home-based physiotherapy intervention (DAART, n = 36) or a group-based exercise and psychosocial intervention (STRETCH, n = 31). Questionnaires on HRQoL, using the Functional Assessment of Cancer Therapy – Breast Cancer plus Arm Morbidity module, were administered at pre-, post-intervention, 6- and 12-months post-diagnosis. Data on a non-intervention group (n = 208) were available 6- and 12-months post-diagnosis. Comparing pre/post-intervention measures, benefits were evident for functional well-being, including reductions in arm morbidity and upper-body disability for participants completing the DAART service at one-to-two months following diagnosis. In contrast, minimal changes were observed between pre/post-intervention measures for the STRETCH group at approximately 4-months post-diagnosis. Overall, mean HRQoL scores (adjusted for age, chemotherapy, hormone therapy, high blood pressure and occupation type) improved gradually across all groups from 6- to 12-months post-diagnosis, and no prominent differences were found. However, this obscured declining HRQoL scores for 20–40% of women at 12 months post-diagnosis, despite receiving supportive care services. Greater awareness and screening for adjustment problems among breast cancer survivors is required throughout the disease trajectory. Early physiotherapy after surgery has the potential for short-term functional, physical and overall HRQoL benefits.     

Effects of resistance exercise on fatigue and quality of life in breast cancer patients undergoing adjuvant chemotherapy: A randomized controlled trial

Multiple exercise interventions have shown beneficial effects on fatigue and quality of life (QoL) in cancer patients, but various psychosocial interventions as well. It is unclear to what extent the observed effects of exercise interventions are based on physical adaptations or rather on psychosocial factors associated with supervised, group‐based programs. It needs to be determined which aspects of exercise programs are truly effective. Therefore, we aimed to investigate whether resistance exercise during chemotherapy provides benefits on fatigue and QoL beyond potential psychosocial effects of group‐based interventions. One‐hundred‐one breast cancer patients starting chemotherapy were randomly assigned to resistance exercise (EX) or a relaxation control (RC) group. Both interventions were supervised, group‐based, 2/week over 12 weeks. The primary endpoint fatigue was assessed with a 20‐item multidimensional questionnaire, QoL with the EORTC QLQ‐C30/BR23. Analyses of covariance for individual changes from baseline to Week 13 were calculated. In RC, total and physical fatigue worsened during chemotherapy, whereas EX showed no such impairments (between‐group p = 0.098 and 0.052 overall, and p = 0.038 and 0.034 among patients without severe baseline depression). Differences regarding affective or cognitive fatigue were not significant. Benefits of EX were also seen to affect role and social function. Effect sizes were between 0.43 and 0.48. Explorative analyses indicated significant effect modification by thyroxin use (p‐interaction = 0.044). In conclusion, resistance exercise appeared to mitigate physical fatigue and maintain QoL during chemotherapy beyond psychosocial effects inherent to supervised group‐based settings. Thus, resistance exercise could be an integral part of supportive care for breast cancer patients undergoing chemotherapy.     

Multimodal exercise improves quality of life of women being treated for breast cancer,but at what cost? Randomized trial with economic evaluation

To evaluate the efficacy and economic efficiency of a multimedia, multimodal physical activity program for women undergoing adjuvant therapy following surgery for breast cancer. We conducted a randomized trial with concurrent incremental cost-effectiveness analysis and blinded baseline, 3, 6 and 12-month follow-up assessments amongst women undergoing adjuvant therapy following surgery for breast cancer (n = 89). The intervention was a multimedia, multimodal exercise program comprising strength, balance and endurance training elements. The control was sham flexibility and relaxation program delivered using similar materials. The primary outcome was health-related quality of life (EQ-5D & VAS, EORTC C30, BR23). Economic outcomes included direct health care costs and productivity gains and losses. Participants in the intervention group demonstrated greater improvement in health-related quality of life between baseline and the 3-month assessment [mean (sd) EQ-5D VAS (0–100) baseline: 72.6 (15.6), 3 month: 80.6 (11.6)] when compared to control group participants [baseline: 77.5 (13.5), 3 month: 74.1 (20.6), P = 0.006] and also improved more in terms of physical function [mean (sd) EORTC C30 physical function scale intervention (0–100) baseline: 84.9 (14.8), 3 month: 86.9 (10.7), control baseline: 91.3 (9.6), 3 month: 86.7 (14.9), P = 0.02]. These improvements were not sustained beyond this point. Upper limb volumes were also lower amongst intervention group participants. However, there was low probability that the intervention would be both less costly and more effective than the control condition (range probability = 0.05–50.02% depending on approach). Provision of multimodal exercise programs will improve the short-term health of women undergoing adjuvant therapy for breast cancer but are of questionable economic efficiency.     

Safety and feasibility of aerobic training on cardiopulmonary function and quality of life in postsurgical nonsmall cell lung cancer patients: a pilot study

BACKGROUND.

A feasibility study examining the effects of supervised aerobic exercise training on cardiopulmonary and quality of life (QOL) endpoints among postsurgical nonsmall cell lung cancer (NSCLC) patients was conducted.

METHODS.

Using a single‐group design, 20 patients with stage I‐IIIB NSCLC performed 3 aerobic cycle ergometry sessions per week at 60% to 100% of peak workload for 14 weeks. Peak oxygen consumption (VO_2peak) was assessed using an incremental exercise test. QOL and fatigue were assessed using the Functional Assessment of Cancer Therapy–Lung (FACT‐L) scale.

RESULTS.

Nineteen patients completed the study. Intention‐to‐treat analysis indicated that VO_2peak increased 1.1 mL/kg^?1/min^?1 (95% confidence interval [CI], ?0.3‐2.5; P = .109) and peak workload increased 9 W (95% CI, 3‐14; P = .003), whereas FACT‐L increased 10 points (95% CI, ?1‐22; P = .071) and fatigue decreased 7 points (95% CI; ?1 to ?17; P = .029) from baseline to postintervention. Per protocol analyses indicated greater improvements in cardiopulmonary and QOL endpoints among patients not receiving adjuvant chemotherapy.

CONCLUSIONS.

This pilot study provided proof of principle that supervised aerobic training is safe and feasible for postsurgical NSCLC patients. Aerobic exercise training is also associated with significant improvements in QOL and select cardiopulmonary endpoints, particularly among patients not receiving chemotherapy. Larger randomized trials are warranted. Cancer 2008. © 2008 American Cancer Society.     

US follow-up protocol in concordant benign result after US-guided 14-gauge core needle breast biopsy

To determine the time when follow-up ultrasound (US) should begin for concordant benign lesions after US-guided 14-gauge core needle breast biopsy (CNB). This was an IRB–approved retrospective study, with a waiver of informed consent. Among 3,888 consecutive US-guided CNBs performed between August 2005 and March 2008, 1,492 breast masses in 1,309 women with concordant benign results and follow-up US after CNB were included. Their medical records were reviewed. Statistical comparisons for the result of first follow-up US and malignant rates among 6-month, 12-month, and long-term intervals were performed by using Fisher exact test. Results dichotomized for symptom, lesion size (10 mm), and CNB result (specific or not), were also analyzed. In 1,492 masses, seven malignancies (0.5%) were diagnosed by interval growth at first follow-up US performed at 6-month (n = 3), 12-month (n = 1), and long-term interval (n = 3). No significant difference in results of follow-up US and malignant rates was found among follow-up intervals. At 6-month interval, malignant rate in symptomatic group (1.9%, 3/162) was significantly higher than in asymptomatic group (0%, 0/819) (P = 0.004). The size of malignancy at long-term interval tended to be larger than at shorter interval, and metastasis was developed in one patient with malignancy at long-term interval. Concordant benign lesions after US-guided 14-gauge CNB should be recommended to begin US follow-up at least at 12 months to detect early-stage cancers. However, for concordant benign lesion associated with any clinical symptoms, follow-up US should begin earlier, at 6 months after CNB.     

A systematic review and meta‐analysis of exercise interventions for colorectal cancer patients

The aim of this systematic review and meta‐analysis was to investigate the effectiveness of exercise for colorectal cancer patients. Pubmed/Medline, Scopus and the Cochrane Library were searched through December 2012 without language restrictions. Randomised controlled trials (RCTs) comparing exercise interventions to control conditions were analysed when they assessed health‐related quality of life, fatigue, physical fitness, survival and/or tumour‐associated biomarkers in colorectal cancer patients. Risk of bias was assessed using the risk of bias tool recommended by the Cochrane Back Review Group. Literature search identified 342 non‐duplicate records of which five RCTs with a total of 238 patients were included; three RCTs had low risk of bias. No evidence was found for short‐term effects on quality of life [standardised mean difference (SMD) = 0.18; 95% confidence interval (CI) ?0.39, 0.76; P = 0.53] or fatigue (SMD = 0.18; 95% CI ?0.22, 0.59; P = 0.38). There was strong evidence for short‐term improvements of physical fitness after aerobic exercise compared with controls (SMD = 0.59; 95% CI 0.25, 0.93; P < 0.01). One RCT each assessed immune parameters and oxidative DNA damage. No study reported survival rates or safety data. Given this insufficient evidence and the lack of safety data, no recommendation can be made regarding exercise interventions as a routine intervention for colorectal cancer patients.