A pilot study of a supervised group exercise programme as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment.

This pilot study examined whether exercise as an adjunctive rehabilitation therapy could benefit women who have early stage breast cancer and are currently receiving chemotherapy/radiotherapy. The study was designed as a randomised controlled trial (RCT). Physical functioning, fatigue and Quality of Life (QoL) outcomes were evaluated pre and post a 12-week intervention. The results showed that after 12 weeks the women who participated in the exercise programme (n = 12) displayed significantly higher levels of physical functioning and reported higher QoL scores than the controls (n = 10). Changes in fatigue and satisfaction with life favoured the intervention group but did not reach significance. These results are encouraging and suggest that a structured group exercise programme during adjuvant treatment is a safe, well tolerated and effective way of providing physical and psychological health benefits to women during treatment for early stage breast cancer. Since this was a pilot study the numbers did not allow appropriately powered analyses of some variables of interest and favoured relatively young and socio-economically advantaged women. Future studies need to address these issues and determine if these short-term benefits can be sustained.     

Fostering positive experiences of group-based exercise classes after breast cancer: what do women have to say?

Purpose: The adverse side effects of current treatments for breast cancer highlight the need for rehabilitative programmes. Group-based exercise programmes have been found to be effective in reducing symptoms and treatment side effects and improving physical and psychological health in cancer survivors. To assist programme administrators and instructors in the ongoing design and delivery of optimal group-based exercise programmes, we conducted a longitudinal qualitative study to explore breast cancer survivors’ perceptions of the instructor and the climate the instructor created within the context of a group-based exercise programme, and how this contributes to women’s motivational experiences. Method: Seven women participating in an eight-week group-based exercise programme were interviewed at the start and end of the programme. Data were analysed using thematic analysis. Results: The instructor’s attributes (energy, enthusiasm, approachability, knowledge, experience) and her focus on promoting self-improvement, personal progress, skill development and task mastery contributed to participants’ positive experiences, which served to enhance their motivation to remain involved in the programme. Conclusions: Instructors play an essential role in creating a supportive climate and fostering positive experiences in group-based exercise programmes for breast cancer survivors. Hiring caring and knowledgeable instructors who are able to create a supportive climate may enhance breast cancer survivors’ experiences in group-based exercise programmes and promote sustained participation.

• Implications for Rehabilitation

• Promoting self-improvement, personal progress, skill development and task mastery can enhance breast cancer survivors’ adherence to group-based exercise programmes, which can help mitigate the effects of cancer and its treatment.

• In addition to training leaders to run safe and effective programmes, hiring instructors who have high energy, and who are enthusiastic, approachable, knowledgeable and experienced can promote breast cancer survivors’ adherence to group-based exercise programmes.

• Training in breast cancer management is required to allow instructors to understand the complexities of this disease and develop tailored exercise programmes.

• Future research needs to identify training techniques that can effectively promote exercise instructors’ competence in working with breast cancer survivors.

     

Differences in quality of life between American and Chinese breast cancer survivors

Objective

It has been speculated that cancer survivors in Asia may have lower quality of life (QOL) compared with their Western counterparts. However, no studies have made international comparisons in QOL using a comprehensive measure. This study aimed to compare Chinese breast cancer survivors’ QOL with US counterparts and examine if demographic and medical factors were associated with QOL across groups.

Method

The sample consisted of 159 breast cancer patients (97 Chinese and 62 American) who completed the Functional Assessment for Cancer Therapy Breast Cancer (FACT-B) scale before the start of radiotherapy in Shanghai, China and Houston, USA.

Results

Higher income was associated with higher QOL total scores in both Chinese and American cancer patients, but QOL was not significantly associated with other factors including age, education, disease stage, mastectomy, and chemotherapy. Consistent with hypotheses, compared to their US counterparts, Chinese breast cancer survivors reported lower QOL and all four subdimensions including functional well-being (FWB), physical well-being (PWB), emotional well-being (EWB), and social well-being (SWB); they also reported more breast cancer-specific concerns (BCS). Differences were also clinically significant for Functional Assessment for Cancer Therapy General (FACT-G) scale total scores and the FWB subscale. After controlling for demographic and medical covariates, these differences remained except for the SWB and BCS. Furthermore, Chinese breast cancer survivors receiving chemotherapy reported significantly lower FACT-G scores than those who did not, but this difference did not emerge among US breast cancer survivors.

Discussion

Chinese breast cancer survivors reported poorer QOL on multiple domains compared to US women. Findings indicate that better strategies are needed to help improve the QOL of Chinese breast cancer survivors, especially those who underwent chemotherapy.

     

A community-based exercise programme to improve functional ability in people with Alzheimer's disease: a randomized controlled trial

Scand J Caring Sci; 2012; 26; 12–19
A community‐based exercise programme to improve functional ability in people with Alzheimer’s disease: a randomized controlled trial Rationale: Dementia is a common neurodegenerative condition in older age associated with functional decline across multiple domains. This decline impacts not only on the person with dementia, but also on their informal carers and health and aged care systems. With the number of people with dementia rapidly increasing and few effective treatments, there is now a critical need for interventions to improve functional ability in those with the condition. Aims and objective: This study assesses the effectiveness of a community‐based home exercise programme in improving cognitive and physical function and independence in activities of daily living (ADL) in people with Alzheimer’s disease, the most common form of dementia. Methods: In a 4‐month randomized controlled trial, 40 community‐dwelling patients diagnosed with Alzheimer’s disease and their informal carers were randomly allocated to either the treatment (exercise plus usual treatment) or control (usual treatment) group. The exercise programme consisted of daily exercises and walking under the supervision of their carer. Patients were assessed at baseline and 4‐months follow‐up by a blinded assessor on primary outcome measures of cognitive and physical function and ADL using standardized assessment scales. Results: Sixteen men and 24 women diagnosed with Alzheimer’s disease participated in the study. They had a mean age of 74.1 years (range 51–89) and a mean Mini Mental State Examination score of 22.0 (range 10–28), indicating mild to moderate dementia. At 4‐months follow‐up, patients who exercised, compared with controls, had improved cognition (increased Mini Mental State Examination scores by 2.6 points, p < 0.001), better mobility (2.9 seconds faster on Timed Up and Go, p = 0.004) and increased Instrumental Activities of Daily Living scores by 1.6 (p = 0.007). Conclusion: This study suggests that participation in a community‐based exercise programme can improve cognitive and physical function and independence in ADL in people with Alzheimer’s disease.     

Effect of supportive care on the anxiety of women with suspected breast cancer

Title.  Effect of supportive care on the anxiety of women with suspected breast cancer.
Aim.  This paper is a report of a study of the effect of supportive care on anxiety levels of women with suspected breast cancer during the diagnostic period.
Background.  Informational and psychosocial support has been shown to improve care outcomes for women with breast cancer. However, little is known about the effect of supportive care on women's psychological status during the breast cancer diagnostic period.
Methods.  For this longitudinal quasi-experimental study, 122 participants were recruited from a large teaching hospital in Taiwan. The experimental group ( n  =   62) received a supportive care programme that included health education pamphlets about breast cancer diagnosis and treatment, three face-to-face sessions of informational and emotional support, and two follow-up telephone consultations. The control group ( n  =   60) received routine care. Data were collected from October 2006 to April 2007 using the State-Trait Anxiety Inventory at baseline (notification of need for breast biopsy), before biopsy, and after receiving biopsy result (diagnosis).
Findings.  After adjusting for covariance of breast discomfort, regular breast self-examination, and biopsy result, the anxiety levels of women receiving supportive care were significantly lower before biopsy ( P  =   0·017) and after diagnosis ( P  =   0·001) than those of women receiving routine care.
Conclusion.  Supportive care that incorporates informational and emotional support and follow-up telephone consultations can decrease anxiety levels of women with suspected breast cancer. These findings can serve as a reference for clinical nursing staff to improve care quality during the breast cancer diagnostic period by providing women with individualized and culturally sensitive care.     

Women's perceptions of home-based exercise performed during adjuvant chemotherapy for breast cancer

PurposeTo describe women's perceptions of a home-based exercise intervention in which they participated while receiving adjuvant chemotherapy for breast cancer.Methods and sampleParticipants were 8 women who were involved in a home-based exercise program while receiving 24 weeks of adjuvant chemotherapy for breast cancer. They were asked about their exercise program every 2 weeks by telephone, and completed a feasibility and acceptability questionnaire at the end of the study. The two principal investigators performed a content analysis on the resulting data.Key resultsParticipants highly valued the exercise program. The content analysis resulted in two major categories: exercise challenges and exercise facilitators and strategies. The most common exercise challenges were side effects of chemotherapy, particularly fatigue and pain. The women overcame challenges in many ways, most notably adapting the routine, internal motivation and external support. Their comprehension of breast cancer and its treatment, reinforced by expert advice and resources on exercise, helped them develop successful strategies to maintain the exercise program.ConclusionsIn spite of challenges, women in this study perceived that a customized, flexible, home-based exercise program was beneficial while they were undergoing adjuvant chemotherapy for breast cancer. Resource material and regular guidance helped them implement strategies to maintain the exercise program.     

Health-related quality of life during adjuvant treatment for breast cancer among postmenopausal women.

The purpose of the present study was twofold: first, to describe changes of Health-Related Quality of Life (HRQoL) during the adjuvant treatment among postmenopausal women with breast cancer; second, in the same population to identify the best predictors of Overall Quality of Life (QoL) after treatment, from perceived functioning, symptoms, emotional distress and clinical/demographic variables measured at baseline. The study group was 150 women (> or = 55 years of age) scheduled for adjuvant chemotherapy (CT, n=75) or radiotherapy (RT, n=75). They were examined before (baseline), during and after completing the treatment. Data about QoL, perceived functioning, symptoms and emotional distress were collected with the European Organisation for Research and Treatment of Cancer (EORTC)-QLQ-C30, BR23 and Hospital Anxiety and Depression Scale (HADS) questionnaires. The general finding was that the adjuvant treatments were associated with decrease in overall QoL, physical and role functioning, anxiety and body image, as well as with increase in fatigue, dyspnoea, pain, nausea/vomiting, constipation and systemic therapy side effects measured over time. For women receiving CT, better emotional functioning and less pain at baseline predicted better overall QoL at the end of the treatment. For women receiving RT, better physical and emotional functioning, less breast symptoms and lower tumour stage at baseline predicted better overall QoL at the end of the treatment.     

The effectiveness of a rehabilitation programme for Chinese cancer survivors: A pilot study

Cancer survivors have experienced high stress which impairs psychological functioning and decreases quality of life (QOL). This study aims to assess the mediating effect of self‐efficacy on mood disturbance and QOL, and determine the effectiveness of a 12 week rehabilitation programme to improve self‐efficacy as well as improve mood disturbance and QOL in Chinese cancer survivors. A total of 47 cancer patients were randomly assigned into the experimental (n = 24) and control (n = 23) groups. The participants in the experimental group received cancer‐related education, progressive muscle relaxation and emotional support. Self‐reported questionnaires, including General Self‐efficacy Scale (GSES), Profile of Mood States Scale–Short Form (POMS‐SF) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ‐C30) were collected in pre‐ and post‐intervention. Findings from this study indicated that self‐efficacy was a complete mediator between mood disturbance and QOL, and the 12 week rehabilitation programme had a positive effect on self‐efficacy, mood disturbance and QOL for Chinese cancer survivors.     

Breast cancer: evaluation of the Common Journey Breast Cancer Support Group

Background. Most studies of cancer support groups have focused on the effects of groups established for research purposes, from the exclusive perspective of the group participants. Aim. This Roy Adaptation Model‐based programme evaluation project focused on identifying the experiences of both participants in and facilitators of a community hospital‐sponsored breast cancer support group. Design. Repeated measures survey methodology. Methods. Ten women with breast cancer and two Registered Nurse group facilitators participated in the programme evaluation project. Qualitative data were analysed using content analysis. Themes extracted from the data were categorized according to the Roy Adaptation Model modes of adaptation. The group participants completed Initial and End of Year Interview Guides and Group Voices Forms; the group facilitators completed the Facilitators’ Voices Form. The Institutional Review Committee of a community hospital approved the programme evaluation project. Results. The Common Journey Breast Cancer Support Group is a community hospital‐sponsored cancer support group established to meet the informational, emotional support, and social support needs of women with breast cancer who reside in a rural state in the New England region of the USA. Responses of participants and facilitators, which reflected all four of the Roy model modes of adaptation, indicated that the combination of information and emotional and social support was effective. Conclusions. Nurses and other health professionals who establish community‐based cancer support groups should consider formal evaluation of the outcomes, from the perspectives of both participants and facilitators, and should publish the results. The results of this programme evaluation project are limited to one breast cancer support group with a small number of female participants and two facilitators. Results cannot be generalized to support groups for other types of cancer or to cancer support groups for men. Relevance to clinical practice. Nurses and other health professionals should consider establishing and facilitating community hospital‐sponsored support groups for women with breast cancer, which have the potential to meet the women's informational, emotional support, and social support needs.     

Influence of a Pilates exercise program on the quality of life of sedentary elderly people: A randomized clinical trial

This study evaluated the influence of a Pilates exercise program on the quality of life (QOL) of sedentary elderly women. Twenty-four elderly women (aged 64.8 ± 3 years) participated in this study. Participants were divided into two groups: a Pilates Group (PG) and a Control Group (CG). The women in the PG performed 30-min sessions of Pilates (on the ground and using appliances) twice a week over six months. To evaluate the QOL, the SF-36 survey was used. The PG achieved significant improvements in 7 out of 8 domains in the survey: functional capacity (p = 0.00), physical aspects (p = 0.03), pain (p = 0.00), general health condition (p = 0.04), vitality (p = 0.02), social aspects (p = 0.03) and mental health (p = 0.05). Our results showed that implementation of a Pilates program can improve QOL of sedentary elderly women.     

肿瘤医院护士生活质量和工作疲溃感相关性分析

目的:调查肿瘤医院护士生活质量与工作疲溃感,并探究两者细分维度上的相关性,为肿瘤医院护士服务管理改善提供依据。方法:通过整体随机抽样对广州市某肿瘤专科医院168名护士进行问卷调查,调查内容包括一般资料调查表、世界卫生组织生存质量测定简表、摩斯腊克工作疲溃量表。结果:肿瘤医院护士生活质量4个维度中生理健康、心理健康、社会关系领域分值低于常模,差异有统计学意义(P<0.01);工作疲溃中的情绪疲溃感和工作冷漠感两个维度得分均显著高于常模,工作无成就感得分低于常模(P<0.01);肿瘤医院护士生活质量与工作疲溃感有相关性,其中情绪疲溃感与生理健康、心理健康、社会关系、周围环境维度呈负相关(P<0.01),工作冷漠感分别和生理健康、社会关系、心理健康、周围环境呈正相关(P<0.05);工作无成就感与生理健康、周围环境呈负相关(P<0.05)。结论:肿瘤医院护士生活质量和工作疲溃感现状亟需改善,建议从职业培训和环境提升等多维度、多领域入手采取综合措施改善护理服务质量。     

乳腺癌化疗患者癌因性疲乏与一般自我效能感的相关性研究

目的 探讨乳腺癌化疗患者癌因性疲乏水平及其与一般自我效能感的关系.方法 采用癌因性疲乏量表(cancer fatigue scale,CFS)、一般自我效能感量表(general self-efficacy scale,GSES)对190例乳腺癌化疗住院患者进行调查,并分析其相关性.结果 乳腺癌化疗患者总疲乏发生率为100.00％,躯体疲乏、情感疲乏、认知疲乏发生率分别为97.89％、97.89％、98.42％.癌因性疲乏各维度得分以躯体疲乏得分最高(12.58±4.81)分,情感疲乏次之(7.36±2.90)分,认知疲乏得分最低(6.58±2.76)分.乳腺癌化疗患者的一般自我效能感得分低于全国常模,两者比较,差异具有统计学意义(P＜0.001).乳腺癌化疗患者的癌因性疲乏各维度与一般自我效能感均呈负相关(P＜0.05或P＜ 0.01).结论 乳腺癌化疗患者癌因性疲乏普遍存在,一般自我效能感得分偏低.癌因性疲乏与患者一般自我效能感呈负相关.应采取有效的措施控制乳腺癌患者癌因性疲乏,以提高患者一般自我效能感.     

Exploring the differential experience of breast cancer treatment-related symptoms: a cluster analytic approach

INTRODUCTION: Cancer patients experience multiple concurrent symptoms. This exploratory analysis assessed symptom burden among patients undergoing chemotherapy for breast cancer to identify distinct subgroups of patients who experience differential symptom burden and assessed whether the patient subgroups were associated with deleterious quality of life (QOL) outcomes. MATERIALS AND METHODS: Women (N = 133) with stage I and II breast cancer undergoing adjuvant chemotherapy after primary surgery were evaluated at baseline and at the end of chemotherapy using the Memorial Symptom Assessment Scale (MSAS) and the SF-36 QOL questionnaire. Post treatment MSAS symptoms were included in hierarchical cluster analysis. Two patient subgroups were identified that corresponded to a high-symptom prevalence group and a low-symptom group. RESULTS AND DISCUSSION: No marked, statistically significant differences were found between groups on demographic, symptoms, QOL, or treatment variables at baseline. Patients in the high-symptom cluster were more likely to have stage I disease (p < 0.05). The two groups of patients showed significant differences in end-of-treatment symptoms and QOL scores (p < 0.05). The high-symptom burden group was more likely to report greater symptom prevalence and poorer QOL. CONCLUSIONS: Future research needs to examine why these differences occur despite similarities in treatment and how symptom burden can be reduced for the high-symptom prevalence group.     

A self‐directed home yoga programme for women with breast cancer during chemotherapy: A feasibility study

Recent studies suggest yoga as a promising approach for improving the cognitive function of cancer survivors. We studied whether a self‐directed home yoga programme was feasible for patients with breast cancer who were undergoing chemotherapy. Participants' preferences for the type of yoga course and the clinical effects of the programme were also assessed. In this study, 18 women (mean age, 43.9 years) were enrolled (44.7% recruitment rate). Of the participants, 63.6% had stage II cancer and 71.4% received adjuvant chemotherapy. Favourable retention (86%), adherence (94.4%) and acceptability (96.5%) rates were determined. Most (94.4%) of the women practiced the home programme more than twice a week on average. The participants preferred to gradually increase the intensity of the exercises. We only observed improvements in the cognitive aspects of fatigue. No serious adverse events were encountered during the programme. This self‐directed home yoga programme was safe and feasible for patients with breast cancer undergoing chemotherapy.     

The effects of physical exercises to mental state and quality of life in patients with schizophrenia

The purpose of this study was to examine the effects of 10 weeks of physical exercises programme on mental states and quality of life (QOL) of individuals with schizophrenia. The study involved 30 inpatients or outpatients with schizophrenia who were assigned randomly into aerobic exercise (n = 15) group and control (n = 15) group, participated to the study voluntarily. There were no personal differences such as age, gender, disorder duration, medication use between the both groups. An aerobic exercise programme was applied to the subject group, the periods of 10 weeks as 3 days in a week. Data were collected by using the Brief Symptom Inventory, the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms and to the both group before and after the exercise programme. After the 10‐week aerobic exercise programmes the subjects in the exercise programme showed significantly decreases in the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms and the Brief Symptom Inventory points and their World Health Organization Quality of Life Scale‐Turkish Version points were increased than controls. These results suggest that mild to moderate aerobic exercise is an effective programme for decreasing psychiatric symptoms and for increasing QOL in patients with schizophrenia.     

Effects of aerobic interval training on cancer patients' functional capacity

The effect of a 10-week aerobic interval-training cycle ergometer protocol on the functional capacity (VO2Lmax) of 45 women receiving chemotherapy for treatment of Stage II breast cancer was studied. Subjects were stratified by baseline functional capacity (+/- 1 MET) and randomized to experimental (EX), placebo (PL), and control (CO) groups. EX subjects completed a 10-week, 3 times/week exercise training program; PL subjects participated in 10 weeks of nonaerobic stretching and flexibility exercises; the CO group maintained normal activities. The EX group showed significant, p less than .05, improvement on pre- to posttest VO2Lmax as well as workload and test time compared to the PL and CO groups. The interval-training exercise intervention was effective in improving the functional capacity of Stage II breast cancer patients on adjuvant chemotherapy.     

肿瘤化疗病人参与护理计划工作的研究

目的　探索有效的护理方法,提高肿瘤化疗病人的护理效果。方法　84例肿 瘤化疗住院病人随机分为观察组(44例)和对照组(40例),观察组病人参与护理计划工作,对 照组进行常规护理。入院后1周和3周分别进行生活质量评分。结果　3周后观察组生活质 量评分优于对照组(P<0.05),特别是在食欲、睡眠、精神、家庭理解与配合、对癌症的认识、 对治疗的态度、日常生活情况及面部表情方面;而疲乏、疼痛、同事的理解配合及治疗的副作用 上无差异(P>0.05)。结论　护患共同参与护理计划工作对肿瘤化疗病人的康复有益;生活 质量评估表可指导护理工作。