有氧运动对结直肠癌术后辅助化疗患者癌因性疲乏及生活质量的影响

目的:研究有氧运动对结直肠癌术后辅助化疗患者癌因性疲乏及生活质量的影响。方法:对60例结直肠癌术后行第一周期辅助化疗患者,按入院时住院号的奇偶数分为实验组与对照组,每组30例,实验组在接受常规出院健康的指导基础上进行有氧运动干预,对照组仅接受常规的出院康复指导。干预前、后采用Piper疲乏修正量表（revised piper fatigue scale,RPFS）、欧洲癌症治疗与研究组织的生活质量问卷（EORTC-QLQ-C30）对患者的CRF及生活质量进行评定分析。结果:有氧运动干预结束时,收集60例患者资料,结直肠癌患者术后辅助化疗,均有不同程度的癌因性疲乏（cancer-related fatigue,CRF）;两组RPFS评分比较,差异具有统计学意义（P＜0.05）;两组生活质量比较,有氧运动干预后EORTC-QLQ-C30分值明显提高,差异具有统计学意义（P＜0.05）。结论:结直肠癌术后辅助化疗患者普遍存在CRF;对该类患者采用有氧干预,能有效缓解其CRF的程度,并提高生活质量。     

The Effect of Exercise on Life Quality and Depression Levels of Breast Cancer Patients

Introduction: The aim of this study is to determine the effects of aerobic and stretching exercises on quality of life and depression levels of breast cancer patients. Methods: A total of 48 women (mean age 45.0±2.2 years) who were previously diagnosed with breast cancer and completed their treatment with no metastasis, were included in the study. Of these, 24 women who received the exercise program were assigned as the study group, while the remaining 24 women who did not receive the exercise program were assigned as the control group. The study group received a 12-week aerobic exercise program at the fitness club and home-based resistance exercise program designed by a sport scientist at the doctoral level. The control group was encouraged to maintain their normal level of physical activity and exercise habits throughout the study. The WHOQOL-BREF, EORTC-QLQ-C30 quality of life assessments and Beck depression inventory (BDI) were used to evaluate quality of life and the severity of depression before and after 12-week exercise programs. Results: EORTC QLQ-C30 scoring showed that in the study group aerobic exercise positively impacted quality of life on the functional scales (physical p=0.001, role p=0.039, emotional p=0.031, social functioning p=0.010) and symptoms (fatigue p=0.001, pain p=0.001, sleep disturbance p=0.038 and financial impact p=0.015). WHOQOL-BREF assessment areas, (general p=0.001, physical p=0.02, mental p=0.001 and social health p=0.017) relationships also improved as a result of exercise. BDI showed that severity of depression in the study group decreased significantly (p=0.001). Conclusion: This study showed that aerobic and resistance exercises improved quality of life and decreased depression levels of women who previously received breast cancer treatments.     

Clinicians Should Actively Promote Exercise in Survivors of Breast Cancer

Breast cancer is the most common cancer affecting women, causing 29% of all female cancers and afflicting 14% of all female cancer-related deaths worldwide. It remains a significant clinical, psychological, and financial burden. Exercise has been suggested to reduce cancer recurrence and cancer-related mortality from research in the past decade. Recent American and European guidelines advise on exercise for breast cancer survivors, not only to improve quality of life and decrease fatigue, but also to aid in decreasing recurrence and improve breast cancer related mortality. Nonetheless, adherence to guidelines remains low, with lack of awareness and fatigue related to chemotherapy as the most common barriers. It remains to be elucidated whether a particular type of exercise, or whether group or individualized activity is most effective. The importance of exercise in avoiding recurrence and improving quality of life needs to be recognized and taken into account in the management of breast cancer survivors. Further patient awareness and education is essential towards this goal, and the role of group exercise should be further explored.     

Effects of a mixed exercise program on cancer related-fatigue and health-related quality of life in oncogeriatric patients: A feasibility study

ObjectivesCancer-related fatigue (CRF) is the most debilitating side effect occurring with cancer treatment accumulation. Although combining aerobic and resistance exercise is an effective strategy to counteract this side effect, there is a paucity of studies performed with older patients even if this is the most affected population. Hence, the objective was to assess the feasibility and the impact of a twelve-week exercise program performed during cancer treatment on CRF, quality of life, and physical capacity in older adults diagnosed with early-stage cancer.Material and MethodsTwenty patients with cancer (70 ± 4 years) beginning systemic cancer treatments were recruited and randomized into two groups: 1) aerobic and resistance training (MIX) and 2) stretching (CON). Both groups were supervised three times/week for a total of twelve weeks. The primary outcome was feasibility and secondary outcomes were CRF (FACIT-Fatigue questionnaire), health-related quality of life (HRQoL) (EORTC QLQ-C30 questionnaire) and physical capacity (6MWT and grip strength).ResultsIn Mix, both exercise adherence (88.2%) and completion rate (86.6%) were high, which suggests that exercise is feasible in an oncologic context. In the MIX group, HRQoL improved (p = 0.05) and CRF was clinically, ableit non-significantly (p = 0.09), decreased. Concerning physical capacity, MIX showed a clinical improvement in the 6MWT during the intervention (p = 0.002) compared to CON.ConclusionThis study suggests that, in older patients with cancer undergoing adjuvant or neoadjuvant systemic treatments, a mixed exercise program is feasible, well tolerated and might help mitigate CRF and HRQoL decrements.     

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.     

Treatment of radiotherapy-induced fatigue through a nonpharmacological approach

BACKGROUND: Cancer-related fatigue (CRF) is a frequently occurring, burdensome side effect of radiation therapy that can result in detrimental effects to health-related quality of life (HRQL). The findings from a pilot study examining the efficacy of the complementary and alternative practice of Polarity Therapy (PT) in reducing CRF and improving HRQL are reported. METHODS: Fifteen women undergoing radiation therapy for breast cancer and experiencing fatigue were randomized to receive 1, 2, or no PT treatments. Treatments were given 1 week apart to the patients receiving 2 treatments. Fatigue and HRQL were assessed at baseline prior to PT, 3 days following the first PT treatment (week 1), and 3 days following the second PT treatment (week 2). RESULTS: There was a statistically significant improvement in both CRF and HRQL in the 10 patients who received a PT treatment compared to the 5 control patients at the week 1 assessment. In addition, there was a statistically significant difference among the 3 treatment groups in improvement in CRF at the week 2 assessment. This finding, coupled with a visual inspection of the means, supports the plausibility of a dose response concerning PT. CONCLUSION: Results from this pilot investigation suggest that PT may have a positive influence on CRF and HRQL in women undergoing radiation treatment for breast cancer. Randomized, controlled clinical trials with larger sample sizes are needed.     

Effects of exercise on angiogenesis and apoptosis‐related molecules,quality of life,fatigue and depression in breast cancer patients

The aim of this study was to explore the effects of exercise on angiogenesis and apoptosis‐related molecules, quality of life, fatigue and depression in patients who completed breast cancer treatment. Sixty breast cancer patients were randomised into three groups, as supervised exercise group, home exercise group and education group. Angiogenesis and apoptosis‐related cytokine levels and quality of life (EORTC QOL‐C30: European Organisation for Research and Treatment of Cancer Quality of Life C30), fatigue (Brief Fatigue Inventory) and depression (BDI: Beck Depression Inventory) scores were compared before and after a 12‐week exercise programme. After the exercise programme, statistically significant decreases were found in interleukin‐8 and neutrophil activating protein‐78 levels in the home exercise group (P < 0.05). The education group showed a statistically significant increase in monocyte chemoattractant protein‐1 level (P < 0.05). Functional score and global health score of EORTC QOL‐C30 in the supervised exercise group and functional score of EORTC QOL‐C30 in the home exercise group increased significantly after exercise programme (P < 0.05). BDI score was significantly lower in the supervised exercise group after the exercise programme (P < 0.05). Changes in angiogenesis and apoptosis‐related molecules in the study groups suggest a possible effect of exercise on these parameters. Exercise programmes are safe and effective on quality of life and depression in breast cancer patients whose treatments are complete.     

Effectiveness of physical activity on cardiorespiratory fitness and health-related quality of life in young and middle-aged cancer patients shortly after chemotherapy.

PURPOSE: To evaluate the effectiveness of a supervised home-based flexible training program on cardiorespiratory fitness (CRF), mental distress, and health-related quality of life (HRQOL) parameters in young and middle-aged cancer patients shortly after curative chemotherapy. PATIENTS AND METHODS: One hundred eleven patients age 18 to 50 years who had received chemotherapy for lymphomas or breast, gynecologic, or testicular cancer completed the trial. These patients were randomly allocated to either an intervention group (n = 59), which underwent a 14-week training program, or a control group (n = 52) that received standard care. Primary outcome was change in CRF, as determined by Astrand-Rhyming indirect bicycle ergometer test (maximum oxygen uptake [VO(2max)]), between baseline (T0) and follow-up (T1). Secondary outcomes were mental distress, as assessed by the Hospital Anxiety and Depression Scale, and HRQOL, as assessed by the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire. Two-way analysis of covariance was used to analyze changes from T0 to T1. RESULTS: VO(2max) increased by 6.4 mL/kg(-1)/min(-1) in patients in the intervention group and by 3.1 mL/kg(-1)/min(-1) in patients in the control group (P < .01). The fatigue score decreased by 17.0 points in the control group compared with only 5.8 points in the intervention group (P < .01). There were no intergroup differences in mental distress or HRQOL. CONCLUSION: A supervised, home-based, flexible training program has significant effect on CRF in young and middle-aged cancer patients shortly after curative chemotherapy, but it has no favorable effect on patients' experience of fatigue, mental distress, or HRQOL.     

Effects of cognitive behavior therapy combined with Baduanjin in patients with colorectal cancer

BACKGROUNDCancer-related fatigue (CRF) is the most common concomitant symptom in the treatment of colorectal cancer (CRC). Such patients often present with subjective fatigue state accompanied by cognitive dysfunction, which seriously affects the quality of life of patients.AIMTo explore the effects of cognitive behavior therapy (CBT) combined with Baduanjin exercise on CRF, cognitive impairment, and quality of life in patients with CRC after chemotherapy, and to provide a theoretical basis and practical reference for rehabilitation of CRC after chemotherapy. METHODSFifty-five patients with CRC after radical resection and chemotherapy were randomly divided into either an experimental or a control group. The experimental group received the intervention of CBT combined with exercise intervention for 6 mo, and indicators were observed and measured at baseline, 3 mo, and 6 mo to evaluate the intervention effect.RESULTSCompared with the baseline values, in the experimental group 3 mo after intervention, cognitive function, quality of life score, and P300 amplitude and latency changes were significantly better (P < 0.01). Compared with the control group, at 3 mo, the experimental group had significant differences in CRF, P300 amplitude, and quality of life score (P < 0.05), as well as significant differences in P300 latency and cognitive function (P < 0.01). Compared with the control group, at 6 mo, CRF, P300 amplitude, P300 latency, cognitive function and quality of life score were further improved in the experimental group, with significant differences (P < 0.01). The total score of CRF and the scores of each dimension were negatively correlated with quality of life (P < 0.05), while the total score of cognitive impairment and the scores of each dimension were positively correlated with quality of life (P < 0.05). CONCLUSIONCBT combined with body-building Baduanjin exercise can improve CRF and cognitive impairment in CRC patients after chemotherapy, and improve their quality of life.     

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.     

Evaluation of a Fatigue Initiative: Information on Exercise for Patients Receiving Cancer Treatment

AimsAn observational cohort study in patients undergoing treatment at a single cancer centre to evaluate the usefulness of providing written information on exercise and fatigue to patients at the start of their treatment, to assess whether patients exercised during treatment and their level of fatigue before and after treatment.Materials and methodsParticipants were 205 patients of mean age 63.4 years (115 men and 90 women), starting a course of radical radiotherapy, postoperative radiotherapy and palliative radiotherapy or chemotherapy between October 2004 and June 2005 for genitourinary, gynaecological or breast cancer. A patient-held folder was provided, containing written information on cancer or treatment-related fatigue and the use of exercise to manage this, together with flyers for workshops on fatigue management held at local palliative care centres. Study evaluation questionnaires were used for patients to rate the information's usefulness and provide information regarding fatigue. Fatigue level was documented using Brief Fatigue Inventory score sheets. The main research variables were patient rating of the usefulness of the written information provided, whether patients reported being able to exercise during their cancer treatment and self-completed fatigue scores.ResultsThe information provided was rated as helpful or very helpful by 70–78% of patients. Overall, 144/163 patients (88.3%) reported exercising during treatment (70.2% of all patients in the fatigue initiative). Patients receiving radical or postoperative radiotherapy as compared with chemotherapy, and those using the information supplied were more likely to exercise during treatment. There was a significant overall increase in mean fatigue from the start to the end of cancer treatment (P < 0.001). Patients who did not exercise, younger patients, those with breast cancer and those receiving chemotherapy (compared with radical or postoperative radiotherapy) all had higher fatigue scores.ConclusionsProvision of written information on exercise to manage fatigue was rated as helpful by most patients receiving cancer therapies; patients who were able to exercise during treatment had lower fatigue levels.     

Resistance exercise in men receiving androgen deprivation therapy for prostate cancer.

PURPOSE: Androgen deprivation therapy is a common treatment in men with prostate cancer that may cause fatigue, functional decline, increased body fatness, and loss of lean body tissue. These physical changes can negatively affect health-related quality of life. Resistance exercise may help to counter some of these side effects by reducing fatigue, elevating mood, building muscle mass, and reducing body fat. METHODS: In a two-site study, 155 men with prostate cancer who were scheduled to receive androgen deprivation therapy for at least 3 months after recruitment were randomly assigned to an intervention group that participated in a resistance exercise program three times per week for 12 weeks (82 men) or to a waiting list control group (73 men). The primary outcomes were fatigue and disease-specific quality of life as assessed by self-reported questionnaires after 12 weeks. Secondary outcomes were muscular fitness and body composition. RESULTS: Men assigned to resistance exercise had less interference from fatigue on activities of daily living (P =.002) and higher quality of life (P =.001) than men in the control group. Men in the intervention group demonstrated higher levels of upper body (P =.009) and lower body (P <.001) muscular fitness than men in the control group. The 12-week resistance exercise intervention did not improve body composition as measured by changes in body weight, body mass index, waist circumference, or subcutaneous skinfolds. CONCLUSION: Resistance exercise reduces fatigue and improves quality of life and muscular fitness in men with prostate cancer receiving androgen deprivation therapy. This form of exercise can be an important component of supportive care for these patients.     

Cancer-related Fatigue in Breast Cancer Survivors: A Review

Fatigue has been the most distressing and frequent symptom in breast cancer (BC) survivors after treatment. Although fatigue can occur in other cancer survivors, women with a history of BC might share some distinctive features. The present study aimed to recapitulate the knowledge about risk factors and correlates of cancer-related fatigue (CRF) in BC survivors after oncologic therapy. An electronic data search was conducted in PubMed using the terms “fatigue,” “breast,” “cancer,” and “survivors.” Records were included if they were original articles, available in English, had used a quantitative scale, had > 100 participants, and had excluded women with BC relapse. BC survivors were required to have finished their treatments ≥ 2 months before, except for hormonal therapy. The physiopathology and other interventions were considered beyond the scope of our review. The correlates were subsequently classified into 7 main categories: (1) sociodemographic data, (2) physical variables, (3) tumor- and treatment-related variables, (4) comorbidities, (5) other symptoms, (6) psychological issues, and (7) lifestyle factors. Fatigue was consistently greater in younger, obese, and diabetic women. Women reporting fatigue often communicated symptoms such as pain, depression, insomnia, and cognitive dysfunction. Coping strategies such as catastrophizing could play an important role in the persistence of fatigue. However, tumor characteristics, previous treatments received, and physical activity were not consistently reported. CRF was a strong predictor of the quality of life of BC survivors after treatment. In conclusion, we found CRF was a frequent and serious symptom that severely affects the quality of life of BC survivors after treatment. Health practitioners require more awareness and information about CRF.     

Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial.

PURPOSE: Self-directed and supervised exercise were compared with usual care in a clinical trial designed to evaluate the effect of structured exercise on physical functioning and other dimensions of health-related quality of life in women with stages I and II breast cancer. PATIENTS AND METHODS: One hundred twenty-three women with stages I and II breast cancer completed baseline evaluations of generic and disease- and site-specific health-related quality of life, aerobic capacity, and body weight. Participants were randomly allocated to one of three intervention groups: usual care (control group), self-directed exercise, or supervised exercise. Quality of life, aerobic capacity, and body weight measures were repeated at 26 weeks. The primary outcome was the change in the Short Form-36 physical functioning scale between baseline and 26 weeks. RESULTS: Physical functioning in the control group decreased by 4.1 points, whereas it increased by 5.7 points and 2.2 points in the self-directed and supervised exercise groups, respectively (P =.04). Post hoc analysis showed a moderately large (and clinically important) difference between the self-directed and control groups (9.8 points; P =.01) and a more modest difference between the supervised and control groups (6.3 points; P =.09). No significant differences between groups were observed for changes in quality of life scores. In a secondary analysis of participants stratified by type of adjuvant therapy, supervised exercise improved aerobic capacity (+3.5 mL/kg/min; P =.01) and reduced body weight (-4.8 kg; P <.05) compared with usual care only in participants not receiving chemotherapy. CONCLUSION: Physical exercise can blunt some of the negative side effects of breast cancer treatment, including reduced physical functioning. Self-directed exercise is an effective way to improve physical functioning compared with usual care. In participants not receiving chemotherapy, supervised exercise may increase aerobic capacity and reduce body weight compared with usual care.     

绝经前乳腺癌改良根治术后患者化疗期间行综合性护理干预的效果观察

目的:观察绝经前乳腺癌改良根治术后患者化疗期间行综合性护理干预的效果。方法:将本院94例乳腺癌患者作为研究对象，分为对照组于化疗后行常规护理干预及观察组于化疗期间行综合性护理干预，两组各47例。通过生存质量评价量表（QLQ-C30）评估患者护理后生活质量的情况。结果:观察组功能质量评分中的情绪功能、躯体功能、角色功能及社会功能的评分较对照组均显著升高（均P<0.05），而两组认知功能的评分并无明显差异（P>0.05）。观察组症状表现评分中的失眠、疼痛、恶心呕吐、疲倦、便秘、食欲下降的评分较对照组均显著降低（均P<0.05），而两组腹泻及呼吸困难评分的比较，均无明显差异（均P>0.05）。结论:绝经前乳腺癌改良根治术后患者化疗期间行综合性护理干预能够明显减轻化疗反应，有效改善临床症状，有助于提高患者的生活质量。     

有氧运动对缓解鼻咽癌放疗病人癌因性疲乏的效果

目的:观察有氧运动对缓解鼻咽癌放疗病人癌因性疲乏的效果.方法:80例接受放疗的鼻咽癌病人随机分成观察组和对照组,对照组患者放疗期同常规护理和随意自我运动,观察组在此基础上于放疗第1天开始实施连续7周的低强度有氧运动.结果:观察组病人癌因性疲乏的程度低于对照组,生活质量优于对照组,两组比较差异均有统计学意义(P＜0.05).结论:有氧运动能够有效缓解鼻咽癌放疗病人癌因性疲乏和提高生活质量.     

Cognitive function, fatigue, and menopausal symptoms in women receiving adjuvant chemotherapy for breast cancer.

PURPOSE: There is evidence that cognitive dysfunction, fatigue, and menopausal symptoms may occur in women receiving adjuvant chemotherapy for breast cancer. Here, we determine their incidence and severity, and interrelationships between them and quality of life. PATIENTS AND METHODS: In this study, 110 women receiving adjuvant chemotherapy each nominated a female relative, friend, or neighbor (matched by age) as a control; 100 eligible matched pairs were evaluated. Patients and controls completed the following assessments: the High-Sensitivity Cognitive Screen, and the Functional Assessment of Cancer Therapy-General (FACT-G) quality of life scale with subscales for fatigue (FACT-F) and endocrine symptoms (FACT-ES). They also performed tests of attention and reaction time. RESULTS: Patients and controls were well matched for age and level of education. There was a higher incidence of moderate or severe cognitive impairment in the patient group (16% v 4%; P =.008). Patients experienced much more fatigue than controls (median FACT-F scores, 31 v 46; P <.0001) and more menopausal symptoms (median FACT-ES scores, 58 v 64; P <.0001). Self-reported quality of life of the patients was poorer than for controls, especially in physical and functional domains (median FACT-G scores, 77 v 93; P <.0001). There was strong correlation between fatigue, menopausal symptoms, and quality of life (P <.0001 for each pair), but none were significantly associated with the presence of cognitive dysfunction. CONCLUSION: Adjuvant chemotherapy causes cognitive dysfunction, fatigue, and menopausal symptoms in women with breast cancer. Priority should be given to the study of strategies that might reduce these toxic effects.