High-intensity strength training improves quality of life in cancer survivors

INTRODUCTION: Cancer rehabilitation programs mainly involve endurance training, and little attention is paid to strength training. Cancer survivors are generally advised to train at much lower workloads than the standard guidelines for strength training suggest. The purpose of this study is to evaluate the effectiveness of an 18-week high-intensity strength training program in cancer survivors. METHODS: Fifty-seven patients (age 24 to 73 years) who had received chemotherapy for lymphomas, breast, gynecologic, testicular, or colorectal cancer completed the program. Outcome measures were changes in muscular strength (one-repetition maximum), cardiopulmonary function (VO2 max), maximal short exercise capacity (MSEC), body composition and health-related quality of life (HRQOL) between baseline and follow-up. DISCUSSION: The high-intensity strength training was well tolerated by all patients. Significant improvements in muscle strength were found, with effect sizes varying from 1.32 to 2.68. VO2 max increased significantly by 10% in men and by 13% in women. Different functional scales of HRQOL improved (p < 0.01), with effect sizes varying from 0.47 to 0.82. Muscle strength correlated significantly with physical functioning before and after the training program. CONCLUSION: We conclude that a supervised, high-intensity strength training program seems to be an effective means to improve muscle strength, cardiopulmonary function, and HRQOL and should be incorporated in cancer rehabilitation programs. Further randomized trials are needed to confirm the results.     

Safety and feasibility of a combined exercise intervention for inoperable lung cancer patients undergoing chemotherapy: a pilot study

Aim

To investigate the safety and feasibility of a six-week supervised structured exercise and relaxation training programme on estimated peak oxygen consumption, muscle strength and health related quality of life (HRHRQOL) in patients with inoperable lung cancer, undergoing chemotherapy.

Methods

A prospective, single-arm intervention study of supervised, hospital based muscle and cardiovascular group training and individual home-based training. Peak oxygen consumption (VO_2peak) was assessed using an incremental exercise test. Muscle strength was measured with one repetition maximum test (1RM). HRQOL was assessed using the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale.

Results

Twenty-five patients with non-small cell cancer (NSCLC) stage III-IV and four patients with extensive disease small cell lung cancer (SCLC-ED) were recruited. Six patients (20.7%) dropped out leaving 23 patients for analysis. Exercise adherence in the group training was 73.0% and 8.7% in the home-based training. There were improvements in estimated VO_2peak and six-minute walk distance (6 MWD) as well as increased muscle strength measurements (p < 0.05). There was significant improvement in the “emotional well-being” parameter (FACT-L) while there were no significant changes in HRQOL.

Conclusion

Exercise training produces significant improvements in physiological indices and emotional HRQOL and is safe and feasible in patients with advanced stage lung cancer, undergoing chemotherapy. No analysis on home-based training was done because of low adherence.     

Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy.

BACKGROUND: Fatigue is a common and often severe problem in cancer patients undergoing chemotherapy. The authors postulated that physical activity training can reduce the intensity of fatigue in this group of patients. METHODS: A group of cancer patients receiving high dose chemotherapy followed by autologous peripheral blood stem cell transplantation (training group; n = 27) followed an exercise program during hospitalization. The program was comprised of biking on an ergometer in the supine position following an interval training pattern for 30 minutes daily. Patients in the control group (n = 32) did not train. Psychologic distress was assessed at hospital admission and discharge with the Profile of Mood States and Symptom Check List 90. RESULTS: By the time of hospital discharge, fatigue and somatic complaints had increased significantly in the control group (P for both < 0.01) but not in the training group. Furthermore, by the time of hospital discharge, the training group had a significant improvement in several scores of psychologic distress (obsessive-compulsive traits, fear, interpersonal sensitivity, and phobic anxiety) (P value for all scores < 0.05); this outcome was not observed in the control group. CONCLUSIONS: The current study found that aerobic exercise can reduce fatigue and improve psychologic distress in cancer patients undergoing chemotherapy.     

An evaluation of a computer‐imaging program to prepare women for chemotherapy‐related alopecia

Objective: This study was conducted to evaluate a computer program named Help with Adjustment to Alopecia by Image Recovery (HAAIR) that was developed to provide educational support and reduce distress in women with hair loss following chemotherapy. Methods: Forty‐five women who had been diagnosed with cancer and anticipated alopecia following treatment were randomly assigned to either the Imagining group (IG) or Standardized Care group (SCG). Patients in the IG used a computer‐imaging program that created the patient's image on a screen to simulate baldness and use of wigs whereas patients in the SCG were directed to a resource room at the Cancer Center established for women with chemotherapy‐related alopecia. Assessment data using the Brief Symptom Inventory, Importance of Hair Questionnaire, and the Brief Cope were completed at baseline (T1), before chemotherapy and hair loss, following hair loss (T2), and 3 months follow‐up (T3). Results: All women were able to successfully use the touch screen computerized‐imaging program and reported that using the computer was a positive, helpful experience, thus establishing acceptability and usability. Women in both the IG and the SCG group showed significantly lower hair loss distress scores at T2 after hair loss than at T1 with T3 distress scores increasing in the SCG and decreasing in the IG. Those with avoidance coping reported more distress. Conclusions: This evaluation demonstrates that the HAAIR program is a patient‐endorsed educational and supportive complement to care for women facing chemotherapy‐related alopecia. Copyright © 2009 John Wiley & Sons, Ltd.     

A randomized controlled trial to evaluate the effectiveness of a brief, behaviorally oriented intervention for cancer-related fatigue

BACKGROUND: It has been shown that nonpharmacologic interventions are effective management techniques for cancer-related fatigue (CRF) in cancer survivors. However, few studies have investigated their effectiveness in patients who are receiving chemotherapy. In this study, the authors tested the effectiveness of a brief behaviorally oriented intervention in reducing CRF and improving physical function and associated distress in individuals who were receiving chemotherapy. METHODS: For this randomized controlled trial, 60 patients with cancer were recruited and received either usual care or the intervention. The intervention was delivered on an individual basis on 3 occasions over a period from 9 weeks to 12 weeks, and the objective of the intervention was to alter fatigue-related thoughts and behavior. Primary outcomes were assessed as follows: CRF using the Visual Analogue Scale-Global Fatigue; physical functioning using the European Organization for Research and Treatment of Cancer Quality-of-Life Core 30 Questionnaire, and CRF-associated distress using the Fatigue Outcome Measure. Assessments were made on 4 occasions: at baseline (T0), at the end of chemotherapy (T1), 1 month after chemotherapy (T2), and 9 months after recruitment (T3). Normally distributed data were analyzed using t tests and random-slope/random-intercept mixed models. RESULTS: The intervention demonstrated a trend toward improved CRF, although this effect was reduced once confounders had been controlled statistically. There was a significant improvement in physical functioning (coefficient, 10.0; 95% confidence interval, 2.5-17.5; P = .009), and this effect remained once the confounding effects of mood disturbance and comorbid disorders were controlled statistically. No decrease in fatigue-related distress was detected. CONCLUSIONS: The behaviorally oriented intervention brought about significant improvements in physical functioning, indicated a trend toward improved CRF, but detected no effect for fatigue-related distress.     

Psychological and fitness changes associated with exercise participation among women with breast cancer

Exercise participation has been shown to improve cardiovascular fitness and reduce psychological distress among women receiving chemotherapy and/or radiation. The purpose of this pilot study was to examine the changes in distress and body image, and fitness following exercise participation among 24 women who had been diagnosed with breast cancer within the previous 3 years. The women were randomly assigned to participate in a 12-week supervised aerobic exercise program in a hospital setting or a wait-list control group. Assessments of distress and body image were conducted at pre- and post-treatment. Data showed that the women in the exercise group improved significantly in body image (Physical Condition and Weight Concerns subscales) vs control group participants at post-treatment. Reductions in distress were also noted in the exercise group, but these were nonsignificant. At post-treatment, there were modest improvements in fitness in the exercise group.     

不同强度有氧运动对脑胶质瘤术后化疗患者癌因性疲乏及HPA轴功能的影响

目的 探讨不同强度有氧运动对脑胶质瘤术后化疗患者癌因性疲乏(CRF)及下丘脑-垂体-肾上腺皮质(HPA)轴功能的影响.方法 选取脑胶质瘤术后化疗并发CRF患者76例,随机分为2组,各38例.A组予以25％VO2max的强度进行有氧运动,B组予以50％VO2max的强度进行有氧运动,2组均连用8周.统计分析2组治疗前后H...     

Partnership status influences quality of life in low-income, uninsured men with prostate cancer

BACKGROUND: Being partnered confers significant benefits in survival for patients with prostate cancer, yet little is known of the impact of relationship status on health-related quality of life (HRQOL). The authors evaluated the influence of partnership on measures of HRQOL. METHODS: The authors studied 291 patients who were enrolled in a program that provided free treatment to impoverished, uninsured men with prostate cancer. The associations between relationship status and measures of general and disease-specific HRQOL were evaluated. Results from multivariate models determined the independent effect of partnership on HRQOL. RESULTS: Partnered patients were more likely than unpartnered patients to be Hispanic (58% vs. 34%) and were more likely to have elected surgical therapy (49% vs. 34%). Multivariate analyses, controlling for age, ethnicity, disease stage, and treatment type, revealed that partnered patients had better mental health (P = 0.009), less urinary bother (P = 0.011), higher spirituality (P = 0.037), and lower symptom distress (P = 0.005) than unpartnered participants. CONCLUSIONS: Relationship status had a positive effect on the quality of life of low-income, uninsured men with prostate cancer.     

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.     

Personality variables are associated with colorectal cancer patients' quality of life independent of psychological distress and disease severity

Objective: The aim of the present study was to test whether psychological distress and personality variables are independently associated with health‐related quality of life (HRQOL) in colorectal cancer patients, after adjusting for age, gender, education and disease severity. Methods: In a cross‐sectional study of 162 colorectal cancer patients (response rate 65.6%), the following self‐report instruments were administered: the Symptom Distress Checklist‐90‐R, the Sense of Coherence scale, the Life Style Index and the Hostility and Direction of Hostility Questionnaire. The outcome measures were the four components of the WHO Quality of Life Instrument, Short Form. We used hierarchical regressions to determine whether psychological distress mediates the relationship of personality and disease parameters with HRQOL. Results: The overall proportion of the variance in the four components of HRQOL explained by our regression models ranged from 28.1 to 44.4%. Psychological distress was an independent correlate of HRQOL, associated with physical (p<0005), mental (p<0.05) and social relationships HRQOL (p<0.02). Personality variables were associated with HRQOL independent of psychological distress and disease severity. Sense of coherence and denial defense were positively associated with all aspects of HRQOL independent of psychological distress and disease parameters (p‐values ranging from p<0.05 to p<0.0005). Hostility (p<0.01) and repression defense (p=0.024) were also independently but negatively associated with physical HRQOL. Conclusions: In colorectal cancer patients, psychological distress is associated with HRQOL independent of disease parameters but personality variables are also associated with HRQOL independent of disease severity and psychological distress, and this could be relevant to psychological interventions. Copyright © 2009 John Wiley & Sons, Ltd.     

Effect of a Pedometer-based Exercise Program on Cancer Related Fatigue and Quality of Life amongst Patients with Breast Cancer Receiving Chemotherapy

Background: Breast cancer is the most common cancer amongst Indian women. Cancer treatments leads to various side effects out of which Cancer-Related fatigue (CRF) is one of the most under-addressed side-effects. It is experienced the most in patients receiving chemotherapy. Exercise has been proven to be a beneficial intervention to manage CRF but the benefits of pedometer-based exercise programs is under-studied in patients with breast cancer. Hence, we set out to investigate the effects of a pedometer-based exercise program for patients with breast receiving chemotherapy. Methods: The current study was a non-randomized controlled trial with 22 patients each in exercise and control group. The exercise group received a pedometer-based walking program, whereas the control group received standard physical activity advice. Fatigue, quality of life, functional capacity and body composition were assessed at baseline, 3rd week and 7th week. Results: At the end of 7 weeks intervention, functional capacity, quality of life and skeletal mass were found to have improved with statistical significance, while the fatigue and changes in total fat did improve but were not statistically significant. Conclusion: A 7-week pedometer-based exercise program improved functional capacity, quality of life and percentage of skeletal mass and also shows to have prevented deterioration in fatigue levels in patients with breast cancer receiving chemotherapy.     

Factors that influence physicians' detection of distress in patients with cancer: can a communication skills training program improve physicians' detection?

BACKGROUND: No study to date has assessed the impact of skills acquisition after a communication skills training program on physicians' ability to detect distress in patients with cancer. METHODS: First, the authors used a randomized design to assess the impact, on physicians' ability to detect patients' distress, of a 1-hour theoretical information course followed by 2 communication skills training programs: a 2.5-day basic training program and the same training program consolidated by 6 3-hour consolidation workshops. Then, contextual, patient, and communication variables or factors associated with physicians' detection of patients' distress were investigated. After they attended the basic communication skills training program, physicians were assigned randomly to consolidation workshops or to a waiting list. Interviews with a cancer patient were recorded before training, after consolidation workshops for the group that attended consolidation workshops, and approximately 5 months after basic training for the group that attended basic training without the consolidation workshops. Patient distress was recorded with the Hospital Anxiety and Depression Scale before the interviews. Physicians rated their patients' distress on a visual analog scale after the interviews. Physicians' ability to detect patients' distress was measured through computing differences between physicians' ratings of patients' distress and patients' self-reported distress. Communication skills were analyzed according to the Cancer Research Campaign Workshop Evaluation Manual. RESULTS: Fifty-eight physicians were evaluable. Repeated-measures analysis of variance showed no statistically significant changes over time and between groups in physicians' ability to assess patient distress. Mixed-effects modeling showed that physicians' detection of patients' distress was associated negatively with patients' educational level (P = 0.042) and with patients' self-reported distress (P < 0.000). Mixed-effects modeling also showed that physicians' detection of patient distress was associated positively with physicians breaking bad news (P = 0.022) and using assessment skills (P = 0.015) and supportive skills (P = 0.045). CONCLUSIONS: Contrary to what was expected, no change was observed in physicians' ability to detect distress in patients with cancer after a communication skills training programs, regardless of whether physicians attended the basic training program or the basic training program followed by the consolidation workshops. The results indicated a need for further improvements in physicians' detection skills through specific training modules, including theoretical information about factors that interfere with physicians' detection and through role-playing exercises that focus on assessment and supportive skills that facilitate detection.     

Symptom distress,functional status and health-related quality of life before high-dose chemotherapy with stem-cell transplantation

The aims of this study were to describe how a group of patients with different malignant diseases perceived symptom distress (SD), functional status (FS) and health-related quality of life (HRQOL) on admission to the hospital for stem-cell transplantation (SCT), to compare the obtained data regarding FS and HRQOL with similar data from two general-population groups, and to relate the results to disease- and treatment-specific data. Fifty-one patients participated in the study. Three instruments were used to collect data: SFID-SCT, SIP and SWED-QUAL. The majority of the patients (92%) reported ongoing symptoms even before the SCT with tiredness (67%) and anxiety (53%) as the two most commonly reported symptoms. Although tiredness and anxiety were reported to be the most frequently occurring symptoms, these symptoms were not considered to cause that much distress. Instead, vomiting, reduced mobility and fever, although less commonly occurring, were reported as highly distressing when present. Compared with the general-population groups, the patients reported significantly poorer FS and HRQOL but no statistically significant correlations were found between SD, FS or HRQOL and the time since the last chemotherapy cycle or cycles respectively. Patients with advanced disease and patients with multiple myeloma were found to report more SD and poorer FS and HRQOL.     

Effect of communication skills training on nurses' detection of patients' distress and related factors after cancer diagnosis: a randomized study

Background: A randomized study was performed to investigate whether a communication skill (CS) training program can improve nurse's ability to detect the distress of patients who have just been informed of cancer diagnosis. Methods: Nurses were randomly assigned to the experimental or control group, and those in the former group had undergone CS training program. Nurses in both groups were then requested to support patients informed of their cancer diagnosis. Intervention consisted of one‐on‐one nurse interviews 3 times (on the day, 1 week, and 1 month after diagnosis). Patient's self‐reported distress according to the Hospital Anxiety and Depression Scale and nurse's ratings of patient distress by Visual Analog Scale were assessed 3 times (1 week, 1 month, and 3 months after diagnosis). These two scales were compared between the nurses of the two groups to assess the impact of CS training. Results: The nurses in the experimental and control groups supported 42 and 47 patients, respectively. The analysis using mixed‐effects modeling revealed no significant differences in the nurse's ability to detect patient's distress between the two groups. However, when the nurse's ratings of patient's distress and patient's self‐reported distress were compared, these two scores were significantly correlated only with the nurses in the experimental group, suggesting that the nurse's ability to become aware of patient's distress had been improved in that group. Conclusions: CS training for health professionals is useful in oncology practice to improve nurse's ability to recognize the distress of patients diagnosed with cancer. Copyright © 2009 John Wiley & Sons, Ltd.     

Multifaceted psychosocial intervention program for breast cancer patients after first recurrence: feasibility study

We developed a novel multifaceted psychosocial intervention program which involves screening for psychological distress and comprehensive support including individually tailored psychotherapy and pharmacotherapy provided by mental health professionals. The purpose of the present study was to investigate the feasibility of the intervention program and its preliminary usefulness for reducing clinical psychological distress experienced by patients with recurrent breast cancer. The subjects who participated in the 3 months intervention program completed psychiatric diagnostic interview and several self-reported measures regarding psychological distress, traumatic stress, and quality of life. The assessments were conducted before the intervention (T1), after the intervention (T2), and 3 months after the intervention (T3). A total of 50 patients participated in the study. The rates of participation in and adherence to the intervention program were 85 and 86%, respectively. While the proportion of psychiatric disorders at T2 (11.6%) was not significantly different from that at T1 (22.0%) (p = 0.15), the proportion of that at T3 (7.7%) had significantly decreased compared with that at T1 (p = 0.005). The novel intervention program is feasible, is a promising strategy for reducing clinically manifested psychological distress and further controlled studies are warranted.     

Impact of oesophagectomy on physical fitness and health‐related quality of life in patients with oesophageal cancer

Although several studies have reported the impact of oesophagectomy on health‐related quality of life (HRQOL), none has objectively assessed its impact on physical fitness. This study aimed to evaluate the impact of oesophagectomy on physical fitness and HRQOL in patients with oesophageal cancer. In this prospective study, we investigated 30 consecutive patients with newly diagnosed resectable oesophageal cancer who were scheduled to receive either neoadjuvant chemotherapy followed by surgery or surgery alone. The primary end‐points were change from baseline in two measures of physical fitness (knee‐extensor muscle strength and 6‐min walking distance) after oesophagectomy. The secondary end‐point was change from baseline in HRQOL measured with the European Organization for the Research and Treatment of Cancer Quality of Life Core Questionnaire with 30 items (EORTC QLQ‐C30). Physical fitness was significantly lower after oesophagectomy than before oesophagectomy (P < 0.001). With regard to HRQOL, there was a significant pre‐ to post‐oesophagectomy change in most of the scales. In the multiple regression analysis, the change in 6‐min walking distance was the only significant variable affecting the change in physical functional score on the EORTC QLQ‐C30 (P = 0.032). In conclusion, oesophagectomy adversely affects physical fitness and HRQOL in patients with oesophageal cancer. Six‐minute walking distance may be a good indicator of HRQOL shortly after oesophagectomy.     

Spirituality influences health related quality of life in men with prostate cancer

Spirituality is interdependent with the biological, psychological, and interpersonal aspects of life. Although spirituality has been studied in breast cancer survivors, little work has been done in men with prostate cancer. We sought to determine whether lower spirituality in men with early stage prostate cancer is associated with worse general health-related quality of life (HRQOL), disease-specific HRQOL, or psychosocial health. Two hundred and twenty-two subjects were drawn from a state-funded program providing free prostate cancer treatment to indigent men. Validated instruments captured spirituality, general and disease-specific HRQOL, anxiety, symptom distress, and emotional well-being. We found a consistent relationship between spirituality and the outcomes assessed. Low spirituality was associated with significantly worse physical and mental health, sexual function and more urinary bother after controlling for covariates. All of the psychosocial variables studied reflected worse adjustment in the men with low spirituality. Because the likelihood of prostate cancer survivorship is high, interventions targeting spirituality could impact the physical and psychosocial health of many men.     

The prevalence,severity, and correlates of psychological distress and impaired health-related quality of life following treatment for testicular cancer: a survivorship study

Purpose

This study aimed to establish the prevalence, severity, and correlates of psychological distress and impaired generic health-related quality of life (HRQOL) in testicular cancer (TC) survivors.

Methods

Men who had completed active anti-cancer treatment for TC between 6 months and 5 years previously showing no evidence of recurrence were recruited from 14 Australian cancer centers from September 2009 to February 2011. Participants completed a self-report questionnaire measuring demographic, disease, and treatment information, psychological distress (i.e., depression, anxiety, and stress; DASS21), generic health-related quality of life (HRQOL; SF-36v2), TC-specific HRQOL (EORTC QLQ-TC26), coping (MAC), social support (DUFSS), and unmet needs (CaSUN).

Results

Of 486 eligible TC survivors, 244 (50.2 %) completed the questionnaire. Compared with normative data, TC survivors reported: small but statistically significant increases in mean levels of anxiety and depression; a greater prevalence of moderate to extremely severe anxiety (19 %) and depression (20 %); and significant deficits to mostly mental aspects of generic HRQOL. The most problematic TC-specific HRQOL issues (e.g., fear of recurrence) were also more mental than physical. In multiple regression analyses, the strongest correlates of psychological distress and impaired generic HRQOL were psychosocial (e.g., helpless/hopeless coping and lower social support) rather than disease or treatment factors.

Conclusions

Generally, TC survivors appear to experience mild psychological distress and HRQOL impairments, while a vulnerable subgroup experience more severe morbidity.

Implications for Cancer Survivors

There is a need to identify TC survivors at risk of poorer outcomes and for interventions to target the areas of greatest impairment (i.e., psychological distress and mental HRQOL).