Thirty percent to 90% of cancer survivors report impaired sleep quality post-treatment, which can be severe enough to increase morbidity and mortality. Lifestyle interventions, such as exercise, are ...recommended in conjunction with drugs and cognitive behavioral therapy for the treatment of impaired sleep. Preliminary evidence indicates that yoga-a mind-body practice and form of exercise-may improve sleep among cancer survivors. The primary aim of this randomized, controlled clinical trial was to determine the efficacy of a standardized yoga intervention compared with standard care for improving global sleep quality (primary outcome) among post-treatment cancer survivors.
In all, 410 survivors suffering from moderate or greater sleep disruption between 2 and 24 months after surgery, chemotherapy, and/or radiation therapy were randomly assigned to standard care or standard care plus the 4-week yoga intervention. The yoga intervention used the Yoga for Cancer Survivors (YOCAS) program consisting of pranayama (breathing exercises), 16 Gentle Hatha and Restorative yoga asanas (postures), and meditation. Participants attended two 75-minute sessions per week. Sleep quality was assessed by using the Pittsburgh Sleep Quality Index and actigraphy pre- and postintervention.
In all, 410 survivors were accrued (96% female; mean age, 54 years; 75% had breast cancer). Yoga participants demonstrated greater improvements in global sleep quality and, secondarily, subjective sleep quality, daytime dysfunction, wake after sleep onset, sleep efficiency, and medication use at postintervention (all P ≤ .05) compared with standard care participants.
Yoga, specifically the YOCAS program, is a useful treatment for improving sleep quality and reducing sleep medication use among cancer survivors.
Cancer-related fatigue (CRF) remains one of the most prevalent and troublesome adverse events experienced by patients with cancer during and after therapy.
To perform a meta-analysis to establish and ...compare the mean weighted effect sizes (WESs) of the 4 most commonly recommended treatments for CRF-exercise, psychological, combined exercise and psychological, and pharmaceutical-and to identify independent variables associated with treatment effectiveness.
PubMed, PsycINFO, CINAHL, EMBASE, and the Cochrane Library were searched from the inception of each database to May 31, 2016.
Randomized clinical trials in adults with cancer were selected. Inclusion criteria consisted of CRF severity as an outcome and testing of exercise, psychological, exercise plus psychological, or pharmaceutical interventions.
Studies were independently reviewed by 12 raters in 3 groups using a systematic and blinded process for reconciling disagreement. Effect sizes (Cohen d) were calculated and inversely weighted by SE.
Severity of CRF was the primary outcome. Study quality was assessed using a modified 12-item version of the Physiotherapy Evidence-Based Database scale (range, 0-12, with 12 indicating best quality).
From 17 033 references, 113 unique studies articles (11 525 unique participants; 78% female; mean age, 54 range, 35-72 years) published from January 1, 1999, through May 31, 2016, had sufficient data. Studies were of good quality (mean Physiotherapy Evidence-Based Database scale score, 8.2; range, 5-12) with no evidence of publication bias. Exercise (WES, 0.30; 95% CI, 0.25-0.36; P < .001), psychological (WES, 0.27; 95% CI, 0.21-0.33; P < .001), and exercise plus psychological interventions (WES, 0.26; 95% CI, 0.13-0.38; P < .001) improved CRF during and after primary treatment, whereas pharmaceutical interventions did not (WES, 0.09; 95% CI, 0.00-0.19; P = .05). Results also suggest that CRF treatment effectiveness was associated with cancer stage, baseline treatment status, experimental treatment format, experimental treatment delivery mode, psychological mode, type of control condition, use of intention-to-treat analysis, and fatigue measures (WES range, -0.91 to 0.99). Results suggest that the effectiveness of behavioral interventions, specifically exercise and psychological interventions, is not attributable to time, attention, and education, and specific intervention modes may be more effective for treating CRF at different points in the cancer treatment trajectory (WES range, 0.09-0.22).
Exercise and psychological interventions are effective for reducing CRF during and after cancer treatment, and they are significantly better than the available pharmaceutical options. Clinicians should prescribe exercise or psychological interventions as first-line treatments for CRF.
Extreme body composition demands of competitive bodybuilding have been associated with unfavorable physiological changes, including alterations in metabolic rate and endocrine profile. The current ...case study evaluated the effects of contest preparation (8 months), followed by recovery (5 months), on a competitive drug-free male bodybuilder over 13 months (M1-M13). Serum testosterone, triiodothyronine (T
), thyroxine (T
), cortisol, leptin, and ghrelin were measured throughout the study. Body composition (BodPod, dualenergy x-ray absorptiometry DXA), anaerobic power (Wingate test), and resting metabolic rate (RMR) were assessed monthly. Sleep was assessed monthly via the Pittsburgh Sleep Quality Index (PSQI) and actigraphy. From M1 to M8, testosterone (623-173 ng∙dL
), T
(123-40 ng∙dL
), and T
(5.8-4.1 mg∙dL
) decreased, while cortisol (25.2-26.5 mg∙dL
) and ghrelin (383-822 pg∙mL
) increased. The participant lost 9.1 kg before competition as typical energy intake dropped from 3,860 to 1,724 kcal∙day
; BodPod estimates of body fat percentage were 13.4% at M1, 9.6% at M8, and 14.9% at M13; DXA estimates were 13.8%, 5.1%, and 13.8%, respectively. Peak anaerobic power (753.0 to 536.5 Watts) and RMR (107.2% of predicted to 81.2% of predicted) also decreased throughout preparation. Subjective sleep quality decreased from M1 to M8, but objective measures indicated minimal change. By M13, physiological changes were largely, but not entirely, reversed. Contest preparation may yield transient, unfavorable changes in endocrine profile, power output, RMR, and subjective sleep outcomes. Research with larger samples must identify strategies that minimize unfavorable adaptations and facilitate recovery following competition.
Purpose
Altered levels of cytokines and chemokines may play a role in cancer- and cancer treatment-related cognitive difficulties. In many neurodegenerative diseases, abnormal concentrations of ...cytokines and chemokines affect neuronal integrity leading to cognitive impairments, but the role of cytokines in chemotherapy-related cognitive difficulties in cancer patients is not well understood. Patients receiving doxorubicin-based (with cyclophosphamide, or cyclophosphamide plus fluorouracil; AC/CAF) chemotherapy or cyclophosphamide, methotrexate, and fluorouracil (CMF) chemotherapy report experiencing cognitive difficulties; because these regimens work by different modes of action, it is possible that they differentially affect cytokine levels.
Methods
This study examined the relationships between cytokine levels (i.e., IL-6, IL-8, and MCP-1) and type of chemotherapy among 54 early-stage breast cancer patients receiving AC/CAF or CMF. Cytokine levels were assessed at two time-points: prior to on-study chemotherapy cycle 2 (cycle 2) and after two consecutive chemotherapy cycles (prior to on-study cycle 4; cycle 4).
Main results
Analyses of variance using cycle 2 levels as a covariate (ANCOVA) were used to determine differences between chemotherapy groups. Levels of IL-6, IL-8, and MCP-1 increased in the AC/CAF group and decreased in the CMF group; the only significant between-group change was in IL-6 (
p
< 0.05).
Conclusions
These results, although preliminary based on the small sample size, suggest that AC/CAF chemotherapy is more cytokine inducing than CMF. Future studies should confirm these results and explore the distinct inflammatory responses elicited by different chemotherapy regimens when assessing cognitive function in cancer patients.
Background: Transgender and gender non-conforming individuals face daily challenges in higher education due to a lack of gender-inclusive resources. This shortcoming is rooted in the minimal ...knowledge about what barriers affect this population.
Aims: The aims of this study were to identify fitness-related barriers faced by the transgender community in higher education and emphasize the need to develop fitness standards for the transgender population to reduce those barriers in higher education.
Methods: Participants completed one or both aspects of this study. A survey was sent to students to gather information about experiences in fitness at a university and how it relates to their gender. Several of the survey respondents then agreed to participate in a series of fitness assessments to evaluate muscular strength, endurance, and body composition.
Results: Seventy-nine students responded to the survey (n = 68 cisgender females, n = 5 cisgender males, n = 2, non-binary, n = 4 transgender males). Proportionally, more transgender and non-binary people (84%) felt that gendered fitness standards did not apply to them when compared to cisgender people (31%). Further, more transgender and non-binary respondents (50%) reported that they were not comfortable working out in all areas of their gym when compared to the cisgender respondents (37%). Twenty-eight students participated in the fitness assessment. The BOD POD assessment of body composition utilizes gender to calculate body fat percentage. When using both male and female classifications, results were not different, meaning the estimated body fat percentage was calculated as the same despite a different gender in the calculation.
Conclusions: This study begins to identify fitness-related barriers faced by the transgender community in higher education. Additionally, these small-scale results provide a starting point for future research on developing gender-neutral fitness standards.
Lisa Sprod, PhD, MPH, provides perspective on Cancer-Related Fatigue Outcome Measures in Integrative Oncology: Evidence for Practice and Research Recommendations Cancer-related fatigue (CRF) is most ...often evaluated using patient-reported tools, making it subjective in nature. Assessment tools vary in their length; the ideal time in which to use them; the recall period; the constructs evaluated; and their sensitivity, reliability, and validity. ...this article may serve as a model that inspires investigators and clinicians to comprehensively review other outcomes with multiple tools for assessment.
Learning Objectives
After completing this course, the reader will be able to:
Describe the influence of cigarette smoking on side effects during cancer treatment and following the end of cancer ...treatment.
Identify areas in your practice in which smoking status can be assessed on a regular basis and devise a plan for disseminating cessation information and free cessation aids.
This article is available for continuing medical education credit at CME.TheOncologist.com
Background.
Cigarette smoking has long been implicated in cancer development and survival. However, few studies have investigated the impact of smoking on symptom burden in cancer survivors during treatment and at survivorship stage. This study examines the influence of cigarette smoking on side effects among 947 cancer patients during and 6 months following treatment.
Methods.
Patients diagnosed with cancer and scheduled to receive chemotherapy and/or radiation therapy reported on current smoking status (yes, no) and total symptom burden the sum of 12 common symptoms (fatigue, hair loss, memory, nausea, depression, sleep, pain, concentration, hot flashes, weight loss, skin problems, and dyspnea) scored on an 11‐point scale ranging from 0 = “not present” to 10 = “as bad as you can imagine” during treatment and at 6‐month follow‐up. The adjusted mean total symptom burden by smoking status was determined by analysis of covariance controlling for age, gender, race, education, occupation, treatment, cancer site, and Karnofsky performance score.
Results.
During treatment, smokers (S) had a significantly higher total symptom burden than nonsmokers (NS) (S = 46.3 vs. NS = 41.2; p < 0.05). At 6‐month follow‐up, smokers continued to report a higher total symptom burden than nonsmokers (S = 27.7 vs. NS = 21.9; p < 0.05). Participants who quit smoking before treatment levels had a total symptom burden similar to nonsmokers.
Conclusion.
Smoking was associated with an increased symptom burden during and following treatments for cancer. Targeted cessation efforts for smokers to decrease symptom burden may limit the likelihood of treatment interruptions and increase quality of life following treatment.
摘要
背景 吸烟一直被认为与癌症发展和生存相关. 但吸烟对癌症幸存者在治疗期间和生存期间的症状负担的影响很少有研究. 本研究探讨吸烟对947例癌症患者治疗期间和治疗后6个月时副作用的影响.
方法 获诊癌症并准备接受化疗和/或放疗的患者在治疗期间和治疗后6个月随访时, 评定吸烟状态 (是, 否) , 按0=“不存在”至10=“所能想象的最差情况”的11分制评定总症状负担12个常见症状 (疲乏, 脱发, 记忆力, 恶心, 抑郁, 睡眠, 疼痛, 注意力, 潮热, 体重减轻, 皮肤问题和呼吸困难) 的总和. 采用协方差分析, 控制年龄, 性别, 种族, 教育程度, 职业, 治疗, 肿瘤部位和Karnofsky体能评分, 确定不同吸烟状态下的总症状负担校正均值.
结果 吸烟者 (S) 治疗期间的总症状负担显著高于不吸烟者 (NS) (S=46.3 vs. NS=41.2, p<0.05) . 吸烟者6个月随访时的自诉总症状负担仍高于不吸烟者 (S=27.7 vs. NS=21.9, p<0.05) . 治疗前戒烟的患者, 其总症状负担与不吸烟者相似.
结论 在癌症治疗期间及治疗后, 吸烟与症状负担增加相关. 吸烟者有针对性地戒烟以减少症状负担, 有可能减少治疗中断的发生, 提高治疗后的生活质量.
The study assessed the effect of smoking on total symptom burden, the sum of 12 common treatment‐related side effects, in patients undergoing treatment for cancer using data from private medical oncology practices that were part of the National Cancer Institute's Community Clinical Oncology Program. Smokers had a higher total symptom burden than nonsmokers during cancer treatment, and this persisted at a follow‐up 6 months after treatment.
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