Jaejoon Song

Response to an exercise intervention after endometrial cancer: Differences between obese and non-obese survivors ☆

OBJECTIVE The objective of this paper is to describe baseline differences between obese and non-obese endometrial cancer survivor in anthropometrics, exercise behavior, fitness, heart rate and blood pressure, and quality of life, and to analyze whether the effect of a home-based exercise intervention on these outcomes differed for obese and non-obese participants. METHODS One hundred post-treatment Stage I-IIIa endometrial cancer survivors participated in a single arm 6month study in which they received a home-based exercise intervention. Cardiorespiratory fitness, anthropometrics, and exercise behavior were measured every two months, and quality of life (QOL) and psychological distress were measured at baseline and 6months. RESULTS Adjusting for potential confounders, at baseline obese survivors had poorer cardiorespiratory fitness (p=.002), higher systolic blood pressure (p=.018), and lower physical functioning (p<.001) and ratings of general health (p=.002), and more pain (p=.037) and somatization (.002). Significant improvements were seen in exercise behavior, resting heart rate, systolic blood pressure, and multiple QOL domains over the course of the intervention. Obese survivors had less improvement in exercise behavior and cardiorespiratory fitness than non-obese survivors, but there were no differences with regard to improvements in QOL and stress. CONCLUSIONS Home based exercise interventions are beneficial to endometrial cancer survivors, including those whose BMI is in the obese range. While obese survivors have lower levels of physical activity and fitness, they experienced similar activity, fitness, quality of life and mental health benefits. Exercise should be encouraged in endometrial cancer survivors, including those who are obese.

Longitudinal social cognitive influences on physical activity and sedentary time in Hispanic breast cancer survivors.

This study evaluated the effect of two home‐based exercise interventions (one culturally adapted and one standard) on changes in social cognitive theory (SCT) variables, physical activity (PA), and sedentary time (ST), and determined the association between changes in SCT variables and changes in PA and ST in Hispanic breast cancer survivors.

Sexual health of endometrial cancer survivors before and after a physical activity intervention: A retrospective cohort analysis

OBJECTIVE Sexual dysfunction is common in endometrial cancer survivors (ECS). Our group previously tested a six-month exercise intervention in ECS. We performed a secondary analysis to determine interventions impact on sexual health. METHODS We studied 100 post-treatment Stage I-IIIa sedentary ECS who participated in a non-controlled, single-arm, home-based exercise intervention utilizing telephone counseling, printed material, and pedometers. Quality-of-life and physical activity measures were collected at baseline and six months. Sexual function (SF) and sexual interest (SI) scores were extracted from the QLACS questionnaire. RESULTS Baseline SF and SI were lower in survivors with less than a four-year college degree (P<0.001). Baseline SI was higher in survivors who were married or living with a significant other (P=0.012). No significant differences in SF or SI were observed based on obesity status, race, time since diagnosis, or treatment type. Post-intervention, mean SF score improved (P=0.002), 51% of participants had improved SI, and 43% had improved SF. When controlled for age and time since diagnosis, a one-hour increase in weekly physical activity was associated with a 6.5% increased likelihood of improved SI (P=0.04). Increased physical activity was not associated with improved SF. CONCLUSIONS Although causation cannot be determined in this study, the correlation between receipt of an exercise intervention and improved sexual health for ECS is a novel finding. This finding suggests a role for physical activity as a strategy to improve the sexual health of ECS, which our group is examining in a larger prospective study.

Predictors of enrollment in individual- and couple-based lifestyle intervention trials for cancer survivors

PurposeTo utilize data from lifestyle intervention pilot studies for cancer survivors to elucidate demographic, disease-related, and health behavior factors that might predict enrollment in this type of research. Additionally, factors were differentially compared based on intervention design (i.e., individual versus couple-based).MethodsSecondary data analysis was conducted regarding predictors of enrollment into lifestyle intervention studies, including Healthy Moves Weight Loss (individual participants, screened n = 89, enrolled n = 30) and Healthy Moves Couples (survivors and their partners, screened n = 197, enrolled n = 23). Due to small sample sizes, common in pilot studies, random forest analyses were used to maximize information yielded by the data.ResultsResults identified numerous important predictors of enrollment in individual and couple-based lifestyle interventions. Percent energy from fat and physical activity minutes were identified as important predictors for both recruitment methods. Age, cancer site, and marital status were important predictors of enrollment in the individual-based intervention. Weight, fiber consumption, and disease-related symptom severity and interference were important predictors of enrollment in the couple-based intervention.ConclusionAlthough there was some overlap in predictors for enrollment between studies, many differential predictors were identified between individual versus couple-based study designs for lifestyle intervention in cancer survivors. Future lifestyle intervention studies for cancer survivors may benefit from targeting different predictors of enrollment based on study design to optimize recruitment. Additionally, understanding predictors may allow certain barriers to enrollment (i.e., symptom burden) to be directly addressed, making lifestyle intervention research more feasible and acceptable to difficult-to-recruit survivors.

Endometrial cancer survivors' sleep patterns before and after a physical activity intervention: A retrospective cohort analysis

OBJECTIVE To identify the baseline sleep patterns of endometrial cancer survivors and examine the impact of a physical activity intervention on their sleep quality via retrospective secondary analysis. METHODS Early-stage endometrial cancer survivors participated in a 6-month single-arm exercise intervention using printed materials, telephone-based counseling, and pedometers to encourage adherence to exercise guidelines. Participants completed questionnaires evaluating their sleep (PSQI), physical activity (CHAMPS), quality of life (SF-36), and stress (PSS) at baseline and study completion. RESULTS Ninety-five survivors had PSQI data at both time points. Mean age was 57.1 years (range, 25-76). Mean body mass index was 34.3 kg/m2. The majority were non-Hispanic white (75%) and had stage I disease (80%). At baseline, most survivors (61%) had poor sleep quality (PSQI > 5), with 24% reporting fairly or very bad sleep. The majority (63%) slept <7 h/night. At least once during the preceding month, 83% had an episode of daytime dysfunction. A pairwise comparison showed that obese survivors had more sleep disturbances than normal weight survivors (p = 0.029). No other clinicodemographic factors were associated with sleep. In unadjusted analyses, sleep quality significantly improved in women who increased weekly total or moderate/vigorous physical activity (p = 0.004 and p < 0.050, respectively). This association persisted after adjusting for the potential covariates of age, time since diagnosis, obesity status, disease stage, and treatment (p = 0.026). CONCLUSIONS Our data demonstrated that poor sleep is common and detrimental to endometrial cancer survivors. Increasing exercise may improve this dysfunction and should be investigated as part of a prospective study.

Abstract B05: Randomized pilot study of Project BALANCE: a weight gain prevention intervention for breast cancer patients receiving neoadjuvant chemotherapy

Background: Weight gain is a common problem after breast cancer diagnosis and treatment, particularly for women who receive chemotherapy. The weight gain has negative effects on quality of life, increases risk for chronic disease, and may increase risk of breast cancer recurrence. This pilot study tested a behavioral weight gain prevention intervention on weight, waist circumference, and biomarkers related to breast cancer prognosis (sex hormone binding globulin [SHBG], adiponectin, and leptin). Methods: Thirty-eight breast cancer patients receiving neoadjuvant chemotherapy were randomized to the weight gain prevention intervention or usual care. The intervention focused on exercise (resistance training, aerobic) and eating a low energy dense diet. Participants received 20 sessions during chemotherapy (14 in person, 6 by telephone) and 9 sessions after surgery (3 in person, 6 by telephone). They completed assessments of weight and waist circumference at baseline (T0), mid-chemotherapy (T1), post-chemotherapy (T2), post surgical recovery (T3), after the post-surgical intervention (T4). Serum was collected at T0, T2, and T3 and SHBG, adiponectin, and leptin was assayed by ELISA. Differences between participants in the intervention and usual care groups for weight, waist circumference, and biomarkers were assessed using linear mixed models. All analyses were controlled for baseline values. Missing observations were imputed by worst observation carried forward. We conducted both an intent-to-treat (all participants) and a per protocol analysis where intervention group participants were included if they completed at least 50% of the intervention sessions. Results: In the intent to treat analysis, the intervention group participants weighed less at T1-T4 (mean difference = 1.12 kg, p = .2225). In the per protocol analysis the mean difference of 1.6 kg was statistically significant (p=.0499). Waist circumference was lower at T1-T4 in the intervention group in both the intent-to-treat analysis (mean difference = 2.8 cm, p=.0354) and the per protocol analysis (mean difference = 3.7 cm, p=.0122). Levels of natural log transformed SHBG were higher for the intervention group at T2-T3; the difference neared significance (intent-to-treat: p=.0914; per protocol analysis: p=.0506), but there was no significant difference between the groups in adiponectin or leptin levels. However, all three biomarkers were significantly correlated with weight, BMI and waist circumference in the expected direction at T0, T2, and T3, with the exception of SHBG at T3, which was significantly correlated with weight only. Conclusion: A diet and exercise intervention delivered during and after chemotherapy can promote weight loss in breast cancer patients. Given the associations between body composition and prognostic biomarkers, the Project BALANCE intervention could be investigated for its effects on prognosis. Citation Format: Karen Basen-Engquist, James L. Murray, III, Abenaa Brewster, Susan M. Schembre, Jaejoon Song, Angelica Gutierrez-Barrera, Banu Arun. Randomized pilot study of Project BALANCE: a weight gain prevention intervention for breast cancer patients receiving neoadjuvant chemotherapy. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr B05.