Joseph J. Trunzo

Home-Based Physical Activity Intervention for Breast Cancer Patients

PURPOSE The efficacy of a home-based physical activity (PA) intervention for early-stage breast cancer patients was evaluated in a randomized controlled trial. PATIENTS AND METHODS Eighty-six sedentary women (mean age, 53.14 years; standard deviation, 9.70 years) who had completed treatment for stage 0 to II breast cancer were randomly assigned to a PA or contact control group. Participants in the PA group received 12 weeks of PA counseling (based on the Transtheoretical Model) delivered via telephone, as well as weekly exercise tip sheets. Assessments were conducted at baseline, after treatment (12 weeks), and 6 and 9 month after baseline follow-ups. The post-treatment outcomes are reported here. RESULTS Analyses showed that, after treatment, the PA group reported significantly more total minutes of PA, more minutes of moderate-intensity PA, and higher energy expenditure per week than controls. The PA group also out-performed controls on a field test of fitness. Changes in PA were not reflected in objective activity monitoring. The PA group was more likely than controls to progress in motivational readiness for PA and to meet PA guidelines. No significant group differences were found in body mass index and percent body fat. Post-treatment group comparisons revealed significant improvements in vigor and a reduction in fatigue in the PA group. There was a positive trend in intervention effects on overall mood and body esteem. CONCLUSION The intervention successfully increased PA and improved fitness and specific aspects of psychological well-being among early-stage breast cancer patients. The success of a home-based PA intervention has important implications for promoting recovery in this population.

Health behaviors during and after a cancer diagnosis

With improvements in cancer survival rates, more patients with cancer are living longer, and hence, cancer is becoming viewed as a chronic illness requiring long‐term management. An important aspect of patient care during and after cancer treatment is patient health behaviors. For example, sequelae from various cancer treatments, such as chemotherapy and radiotherapy (RT), can compromise health in a variety ways, including decreased immune functioning, cardiotoxic effects of chemotherapy and/or RT, and weight gain. In addition, the stress caused by a cancer diagnosis and its treatment can disrupt existing health behaviors or exacerbate unhealthy behaviors. Continued smoking or alcohol use can complicate treatment and increase risk for further malignancy. Furthermore, decreased physical activity and poor nutrition can cause weight gain, which may contribute to secondary health problems such as cardiovascular disease and diabetes. The authors reviewed the extant literature on four key health behaviors among patients with cancer and survivors: healthy diet, reduced tobacco use, reduced alcohol use, and increased physical activity. They described the prevalence of these behaviors, reviewed the effects of interventions designed to alter unhealthy behaviors, and discussed the implications and future directions for this emerging area of research. Cancer 2005.

Body Esteem and Mood Among Sedentary and Active Breast Cancer Survivors

OBJECTIVES To assess mood states and body esteem in 2 groups of breast cancer survivors, regular exercisers and sedentary women, and to examine these variables among younger and older women in each group. PATIENTS AND METHODS Between 1998 and 2002, we conducted a cross-sectional study among early-stage breast cancer survivors at the Miriam Hospital in Providence, RI, comparing 40 women who reported regular exercise with 79 sedentary women. We used multivariate and univariate analyses to compare the exercisers with sedentary women on fitness, physical activity, and questionnaire measures of body esteem and mood. Analyses were repeated after the 2 groups were subdivided by age (< 50 years vs > or = 50 years). RESULTS Regular exercisers (mean +/- SD age, 54.57 +/- 9.18 years) reported significantly more positive attitudes toward their physical condition and sexual attractiveness; significantly less confusion, fatigue, depression, and total mood disturbance; and higher vigor than sedentary women (mean +/- SD age, 52.33 +/- 9.11 years). Both younger and older exercisers had higher physical condition scores than their sedentary peers. Older exercisers reported higher vigor and less confusion, anger, fatigue, depression, and total mood disturbance than sedentary women, regardless of age. Younger exercisers reported higher vigor than their sedentary peers and less confusion than older sedentary women. CONCLUSIONS In this largely white sample of well-educated women, breast cancer survivors who exercised (particularly older women) reported higher body esteem and better mood than sedentary breast cancer survivors.

College Students’ Use of Energy Drinks, Social Problem-Solving, and Academic Performance

Abstract Energy drink (ED) use among college students to improve academic performance (AP) has skyrocketed. A growing body of literature indicates that the risks associated with ED use may outweigh the perceived benefits. In this study, 486 undergraduates were surveyed on their general substance and ED usage, Social Problem-Solving (SPS) ability, and AP. It was hypothesized that: (1) ED use would be a negative predictor of AP; (2) SPS would be a positive predictor of AP; (3) SPS would be a negative predictor of ED use; and (4) SPS and ED use would account for a significant amount of the variance in AP. A linear multiple regression for AP was conducted, with predictor variables entered in the following order: total drug use, non-ED caffeine use, SPS, and ED use. The overall model was significant and accounted for approximately 7% of the variance in AP. The hypotheses of the study were supported, indicating that ED use may be related to decreased AP, SPS ability may be related to increased AP, or that students with poor AP and less effective SPS skills are more likely to use EDs. Implications of these findings are important for college students and other users of ED products.

Recruitment Strategies for a Home-Based Physical Activity Intervention for Breast Cancer Patients

Recruiting cancer patients for randomized trials investigating psychosocial interventions presents several unique challenges. This paper describes the challenges and yields for different recruitment methods used in Moving Forward, a randomized trial of a home-based moderate-intensity physical activity program for early-stage breast cancer survivors. Recruitment methods included letters sent to patients by their oncologists, direct referrals from oncologists, in-person recruitment in oncology clinics, referrals from nurses and medical assistants, passive recruitment, other mailings, and community outreach strategies. Of the 424 screenings completed, 86 (20.3%) participants were randomized. Physician letters yielded the greatest number of initial screenings (147; 34.7%) and participants randomized (28; 32.5%). In-person recruitment also proved to be a productive recruitment strategy; 14 (16.3%) of the participants were recruited via this strategy. Community outreach efforts did not provide as great a yield and were labor intensive. We discuss suggestions for recruitment of cancer patients in future trials.

Smoking Related Cancers: A Brief Report on Problem Solving, Distress, and Risk Behaviors in Patients and Caregivers

Cancer diagnoses may adversely affect emotional functioning in patients and their caregivers, which in turn may increase risk behaviors, such as tobacco and alcohol use. This study investigates the relationships among problem-solving ability, distress, and risk behaviors in patients with head/neck and lung cancer and their caregivers. The authors hypothesized that patients and caregivers who experienced higher distress would engage in more risk behaviors, but that Social Problem-Solving (SPS) would moderate this effect, in that those who possessed greater SPS ability would engage in fewer risk behaviors. Twenty-one cancer patients and 11 of their caregivers were surveyed shortly after diagnosis. Participants completed the Profile of Mood States, the Social Problem-Solving Inventory—Revised, and measures of tobacco and alcohol use. Total SPS ability was higher in patients than caregivers but generally low in both groups. Total distress was lower in patients compared to caregivers. Mean comparisons indicated that caregivers smoked more cigarettes per day and consumed more alcohol than patients. Results indicate that patients and caregivers may have a decreased ability to solve problems, and that caregivers engage in more frequent risk behaviors than patients, suggesting that caregivers may be at risk and warrant further study. The study design prevents causative conclusions and limited sample size prohibits more complex analyses. Further research on social problem-solving ability, distress, and risk behaviors may reveal more robust relationships and provide insight for intervention development for these groups.

The Influence of Uncertainty and Social Support on Information Seeking Concerning Illicit Stimulant Use Among Young Adults

Using the Theory of Motivated Information Management (TMIM) and the concept of desired informational support as a framework, this project examined factors in the information management process young adults employ in potential information seeking about illicit stimulant drug use with members of their social networks. One hundred and seventy-three individuals participated in the study. Results indicated that (a) uncertainty discrepancy and the desire for informational support covaried, and (b) uncertainty discrepancy, anxiety, and outcome expectancy had significant impacts on the efficacy judgments made by individuals with regard to potential information seeking with their social networks about their stimulant drug use. The study thus provides further evidence for the utility of TMIM as a framework for understanding health communication in regard to drug use, and suggests that desired informational support may be a useful addition to the model for this health issue.