Lene Thorsen

A systematic review of physical activity in prostate cancer survivors: outcomes, prevalence, and determinants

IntroductionWe reviewed physical activity (PA) studies in prostate cancer (PC) survivors investigating (a) the effects of PA on health outcomes, (b) the prevalence of PA, and (c) the determinants of PA.Materials and methodsA systematic search of the literature identified nine studies on the outcomes of PA, six studies on the prevalence of PA, and four studies on the determinants of PA in PC survivors.ResultsResults showed promising effects of PA on muscular fitness, physical functioning, fatigue, and health-related quality of life. The prevalence of PA varied widely from <30% to >70%, depending on the type of measure used. PA in PC survivors was predicted by motivational variables such as intentions, perceived behavioral control, and subjective norms.ConclusionAlthough preliminary research is promising, there remains a significant amount of research to be done on the role of PA in PC survivors. Moreover, future research would benefit from larger samples using randomized controlled trial methodology.

Self-reported health and use of health care services in long-term cancer survivors

Owing to an increasing number of long‐term cancer survivors, the use of health care services and somatic health problems were compared between cancer survivors and a noncancer population. Data from the Nord‐Trøndelag Health Survey 2 (HUNT 2, 1995–1997) was merged with the Cancer Registry of Norway. Six cancer subgroups were constructed with diagnosis 5 years prior HUNT 2: testicular cancer (n= 59), colorectal cancer (n= 175), prostate cancer (n= 87), breast cancer (n= 258), gynaecological cancer (n= 153) and lymphoma/leukaemia (n= 83). For each cancer survivor 3 matched noncancer controls were selected from the HUNT 2 survey. The prevalence of common health problems, use of health care services and unfavourably life style parameters were compared between the 2 groups. Cancer survivors used health care services and received social welfare benefits more often than the controls. There was an increased risk of perceiving poor health after a history of cancer. Common health problems and/or unfavourable life style parameters could not explain poor health or the increased use of health care services among cancer survivors. Further studies are needed to investigate the reasons for increased use of health care services and perceived poor health in cancer survivors.

Cancer patients’ needs for rehabilitation services

Abstract Purpose. To examine cancer patients’ needs for rehabilitation services and factors associated with such needs, and secondly identify unmet needs for rehabilitation services and related factors. Material and methods. In 2008 persons aged 25–60 years, diagnosed in 2005/2006 with the ten most prevalent cancers in Norway were identified through the Cancer Registry of Norway. These patients were contacted by their treating hospital receiving a mailed questionnaire. Main outcomes for the present study were measured by two questions assessing a) needs for rehabilitation services and b) rehabilitation services offered/used. For each question seven services were listed; physical therapy, physical training, psychological counseling, consultations with social worker, occupational therapy, supportive group sessions and admittance to a convalescent home. The respondents then rated to what extent they had experienced needs and if they had been offered and used each service. Those who reported need for a service that not had been offered were defined as having unmet need. Associations between demographic, health-related and outcome variables were analyzed by multivariate logistic and linear regression analyses. Results. Among the 1 325 respondents, the mean age was 52 years and 70% were women. Sixty-three percent reported need for at least one rehabilitation service. Need for physical therapy was most frequently reported (43%), followed by physical training (34%), psychological counseling (27%), supportive group sessions (24%), admittance to a convalescent home (24%), consultation with social worker (19%) and occupational therapy (6%). Changes in employment status and ongoing or previous chemotherapy were associated with reporting needs for all rehabilitation services. Forty percent reported unmet needs, which most frequently was reported among persons living alone, who had changed their employment status, receiving or had received chemotherapy or reported comorbidities. Conclusions. The majority reported need for at least one rehabilitation service, and 40% reported unmet needs. Prospective studies are recommended in order to better understand needs for rehabilitation services, such as needs in relation to time since treatment, extent of disease and treatment intensity.

The association between self-reported physical activity and prevalence of depression and anxiety disorder in long-term survivors of testicular cancer and men in a general population sample

Goals of workPhysical activity is claimed to have a beneficial influence on a person’s mental health, though its impact may be different in cancer patients and individuals in the general population. The objective of this cross-sectional study was (1) to estimate the associations between the level of self-reported physical activity as a lifestyle factor (LPA) and the prevalence of depression and anxiety disorder in testicular cancer survivors (TCSs) and in men of similar age from the general population (GenPop), and (2) to examine whether these associations differ in the two groups.Patients and methodA total of 1260 TCSs and 20,207 men from the GenPop completed a questionnaire that assessed LPA, and depression and anxiety disorder on the Hospital Anxiety and Depression Scale (HADS).Main resultsThe prevalence of HADS-defined depression was lower among those who were physically active than in those who were physically inactive (TCSs 9% vs 17%, P<0.001; GenPop 8% vs 15%, P<0.001). Among physically inactive TCSs there was a trend towards higher a prevalence of HADS-defined anxiety disorder compared to physically active TCSs (P=0.07). In the GenPop this difference was statistically significant (P<0.001). Multivariate analysis confirmed the association between LPA and HADS-defined depression in both the TCSs [adjusted odds ratio (aOR)=0.56; 95% confidence interval (CI) (0.31, 1.02)] and the GenPop [aOR=0.58; 95% CI (0.51, 0.65)], but not the association between LPA and HADS-defined anxiety disorder. The associations between LPA and HADS-defined depression and HADS-defined anxiety disorder did not differ between the TCSs and the GenPop.ConclusionIn both the TCSs and the GenPop, the prevalence of HADS-defined depression was higher among those who were physically inactive than among those who were physically active, with no intergroup difference. There was no association between LPA and prevalence of HADS-defined anxiety disorder in either of the groups after adjusting for background variables. Prospective studies are needed to allow causal inferences to be drawn.

Effects and moderators of exercise on quality of life and physical function in patients with cancer: An individual patient data meta-analysis of 34 RCTs

This individual patient data meta-analysis aimed to evaluate the effects of exercise on quality of life (QoL) and physical function (PF) in patients with cancer, and to identify moderator effects of demographic (age, sex, marital status, education), clinical (body mass index, cancer type, presence of metastasis), intervention-related (intervention timing, delivery mode and duration, and type of control group), and exercise-related (exercise frequency, intensity, type, time) characteristics. Relevant published and unpublished studies were identified in September 2012 via PubMed, EMBASE, PsycINFO, and CINAHL, reference checking and personal communications. Principle investigators of all 69 eligible trials were requested to share IPD from their study. IPD from 34 randomised controlled trials (n=4519 patients) that evaluated the effects of exercise compared to a usual care, wait-list or attention control group on QoL and PF in adult patients with cancer were retrieved and pooled. Linear mixed-effect models were used to evaluate the effects of the exercise on post-intervention outcome values (z-score) adjusting for baseline values. Moderator effects were studies by testing interactions. Exercise significantly improved QoL (β=0.15, 95%CI=0.10;0.20) and PF (β=0.18, 95%CI=0.13;0.23). The effects were not moderated by demographic, clinical or exercise characteristics. Effects on QoL (βdifference_in_effect=0.13, 95%CI=0.03;0.22) and PF (βdifference_in_effect=0.10, 95%CI=0.01;0.20) were significantly larger for supervised than unsupervised interventions. In conclusion, exercise, and particularly supervised exercise, effectively improves QoL and PF in patients with cancer with different demographic and clinical characteristics during and following treatment. Although effect sizes are small, there is consistent empirical evidence to support implementation of exercise as part of cancer care.

The level of physical activity in long-term survivors of testicular cancer

The aim of this study was to estimate the level of physical activity (LPA) in a large cohort of testicular cancer survivors (TCSs) and compare these results with observations from men in the same age range in the general population (GenPop). We also wanted to identify parameters that influenced physical activity. The study populations consisted of 1276 TCSs treated with surgery, radiotherapy or chemotherapy with or without surgery (mean observation time was 12 years), and 20391 male inhabitants from a Norwegian county (GenPop). All completed a question investigating two sub-levels of physical activity. The logistic regression analysis adjusting for different covariates, showed significantly more physically active men among the TCSs compared with the GenPop (43 versus 37%) (adjusted odds ratio (aOR)=1.32 (95% Confidence Interval (CI) 1.10-1.58)). The results indicate that the experience of testicular cancer increases rather than reduces the LPA in TCSs, independent of treatment given.

Interest and preferences for exercise counselling and programming among Norwegian cancer survivors

To be able to make suitable exercise intervention programmes for cancer survivors, we need more information about exercise preferences. The primary aim of the study was to investigate the interest and preferences for exercise among Norwegian cancer survivors. A secondary aim was to identify demographic and medical characteristics associated with interest in exercise counselling. A questionnaire was completed by 1284 cancer survivors. Overall, 76% of participants were interested or maybe interested in receiving exercise counselling at some point during their cancer experience. Logistic regression analyses indicated that the interest in exercise counselling in men was associated with younger age, presence of comorbidity and having received chemotherapy. In women, the interest was associated with younger age, higher education and change in physical activity level. The participants preferred face-to-face exercise counselling with an exercise specialist from a cancer centre, at a hospital, immediately after treatment. Most cancer survivors were interested in an exercise programme, walking as activity, at moderate intensity and they wanted to start immediately after treatment. The knowledge from this study can contribute to make suitable physical rehabilitation available to cancer patients in the future.

Effects of strength training on body composition, physical functioning, and quality of life in prostate cancer patients during androgen deprivation therapy

Background. Androgen deprivation therapy (ADT) increases survival rates in prostate cancer (PCa) patients with locally advanced disease, but is associated with side effects that may impair daily function. Strength training may counteract several side effects of ADT, such as changes in body composition and physical functioning, which in turn may affect health-related quality of life (HRQOL). However, additional randomised controlled trials are needed to expand this knowledge. Material and methods. Fifty-eight PCa patients on ADT were randomised to either 16 weeks of high-load strength training (n = 28) or usual care (n = 30). The primary outcome was change in total lean body mass (LBM) assessed by dual x-ray absorptiometry (DXA). Secondary outcomes were changes in regional LBM, fat mass, and areal bone mineral density (aBMD) measured by DXA; physical functioning assessed by 1-repetition maximum (1RM) tests, sit-to-stand test, stair climbing test and Shuttle walk test; and HRQOL as measured by the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30. Results and Conclusion. No statistically significant effect of high-load strength training was demonstrated on total LBM (p = 0.16), but significant effects were found on LBM in the lower and upper extremities (0.49 kg, p < 0.01 and 0.15 kg, p < 0.05, respectively). Compared to usual care, high-load strength training showed no effect on fat mass, aBMD or HRQOL, but beneficial effects were observed in all 1RM tests, sit-to-stand test and stair climbing tests. Adherence to the training program was 88% for lower body exercises and 84% for upper body exercises. In summary, high-load strength training improved LBM in extremities and physical functioning, but had no effect on fat mass, aBMD, or HRQOL in PCa patients on ADT.

Exercise behavior in cancer survivors and associated factors

IntroductionPhysical activity is an important component in promoting a healthy life style in cancer survivors. We estimated the proportion of cancer survivors who are physically active, defined as meeting public health exercise guidelines, and changes in level of physical activity (LPA) from before diagnosis to after treatment. We also identified medical and demographic factors associated with LPA and its changes.MethodsA cross-sectional survey assessing LPA before diagnosis and after treatment, together with demographic and medical variables in 975 cancer survivors.ResultsForty-five percent of the cancer survivors were physically active after treatment. Before diagnosis and after treatment 33% were active, whereas 40% were inactive at both time points. Fifteen percent were active before diagnosis but inactive after treatment, and 12% were inactive before diagnosis but active after treatment. Increasing age and weight, low education, comorbidity and smoking were associated with physical inactivity after treatment. Change in LPA from active to inactive was associated with comorbidity, distant disease and smoking, while a change from inactive to active was associated with high education.ConclusionsLess than half of cancer survivors were physically active. Almost three quarters of cancer survivors remained stable in LPA. The remaining quarter changed LPA, with slightly more cancer survivors becoming inactive than active. Age, weight, education, comorbidity, disease stage and smoking can identify survivors at risk of physical inactivity after treatment.Implications for cancer survivorsRecognizable variables can be used to identify physically inactive cancer survivors after treatment and give these survivors support to start or maintain LPA.

A randomized controlled trial on the effectiveness of strength training on clinical and muscle cellular outcomes in patients with prostate cancer during androgen deprivation therapy: rationale and design

BackgroundStudies indicate that strength training has beneficial effects on clinical health outcomes in prostate cancer patients during androgen deprivation therapy. However, randomized controlled trials are needed to scientifically determine the effectiveness of strength training on the muscle cell level. Furthermore, close examination of the feasibility of a high-load strength training program is warranted. The Physical Exercise and Prostate Cancer (PEPC) trial is designed to determine the effectiveness of strength training on clinical and muscle cellular outcomes in non-metastatic prostate cancer patients after high-dose radiotherapy and during ongoing androgen deprivation therapy.Methods/designPatients receiving androgen deprivation therapy for 9-36 months combined with external high-dose radiotherapy for locally advanced prostate cancer are randomized to an exercise intervention group that receives a 16 week high-load strength training program or a control group that is encouraged to maintain their habitual activity level. In both arms, androgen deprivation therapy is continued until the end of the intervention period.Clinical outcomes are body composition (lean body mass, bone mineral density and fat mass) measured by Dual-energy X-ray Absorptiometry, serological outcomes, physical functioning (muscle strength and cardio-respiratory fitness) assessed with physical tests and psycho-social functioning (mental health, fatigue and health-related quality of life) assessed by questionnaires. Muscle cellular outcomes are a) muscle fiber size b) regulators of muscle fiber size (number of myonuclei per muscle fiber, number of satellite cells per muscle fiber, number of satellite cells and myonuclei positive for androgen receptors and proteins involved in muscle protein degradation and muscle hypertrophy) and c) regulators of muscle fiber function such as proteins involved in cellular stress and mitochondrial function. Muscle cellular outcomes are measured on muscle cross sections and muscle homogenate from muscle biopsies obtained from muscle vastus lateralis.DiscussionThe findings from the PEPC trial will provide new knowledge on the effects of high-load strength training on clinical and muscle cellular outcomes in prostate cancer patients during androgen deprivation therapy.Trial registrationClinicalTrials.gov: NCT00658229