Louise C. Mâsse

An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis

IntroductionApproximately 11.1 million cancer survivors are alive in the United States. Activity prescriptions for cancer survivors rely on evidence as to whether exercise during or after treatment results in improved health outcomes. This systematic review and meta-analysis evaluates the extent to which physical activity during and post treatment is appropriate and effective across the cancer control continuum.MethodsA systematic quantitative review of the English language scientific literature searched controlled trials of physical activity interventions in cancer survivors during and post treatment. Data from 82 studies were abstracted, weighted mean effect sizes (WMES) were calculated from 66 high quality studies, and a systematic level of evidence criteria was applied to evaluate 60 outcomes. Reports of adverse events were abstracted from all studies.ResultsQuantitative evidence shows a large effect of physical activity interventions post treatment on upper and lower body strength (WMES = 0.99 & 0.90, p < 0.0001 & 0.024, respectively) and moderate effects on fatigue and breast cancer-specific concerns (WMES = −0.54 & 0.62, p = 0.003 & 0.003, respectively). A small to moderate positive effect of physical activity during treatment was seen for physical activity level, aerobic fitness, muscular strength, functional quality of life, anxiety, and self-esteem. With few exceptions, exercise was well tolerated during and post treatment without adverse events.ConclusionsCurrent evidence suggests many health benefits from physical activity during and post cancer treatments. Additional studies are needed in cancer diagnoses other than breast and with a focus on survivors in greatest need of improvements for the health outcomes of interest.

Controlled Physical Activity Trials in Cancer Survivors: A Systematic Review and Meta-analysis

Background: Approximately 9.8 million cancer survivors are alive in the United States today. Enthusiasm for prescribing physical activity for cancer survivors depends on evidence regarding whether physical activity during or after completion of treatment results in improved outcomes such as cardiorespiratory fitness, fatigue, symptoms, quality of life, mental health, or change in body size. Methods: A systematic qualitative and quantitative review of the English language scientific literature identified controlled trials of physical activity interventions in cancer survivors during and after treatment. Data from 32 studies were abstracted, weighted mean effect sizes (WMES) were calculated from the 22 high-quality studies, and a systematic level of evidence criteria was applied to evaluate 25 outcomes. Results: There was qualitative and quantitative evidence of a small to moderate effect of physical activity interventions on cardiorespiratory fitness (WMES = 0.51 and 0.65 during and after treatment respectively, P < 0.01), physiologic outcomes and symptoms during treatment (WMES = 0.28, P < 0.01 and 0.39, P < 0.01, respectively), and vigor posttreatment (WMES = 0.83, P = 0.04). Physical activity was well tolerated in cancer survivors during and after treatment, but the available literature does not allow conclusions to be drawn regarding adverse events from participation. Conclusions: Physical activity improves cardiorespiratory fitness during and after cancer treatment, symptoms and physiologic effects during treatment, and vigor posttreatment. Additional physical activity intervention studies are needed to more firmly establish the range and magnitude of positive effects of physical activity among cancer survivors.

Measuring collaboration and transdisciplinary integration in team science.

PURPOSE As the science of team science evolves, the development of measures that assess important processes related to working in transdisciplinary teams is critical. Therefore, the purpose of this paper is to present the psychometric properties of scales measuring collaborative processes and transdisciplinary integration. METHODS Two hundred-sixteen researchers and research staff participating in the Transdisciplinary Tobacco Use Research Centers (TTURC) Initiative completed the TTURC researcher survey. Confirmatory-factor analyses were used to verify the hypothesized factor structures. Descriptive data pertinent to these scales and their associations with other constructs were included to further examine the properties of the scales. RESULTS Overall, the hypothesized-factor structures, with some minor modifications, were validated. A total of four scales were developed, three to assess collaborative processes (satisfaction with the collaboration, impact of collaboration, trust and respect) and one to assess transdisciplinary integration. All scales were found to have adequate internal consistency (i.e., Cronbach alphas were all >0.70); were correlated with intermediate markers of collaborations (e.g., the collaboration and transdisciplinary-integration scales were positively associated with the perception of a centers making good progress in creating new methods, new science and models, and new interventions); and showed some ability to detect group differences. CONCLUSIONS This paper provides valid tools that can be utilized to examine the underlying processes of team science--an important step toward advancing the science of team science.

Discrepant views of oncologists and cancer patients on complementary/alternative medicine

GoalsComplementary/alternative medicine (CAM) is widely used by patients but rarely discussed with oncologists. To understand reasons for the communication gap, this study compares physicians and patients on perceived reasons for CAM use and nondisclosure of use, reactions of physicians to disclosure, and expectations for CAM.Patients and methodsCross-sectional studies assessed 82 physicians (response 68.3%) and 244 of 374 outpatients (response 65.2%) identified as CAM users at the MD Anderson Cancer Center. Data were summarized by frequency and compared using chi-square tests.Main resultsPhysicians were more likely (p<0.001) than patients to attribute CAM use to hope (χ2=17.7), control (χ2=17.5), incurable disease (χ2=42.8), or a nontoxic approach (χ2=50.9). Both physicians and patients agreed CAM could relieve symptoms/side effects, but physicians were less likely (p<0.001) than patients to expect that CAM improved immunity (χ2=72.2) or quality of life (χ2=17.1), cured disease (χ2=42.5), or prolonged life (χ2=58.4). Physicians and patients responded differently (p<0.005) on reasons for nondisclosure. Physicians believed patients felt CAM discussions were unimportant (χ2=7.9) and physicians would not understand (χ2=48.1), discontinue treatment (χ2=26.4), discourage or disapprove of the use (χ2=131.7); patients attributed nondisclosure to their uncertainty of its benefit (χ2=10.4) and never being asked about CAM (χ2=9.9) by physicians. Physicians were more likely (χ2=9.5, p<0.002) to warn of risks and less likely (χ2=23.5, p<0.001) to encourage use than patients perceived.ConclusionOncologists and cancer patients hold discrepant views on CAM that may contribute to a communication gap. Nevertheless, physicians should ask patients about CAM use, discuss possible benefits, and advise of potential risks.

The Evaluation of Large Research Initiatives A Participatory Integrative Mixed-Methods Approach

Over the past few decades there has been a rise in the number of federally funded large scientific research initiatives, with increased calls to evaluate their processes and outcomes. This article describes efforts to evaluate such initiatives in one agency within the U.S. federal government. The authors introduce the Evaluation of Large Initiatives (ELI) project, a preliminary effort to explore how to accomplish such evaluation. They describe a pilot effort of this project to evaluate the Transdisciplinary Tobacco Use Research Center (TTURC) initiative of the National Cancer Institute. They present a summary of this pilot evaluation including the methods used (concept mapping, logic modeling, a detailed researcher survey, content analysis and systematic peer-evaluation of progress reports, bibliometric analysis and peer evaluation of publications and citations, and financial expenditures analysis) and a brief overview of results. Finally, they discuss several important lessons and recommendations that emerged from this work.

Psychosocial mediation of fruit and vegetable consumption in the body and soul effectiveness trial

In this study the authors examined psychosocial variables as mediators for fruit and vegetable (FV) intake in a clustered, randomized effectiveness trial conducted in African American churches. The study sample included 14 churches (8 intervention and 6 control) with 470 participants from the intervention churches and 285 participants from the control churches. The outcome of FV intake and the proposed mediators were measured at baseline and at 6-month follow-up. Structural equation modeling indicated that the intervention had direct effects on social support, self-efficacy, and autonomous motivation; these variables also had direct effects on FV intake. Applying the M. E. Sobel (1982) formula to test significant mediated effects, the authors confirmed that social support and self-efficacy were significant mediators but that autonomous motivation was not. Social support and self-efficacy partially mediated 20.9% of the total effect of the intervention on changes in FV intake. The results support the use of strategies to increase social support and self-efficacy in dietary intervention programs.

Emerging measurement and statistical methods in physical activity research

Although many studies have attempted to identify mediators and moderators of changes in physical activity involvement, the literature is inconclusive regarding which variable(s) relate to physical activity behavior change. The Cooper 2001 Conference series dedicated a session to discussing measurement and statistical methods that could contribute to advancing this research agenda. This article focuses on four such methodologic approaches: qualitative; psychometric; latent-variable, structural equation modeling; and multilevel modeling. The article presents a brief overview of these methods and discusses potential advantages and limitations of using them.

Comparing the content of participation instruments using the International Classification of Functioning, Disability and Health

BackgroundThe concept of participation is recognized as an important rehabilitation outcome and instruments have been developed to measure participation using the International Classification of Functioning, Disability and Health (ICF). To date, few studies have examined the content of these instruments to determine how participation has been operationalized. The purpose of this study was to compare the content of participation instruments using the ICF classification.MethodsA systematic literature search was conducted to identify instruments that assess participation according to the ICF. Instruments were considered to assess participation and were included if the domains contain content from a minimum of three ICF chapters ranging from Chapter 3 Communication to Chapter 9 Community, social and civic life in the activities and participation component. The instrument content was examined by first identifying the meaningful concepts in each question and then linking these concepts to ICF categories. The content analysis included reporting the 1) ICF chapters (domains) covered in the activities and participation component, 2) relevance of the meaningful concepts to the activities and participation component and 3) context in which the activities and participation component categories are evaluated.ResultsEight instruments were included: Impact on Participation and Autonomy, Keele Assessment of Participation, Participation Survey/Mobility, Participation Measure-Post Acute Care, Participation Objective Participation Subjective, Participation Scale (P-Scale), Rating of Perceived Participation and World Health Organization Disability Assessment Schedule II (WHODAS II). 1351 meaningful concepts were identified in the eight instruments. There are differences among the instruments regarding how participation is operationalized. All the instruments cover six to eight of the nine chapters in the activities and participation component. The P-Scale and WHODAS II have questions which do not contain any meaningful concepts related to the activities and participation component. Differences were also observed in how other ICF components (body functions, environmental factors) and health are operationalized in the instruments.ConclusionLinking the meaningful concepts in the participation instruments to the ICF classification provided an objective and comprehensive method for analyzing the content. The content analysis revealed differences in how the concept of participation is operationalized and these differences should be considered when selecting an instrument.

Factors Influencing Lunchtime Food Choices Among Working Americans

There is growing interest in the usefulness of the workplace as a site for promotion of healthful food choices. The authors therefore analyzed data of U.S. adults (N = 1,918) who reported working outside the home and eating lunch. The majority (84.0%) of workers had a break room. About one half (54.0%) purchased lunch ≥ 2 times/week, with higher percentages for males, Blacks, younger (age 18-34 years) versus older adults (age 55 years or older), and obese versus normal-weight persons. The most important lunch food choice value was convenience (34.3%), followed by taste (27.8%), cost (20.8%), and health (17.1%). The typical source for purchasing lunch was a fast-food restaurant (43.4%), followed by on-site cafeteria/snack shop (25.3%), full-service restaurant (16.9%), supermarket (5.2%), vending machine (4.4%), and convenience store (4.0%); younger adults and those less educated relied more on fast-food places. This study identifies individual factors and values that may influence future dietary health initiatives in the work site.

How many days was that? We're still not sure, but we're asking the question better!

Unreliable measures limit the ability to detect relationships with other variables. Day-to-day variability in measurement is a source of unreliability. Studies vary substantially in numbers of days needed to reliably assess physical activity. The required numbers of days has probably been underestimated due to violations of the assumption of compound symmetry in using the intraclass correlation. Collecting many days of data become unfeasible in real-world situations. The current dilemma could be solved by adopting distribution correction techniques from nutrition or gaining more information on the measurement model with generalizability studies. This would partition the variance into sources of error that could be minimized. More precise estimates of numbers of days to reliably assess physical activity will likely vary by purpose of the study, type of instrument, and characteristics of the sample. This work remains to be done.