The association between age and long-term quality of life after curative treatment for prostate cancer: a cross-sectional study.

OBJECTIVE: We aimed to investigate the associations between age at radical prostate cancer treatment and long-term global quality of life (QoL), physical function (PF), and treatment-related side effects. MATERIAL AND METHODS: This single-center, cross-sectional study included men treated for localized prostate cancer with robotic-assisted radical prostatectomy (RARP) or external beam radiotherapy (EBRT) in 2014-2018. Global QoL and PF were assessed by the European Organisation of Research and Treatment in Cancer Quality of life Questionnaire-C30 (QLQ-C30), side effects by the Expanded Prostate Cancer Index Composite (EPIC-26). Adjusted linear regression models were estimated to assess associations between age (continuous variable) at treatment and outcomes. QLQ-C30 scores were compared to normative data after dividing the cohort in two groups, <70 years and ≥70 years at treatment. RESULTS: Of 654 men included, 516 (79%) had undergone RARP, and 138 (21%) had undergone EBRT combined with androgen deprivation therapy for 93%. Mean time since treatment was 57 months. Median age at treatment was 68 (min-max 44-84) years. We found no statistically significant independent association between age at treatment and global QoL, PF or side effects, except for sexual function (regression coefficient [RC] -0.77; p < 0.001) and hormonal/vitality (RC 0.30; p = 0.006) function. Mean QLQ-C30 scores were slightly poorer than age-adjusted normative scores, for men <70 years (n = 411) as well as for men ≥70 years (n = 243) at treatment, but the differences were not beyond clinical significance. CONCLUSIONS: In this cohort of prostate cancer survivors, age at treatment had little impact on long-term QoL and function. Due to the cross-sectional design, short term impact or variation over time cannot be ruled out.

Geriatric impairments are associated with reduced quality of life and physical function in older patients with cancer receiving radiotherapy - A prospective observational study.

INTRODUCTION: Quality of life (QoL) and function are important outcomes for older adults with cancer. We aimed to assess differences in trends in patient-reported outcomes (PROs) during radiotherapy (RT) between (1) groups with curative or palliative treatment intent and (2) groups defined according to the number of geriatric impairments. MATERIALS AND METHODS: A prospective observational study including patients aged ≥65 years receiving curative or palliative RT was conducted. Geriatric assessment (GA) was performed before RT, and cut-offs for impairments within each domain were defined. Patients were grouped according to the number of geriatric impairments: 0, 1, 2, 3, and ≥ 4. Our primary outcomes, global QoL and physical function (PF), were assessed by The European Organisation for Research and Treatment of Cancer Quality-of-Life Core Questionnaire (EORTC) (QLQ-C30) at baseline, RT completion, and two, eight, and sixteen weeks later. Differences in trends in outcomes between the groups were assessed by linear mixed models. RESULTS: 301 patients were enrolled, mean age was 73.6 years, 53.8% received curative RT. Patients receiving palliative RT reported significantly worse global QoL and PF compared to the curative group. The prevalence of 0, 1, 2, 3 and ≥ 4 geriatric impairments was 16.6%, 22.7%, 16.9%, 16.3% and 27.5%, respectively. Global QoL and PF gradually decreased with an increasing number of impairments. These group differences remained stable from baseline throughout follow-up without any clinically significant changes for any of the outcomes. DISCUSSION: Increasing number of geriatric impairments had a profound negative impact on global QoL and PF, but no further decline was observed for any group or outcome, indicating that RT was mainly well tolerated. Thus, geriatric impairments per se should not be reasons for withholding RT. GA is key to identifying vulnerable patients in need of supportive measures, which may have the potential to improve treatment tolerance. Registered at clinicaltrials.gov (NCT03071640).

Colorectal cancer patients' experiences with supervised exercise during adjuvant chemotherapy-A qualitative study.

BACKGROUND: Colorectal cancer (CRC) is a common cancer worldwide, with increasing numbers surviving and living with long-term side effects from treatment. Physical exercise during or after treatment may have several beneficial effects, but knowledge of CRC patients' reflections on exercising during adjuvant therapy is limited. The aim of this study was to explore the experiences of CRC patients participating in a supervised exercise program during adjuvant chemotherapy. METHODS: This study included CRC patients participating in two intervention studies with individually tailored and supervised combinations of endurance, resistance, and balance exercises during adjuvant chemotherapy. Semi-structured interviews performed at the beginning, during, and immediately after the intervention period from 15 participants were analyzed using thematic analysis. RESULTS: Four main themes identified were "structuring life with cancer," "motivation to exercise," "training experiences," and "effects of exercise." Scheduled appointments gave structure to daily life and served as an external motivational factor. The individual adjustments of exercise gave a sense of security and helped improving adherence, especially when feeling depressed or fatigued. Common expectations were improvement of endurance and strength and counteracting negative effects of chemotherapy. Experienced positive effects from exercising, both mentally and physically, contributed to inner motivation and inspired continued exercising after the study period. CONCLUSION: This study offers important insights into CRC patients' experiences of participating in a physical exercise program during adjuvant chemotherapy. Based on our findings, we recommend supervised and individually tailored physical exercise during adjuvant chemotherapy to this patient group.

Healthy Life Centres: a 3-month behaviour change programme's impact on participants' physical activity levels, aerobic fitness and obesity: an observational study.

OBJECTIVES: Individuals with low socioeconomic status and multimorbidity tend to have lower physical activity (PA) levels than the general population. Primary care is an important setting for reaching high-risk individuals to support behaviour change. This study aimed to investigate the impact of behaviour change interventions delivered by Norwegian Healthy Life Centres (HLCs) on participants' PA levels, aerobic fitness and obesity, and furthermore to investigate possible predictors of change. DESIGN: An observational study with a pre-post design and a 3-month follow-up. SETTING: Thirty-two HLCs in Norway were included. PARTICIPANTS: A total of 713 participants (72% of the participants included at baseline), 71% women, with a mean age of 51 (18-87 years) and body mass index (BMI) of 32 (SD 7) met to follow-up. INTERVENTION: Individual consultations and tailored individual and group-based exercise and courses organised by the HLCs and cooperating providers. OUTCOME MEASURES: The primary outcome was time spent in moderate to vigorous PA (MVPA, min/day) (ActiGraph GT3X+ accelerometer). The secondary outcomes were light PA (LPA, min/day), number of steps per day, time spent sedentary (SED, min/day), aerobic fitness (submaximal treadmill test, min), BMI (kg/m2) and waist circumference (WC, cm). RESULTS: There was no change in MVPA (B 1.4, 95% CI -0.4 to 3.1) after 3 months. The participants had improved LPA (4.0, 95% CI 0.5 to 7.5), increased number of steps (362, 95% CI 172 to 552), reduced SED (-5.6, 95% CI -9.8 to -1.3), improved fitness (0.8, 95% CI 0.6 to 1.0), reduced BMI (-0.2, 95% CI -0.1 to -0.3) and reduced WC (-1.7, 95% CI -2.0 to -1.3). Positive predictors of change were number of exercise sessions completed per week, duration of adherence to HLC offers and participation in exercise organised by HLC. CONCLUSION: Participation in the HLC interventions had small positive impacts on participants' PA levels, aerobic fitness and obesity. Further research to develop effective behaviour change programmes targeting individuals with complex health challenges is needed. TRIAL REGISTRATION NUMBER: NCT03026296.

Health-related quality of life and physical activity level after a behavior change program at Norwegian healthy life centers: a 15-month follow-up.

PURPOSE: The long-term impact of primary care behavior change programs on health-related quality of life (HRQoL) and physical activity (PA) level is unknown. The aim of this study was to investigate changes in HRQoL and PA among participants after a 3-month behavior change intervention at Norwegian healthy life center (HLCs) and at a 15-month follow-up. Furthermore, we aimed to study associations between changes in PA and HRQoL. METHODS: We followed 524 adult participants (18-83 years), recruited from 32 HLCs in August 2016-January 2018, who provided data on HRQoL (SF-36) and PA (ActiGraph accelerometers) 12 months after a 3-month behavior change intervention. Changes in HRQoL and PA between baseline, 3-month and 15-month follow-ups, and associations between changes in PA and HRQoL were analyzed by linear mixed models. RESULTS: All HRQoL dimensions improved from baseline to 3-month follow-up, and the improvements maintained at 15-month follow-up (mean 3.1-13.1 points, p < 0.001). PA increased from baseline to 3 months (mean 418 steps/day, p < 0.001), but declined from 3 to 15 months (mean - 371 steps/day, p < 0.001). We observed positive associations between changes in PA and HRQoL (0.84-3.23 points per 1000 steps/day, p < 0.023). CONCLUSIONS: Twelve months after completing a 3-month HLC intervention we found improved HRQoL, but not PA level. Still, there were positive associations between PA and HRQoL over this period, indicating that participants increasing their PA were more likely to improve their HRQoL.

Pulmonary Rehabilitation in Patients with Pulmonary Sarcoidosis: Impact on Exercise Capacity and Fatigue.

BACKGROUND: There is limited evidence regarding the impact of multidisciplinary pulmonary rehabilitation (PR) on exercise capacity and fatigue in patients with pulmonary sarcoidosis. The aim of this study was to evaluate the impact on exercise capacity and fatigue following PR, and to examine whether baseline fatigue was related to change in peak oxygen uptake (ΔV̇O2peak). METHODS: Forty-one patients with pulmonary sarcoidosis attending a 4-week inpatient PR program were recruited to this pre-post study. Both maximal exercise capacity, defined as V̇O2peak and measured with a cardiopulmonary exercise test, and fatigue, assessed with the Fatigue Assessment Scale (score 10-50 points), were measured before and after PR. RESULTS: There was a statistically significant improvement in V̇O2peak (1.2 ± 2.3 mL/kg/min, p = 0.002), and fatigue decreased significantly (-1.7 ± 3.9 points, p = 0.009) following PR. Unadjusted linear regression analyses demonstrated that age (B = -0.076, p = 0.017) and baseline fatigue (B = 0.196, p = 0.001) were predictors for change in V̇O2peak, while in adjusted analyses (age, sex, baseline V̇O2peak, baseline fatigue, and diffusion capacity of the lung for carbon monoxide), only baseline fatigue predicted change in V̇O2peak following PR (B = 0.165, p = 0.026). CONCLUSION: A 4-week multidisciplinary PR program improves maximal exercise capacity and reduces fatigue in patients with pulmonary sarcoidosis. Baseline fatigue only partly predicted change in V̇O2peak following PR.

The acute impact of resistance training on fatigue in patients with pulmonary sarcoidosis.

Fatigue is the most prevalent symptom among patients with sarcoidosis, and skeletal muscle dysfunction is a common clinical feature, making resistance training (RT) a recommended treatment strategy. Despite lacking knowledge regarding whether high-intensity RT will aggravate fatigue, low to moderate-intensity is routinely used even if the evidence for this protocol to improve muscle strength is inconclusive. This study aimed to investigate whether one single session of high-intensity RT induces a higher increase in fatigue than one single session of moderate-intensity RT. In this randomized crossover study, 41 patients with pulmonary sarcoidosis (age: 53 ± 11 yr) were recruited. They randomly performed one single session of high-intensity RT, 4 sets × 5 repetitions maximum (5RM), and one single session of moderate-intensity RT, 2 sets × 25 RM. Fatigue was assessed with the Visual Analogue Scale (0-100 mm) immediately before (T0), immediately after (T1) and 24 hours after (T2) each exercise session. Fatigue development from T0 to T1 was significantly lower after 5RM (-3 ± 18 mm) than after 25RM (5 ± 15 mm), p = 0.004. No difference was seen from T0 to T2 between 5RM (0 ± 17 mm) and 25RM (6 ± 18 mm), p = 0.147. The high-intensity 5RM session did not induce a larger increase in fatigue than the moderate-intensity 25RM session. RT appears feasible and safe in patients with pulmonary sarcoidosis irrespective of the intensity. Thus, the long-term effects of high-intensity RT on fatigue should be explored in a RT programme of longer duration.

Health-related quality of life and intensity-specific physical activity in high-risk adults attending a behavior change service within primary care.

OBJECTIVES: Health-related quality of life (HRQoL) is an important outcome for health interventions, such as physical activity (PA) promotion among high-risk populations. The aim of this study was to investigate levels of PA and HRQoL, and associations between PA and HRQoL, in participants attending a behavior change service within primary care in Norway. METHODS: Adult participants (≥ 18 years) from 32 Healthy Life Centers (HLCs) in four regions of Norway, who provided valid data on HRQoL (SF-36) and PA (ActiGraph accelerometer) were included (N = 835). HRQoL scores were compared to normative data by independent sample t-tests. Associations between eight dimensions of HRQoL and time spent sedentary (SED), in light PA (LPA) or in moderate to vigorous PA (MVPA) were determined using general linear models adjusted for relevant confounders. RESULTS: Nineteen percent of the participants (mean age 50; body mass index 32) met PA recommendations of > 150 min MVPA per week. SF-36 scores were 10 to 28 points lower than the norm (all p < 0.001). Positive associations were found between MVPA and the SF-36 dimensions physical functioning, role physical, general health and vitality, (all p < 0.045). LPA was positively associated with physical functioning, role physical, general health, vitality and role emotional (all p < 0.046). Time spent SED was negatively associated with physical functioning, general health, vitality, social functioning and mental health (all p < 0.030). CONCLUSIONS: Individuals attending a Norwegian behavior change service within primary care had low PA level and low HRQoL compared to the general population. Our study suggest there is a positive dose-response relationship between PA and HRQoL, and a negative relationship between SED and HRQoL. Furthermore, that specific PA intensities and SED are related to different dimensions of HRQoL.

Feasibility and preliminary effects of resistance training and nutritional supplements during versus after radiotherapy in patients with head and neck cancer: A pilot randomized trial.

BACKGROUND: Patients with head and neck cancer (HNC) experience involuntary weight loss that has a negative impact on physical function, morbidity, and survival. The objective of the current study was to evaluate the feasibility of an exercise and nutrition intervention during radiotherapy (RT) compared with after RT, and to examine preliminary effects on skeletal muscle mass. METHODS: Patients with HNC were randomized to an exercise and nutrition intervention during RT (EN-DUR) or after RT (EN-AF). The EN-DUR intervention was conducted at a hospital and the EN-AF intervention took place at a rehabilitation center. The interventions consisted of progressive resistance training (PRT) and oral nutritional supplements (ONS). Feasibility outcomes were tracked weekly and muscle mass was measured by computed tomography scans before and after RT and at 2 months follow-up. RESULTS: Of the 50 eligible patients, 41 (82%) agreed to participate. 90% of patients completed the EN-DUR intervention and the adherence to PRT and ONS was 81% and 57%, respectively. 52% of patients attended the EN-AF intervention and adherence to PRT and ONS was 94% and 76%, respectively. The EN-DUR demonstrated a trend toward mitigating loss of muscle mass during RT and the EN-AF demonstrated a similar trend after RT. No difference in muscle mass was detected between the groups from baseline to week 14. CONCLUSIONS: An exercise and nutrition intervention is feasible for patients with HNC during RT, and the intervention is potentially effective in mitigating loss of muscle mass both during and after RT. Future trials should assess the feasibility and effects of extended interventions during and after treatment. Cancer 2017;123:4440-8. © 2017 American Cancer Society.

Palliative cancer patients' experience of physical activity.

Results from pilot studies indicate that palliative cancer patients report increased well-being and less fatigue after physical activity. This study aimed to explore how palliative cancer patients experienced physical activity. A qualitative design with semi-structured interviews was used. Eleven palliative cancer patients over 18 years old with different diagnoses and Eastern Cooperative Oncology Group Scale performance status levels of between 1 and 3 were interviewed. Four main themes emerged: routines of everyday life, less fatigue, professional guidance, and hope. The first theme comprised two categories: something to do, and being together with others in a similar situation. The theme professional guidance also comprised two categories: the physiotherapist as tutor, and the physiotherapist as motivator. Some cancer patients in palliative care who participated in physical activity experienced less fatigue and enhanced energy. Physical activity helps to bring structure to everyday life and gives a feeling of hope for the future.