Demographic, medical, social-cognitive, and environmental correlates of meeting independent and combined physical activity guidelines in kidney cancer survivors.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
PURPOSE:Guidelines for cancer survivors recommend both aerobic physical activity (PA) and strength training (ST). Few kidney cancer survivors (KCS) are meeting single-activity or combined guidelines; therefore, examining factors influencing PA participation is warranted. The purpose of this study is to examine demographic, medical, social-cognitive, and environmental correlates of meeting independent (i.e., aerobic-only, strength training (ST)-only) and combined guidelines (i.e., aerobic and ST) in KCS. METHODS:KCS (N = 651) completed self-reported measures of PA and demographic, medical, social-cognitive, and perceived environmental factors. Built environment was assessed using the geographic information systems (GIS). Multinomial logistic regressions were conducted to determine the correlates of meeting the combined versus independent guidelines. RESULTS:Compared with meeting neither guideline, meeting aerobic-only guidelines was associated with higher intentions (p < .01) and planning (p < .01); meeting ST-only guidelines was associated with higher intentions (p = .02) and planning (p < .01), lower perceived behavioral control (PBC) (p = .03), healthy weight (p = .01), and older age (p < .01); and meeting the combined guidelines were associated with higher intentions (p < .01), planning (p = .02), higher instrumental attitudes (p < .01), higher education (p = .04), better health (p < .01), and localized cancer (p = .05). Additionally, compared with neither guideline, meeting aerobic-only (p < .01) and combined (p < .01) guidelines was significantly associated with access to workout attire. Compared with neither guideline, meeting aerobic-only guidelines was associated with proximity to retail (p = .02). CONCLUSION:PA participation correlates may vary based on the modality of interest. Interventions may differ depending on the modality promoted and whether KCS are already meeting single-modality guidelines.
Optimizing Cancer Rehabilitation through Activity-focused Approaches.
Brick Rachelle,Skidmore Elizabeth
Seminars in oncology nursing
OBJECTIVES:This article discusses the effects of cancer on broader domains of health; the evidence and application of activity-focused rehabilitation approaches in rehabilitation populations; and the role of nurses in the promotion of activity-focused rehabilitation. DATA SOURCES:Narrative review of rehabilitation literature. CONCLUSION:Cancer impacts activity engagement, community participation, and quality of life. Optimal cancer rehabilitation may lie in adoption and implementation of activity-focused rehabilitation approaches. Recent research suggests that this approach may improve impairments and activity engagement outcomes. IMPLICATIONS FOR NURSING PRACTICE:Nurses are critical for screening for activity limitations and participation restrictions and early referral to rehabilitation treatment. Nurses can also educate survivors on the importance of meta-cognitive and self-management strategies to promote engagement in meaningful activities to reduce long-term disability.
Synergy Between Licensed Rehabilitation Professionals and Clinical Exercise Physiologists: Optimizing Patient Care for Cancer Rehabilitation.
Coletta Adriana M,Campbell Anna,Morris G Stephen,Schmitz Kathryn H
Seminars in oncology nursing
OBJECTIVES:To differentiate between rehabilitation and exercise training and propose how rehabilitation professionals and exercise physiologists can collaborate to optimize cancer survivor care. DATA SOURCE:Professional organizations and peer-reviewed manuscripts. CONCLUSION:Both professions offer complementary skillsets that, when integrated, optimize the ability of the cancer care team to implement more effective survivorship care plans. Future models of care must incorporate efficient communications between the cancer rehabilitation program and oncology team, include various reimbursement/payment/funding options, and continuously assess program efficacy. IMPLICATIONS FOR NURSING PRACTICE:Nurses must be cognizant of physical needs (ie, functional and conditioning status) and cancer-related comorbidities when referring cancer survivors for exercise reconditioning.
Clinical practice guidelines for the management of brain tumours: A rehabilitation perspective.
Kim Woo-Jin,Novotna Klara,Amatya Bhasker,Khan Fary
Journal of rehabilitation medicine
OBJECTIVE:To critically appraise published clinical practice guidelines (CPGs) for brain tumours, and to synthesize evidence-based recommendations from a rehabilitation perspective. METHODS:A comprehensive literature search included: health science databases, CPG clearinghouse/developer websites, and grey literature up to March 2018. All brain tumour CPGs that reported systematic methods for evidence search, and clearly defined recommendations supporting evidence for rehabilitation interventions were included. Three authors independently selected potential CPGs and assessed their methodological quality using the Appraisal of Guidelines, Research and Evaluation (AGREE-II) Instrument. Recommendations from included CPGs were categorized from a rehabilitation perspective. RESULTS:Of the 11 CPGs identified, only 2, developed by the National Institute for Health and Clinical Excellence (NICE) and the Australian Cancer Network (ACN), included rehabilitation components for the management of brain tumours. Both CPGs were of moderate quality. The recommendations reported were generic, and only the ACN guidelines provided detailed recommendations for rehabilitation interventions. Both guidelines recommend a comprehensive multi-disciplinary care approach. Detailed comparison, however, was not possible due to inconsistent recommendations, making it difficult to summarize rehabilitative care. CONCLUSION:Despite rehabilitation being an integral component of the management of brain tumours, only a limited number of CPGs have incorporated recommendations for specific rehabilitation interventions. In order to improve clinical outcomes in this population future CPGs should incorporate rehabilitation interventions.
Preparedness to Implement Physical Activity and Rehabilitation Guidelines in Routine Primary Care Cancer Rehabilitation: Focus Group Interviews Exploring Rehabilitation Professionals' Perceptions.
Neher Margit,Landén Ludvigsson Maria,Enblom Anna
Journal of cancer education : the official journal of the American Association for Cancer Education
To explore primary care professionals' perceptions of physical activity and other cancer rehabilitation practice in cancer survivors, investigating the preparedness to implement guidelines regarding cancer rehabilitation. We collected qualitative data through seven semi-structured focus group interviews with 48 rehabilitation professionals, with mean 9 years of experience in primary care rehabilitation (32 physiotherapists, 15 occupational therapists, and 1 rehabilitation assistant) in a primary care setting. Data was analyzed using content analysis. Primary care rehabilitation professionals expressed limited experience of cancer survivors, experienced lack of knowledge of cancer-related disability, and had doubts concerning how to treat cancer survivors. They also experienced uncertainty about where to find collaboration and support in the healthcare system outside their own rehabilitation clinic. There is a need to combine different implementation strategies to tackle multiple barriers for effective cancer survivor rehabilitation in primary care, to boost individual rehabilitation professionals' knowledge and self-efficacy, to clarify roles and responsibilities for cancer rehabilitation across levels of care, and to develop and strengthen organizational bridges to provide adequate access to rehabilitation for cancer survivors.
Determinants of adherence to physical cancer rehabilitation guidelines among cancer patients and cancer centers: a cross-sectional observational study.
IJsbrandy Charlotte,Ottevanger Petronella B,Gerritsen Winald R,van Harten Wim H,Hermens Rosella P M G
Journal of cancer survivorship : research and practice
PURPOSE:To tailor implementation strategies that maximize adherence to physical cancer rehabilitation (PCR) guidelines, greater knowledge concerning determinants of adherence to those guidelines is needed. To this end, we assessed the determinants of adherence to PCR guidelines in the patient and cancer center. METHODS:We investigated adherence variation of PCR guideline-based indicators regarding  screening with the Distress Thermometer (DT),  information provision concerning physical activity (PA) and physical cancer rehabilitation programs (PCRPs),  advice to take part in PA and PCRPs,  referral to PCRPs,  participation in PCRPs, and  PA uptake (PAU) in nine cancer centers. Furthermore, we assessed patient and cancer center characteristics as possible determinants of adherence. Regression analyses were used to determine associations between guideline adherence and patient and cancer center characteristics. In these analyses, we assumed the patient (level 1) nested within the cancer center (level 2). RESULTS:Nine hundred and ninety-nine patients diagnosed with cancer between January 2014 and June 2015 were included. Of the 999 patients included in the study, 468 (47%) received screening with the DT and 427 (44%) received information provision concerning PA and PCRPs. Subsequently, 550 (56%) patients were advised to take part in PA and PCRPs, which resulted in 174 (18%) official referrals. Ultimately, 280 (29%) patients participated in PCRPs, and 446 (45%) started PAU. Screening with the DT was significantly associated with information provision concerning PA and PCRPs (OR 1.99, 95% CI 1.47-2.71), advice to take part in PA and PCRPs (OR 1.79, 95% CI 1.31-2.45), referral to PCRPs (OR 1.81, 95% CI 1.18-2.78), participation in PCRPs (OR 2.04, 95% CI 1.43-2.91), and PAU (OR 1.69, 95% CI 1.25-2.29). Younger age, male gender, breast cancer as the tumor type, ≥2 cancer treatments, post-cancer treatment weight gain/loss, employment, and fatigue were determinants of guideline adherence. Less variation in scores of the indicators between the different cancer centers was found. This variation between centers was too low to detect any association between center characteristics with the indicators. CONCLUSIONS:The implementation of PCR guidelines is in need of improvement. We found determinants at the patient level associated with guideline-based PCR care. IMPLICATIONS FOR CANCER SURVIVORS:Implementation strategies that deal with the determinants of adherence to PCR guidelines might improve the implementation of PCR guidelines and the quality of life of cancer survivors.
A systematic review of rehabilitation and exercise recommendations in oncology guidelines.
Stout Nicole L,Santa Mina Daniel,Lyons Kathleen D,Robb Karen,Silver Julie K
CA: a cancer journal for clinicians
Guidelines promote high quality cancer care. Rehabilitation recommendations in oncology guidelines have not been characterized and may provide insight to improve integration of rehabilitation into oncology care. This report was developed as a part of the World Health Organization (WHO) Rehabilitation 2030 initiative to identify rehabilitation-specific recommendations in guidelines for oncology care. A systematic review of guidelines was conducted. Only guidelines published in English, for adults with cancer, providing recommendations for rehabilitation referral and assessment or interventions between 2009 and 2019 were included. 13840 articles were identified. After duplicates and applied filters, 4897 articles were screened. 69 guidelines were identified with rehabilitation-specific recommendations. Thirty-seven of the 69 guidelines endorsed referral to rehabilitation services but provided no specific recommendations regarding assessment or interventions. Thirty-two of the 69 guidelines met the full inclusion criteria and were assessed using the AGREE II tool. Twenty-one of these guidelines achieved an AGREE II quality score of ≥ 45 and were fully extracted. Guidelines exclusive to pharmacologic interventions and complementary and alternative interventions were excluded. Findings identify guidelines that recommend rehabilitation services across many cancer types and for various consequences of cancer treatment signifying that rehabilitation is a recognized component of oncology care. However, these findings are at odds with clinical reports of low rehabilitation utilization rates suggesting that guideline recommendations may be overlooked. Considering that functional morbidity negatively affects a majority of cancer survivors, improving guideline concordant rehabilitative care could have substantial impact on function and quality of life among cancer survivors.
Clinical Impact of a Perioperative Exercise Program for Sarcopenia and Overweight/Obesity Gastric Cancer.
Aoyama Toru,Nakazono Masato,Nagasawa Shinsuke,Segami Kenki
In vivo (Athens, Greece)
Gastrectomy with D2 lymph node dissection and perioperative adjuvant treatment is the standard treatment for locally advanced gastric cancer. However, the morality rate is reported to be 20%-40% after gastrectomy for gastric cancer. Perioperative sarcopenia and obesity are strongly related to postoperative surgical complications after gastrectomy. Furthermore, recent studies have shown that postoperative surgical complications are related to long-term oncological outcomes. If we can prevent or improve perioperative sarcopenia or obesity in gastric cancer patients, the rate of postoperative surgical complications in these patients might be reduced, thereby improving the long-term oncological outcomes. Given this hypothesis, recent studies have focused on enacting perioperative exercise programs for gastric cancer patients with sarcopenia and overweight/obesity. Such exercise programs have proven promising and demonstrated some clinical benefits for gastric cancer patients with sarcopenia and overweight/obesity. However, whether or not perioperative exercise programs have clinical benefits with regard to long-term oncological outcomes in gastric cancer patients is unclear. To optimize these perioperative exercise programs for gastric cancer patients, it is necessary to clarify the benefits with regard to the long-term oncological outcomes in these patients and establish an optimal perioperative exercise program.
Physical decline and its implications in the management of oesophageal and gastric cancer: a systematic review.
O'Neill Linda,Moran Jonathan,Guinan Emer M,Reynolds John V,Hussey Juliette
Journal of cancer survivorship : research and practice
PURPOSE:The management of oesophageal and gastric cancer can cause significant physical decline, impacting on completion rates and outcomes. This systematic review aimed to (i) determine the impact of chemotherapy, chemoradiotherapy and surgery on physical function; (ii) identify associations between physical function and post-operative outcomes; and (iii) examine the effects of rehabilitation on physical function. METHODS:We included randomised controlled trials (RCT), non-RCTs of interventions and cohort studies that measured physical function by objective means in patients with oesophageal or gastric cancer. EMBASE, PubMed, CINAHL, Cochrane Library, SCOPUS, PEDro and the WHO Trial Registry were searched up to June 2016. Risk of bias assessment was performed using a suite of validated tools. RESULTS:Twenty-five studies involving 1897 participants were included. A meta-analysis was not indicated due to the heterogeneity of the literature. Significant reductions in physical function occur in patients undergoing neoadjuvant treatment and in the first 3 months post-resection. Lower pre-operative exercise capacity is associated with an increased risk of post-operative pulmonary complications (PPCs). Evidence to support exercise prehabilitation and rehabilitation in these treatment pathways is currently lacking. CONCLUSIONS:Chemotherapy, chemoradiation and surgery lead to reduced physical function in patients with oesophageal and gastric cancer. High quality evidence is lacking to prove the benefit of interventions that improve physical function through the treatment pathway and in recovery, and well-designed studies are required. This review was limited due to the heterogeneity of the literature, high risk of bias in some articles and the lack of high quality research encompassing sufficient time points in the patient journey. IMPLICATIONS FOR CANCER SURVIVORS:Curative treatment for oesophago-gastric cancer can negatively impact on physical function. Rehabilitation programmes have considerable potential to enhance physical function across the oesophago-gastric cancer journey.