BACKGROUNDFew studies to date have used the cancer diagnosis as a teachable moment to promote healthy behavior changes in survivors of cancer and their family members. Given the role of obesity in the primary and tertiary prevention of breast cancer, the authors explored the feasibility of a mother-daughter weight loss intervention.METHODSA randomized controlled trial of a mailed weight loss intervention was undertaken among 68 mother-daughter dyads (n = 136), each comprised of a survivor of breast cancer (AJCC stage 0-III) and her adult biological daughter. All women had body mass indices ≥ 25 kg/m2 and underwent in-person assessments at baseline, 6 months, and 12 months, with accelerometry and exercise capacity performed on a subset of individuals. All women received a personalized workbook and 6 newsletters over a 1-year period that promoted weight loss; exercise; and a nutrient-rich, low-energy density diet. A total of 25 dyads received individually tailored instruction (INDIVIDUAL), 25 dyads received team-tailored instruction (TEAM), and 18 dyads received standardized brochures (CONTROL).RESULTSThe trial met its accrual target, experienced 90% retention, and caused no serious adverse events. Significant differences in baseline to 12-month changes were observed between INDIVIDUAL versus CONTROL mothers for body mass index, weight, and waist circumference (WC); significant differences also were observed in the WC of corresponding daughters (P < .05). Significant differences were found between INDIVIDUAL versus CONTROL and TEAM versus CONTROL dyads for WC (P = .0002 and .018, respectively), minutes per week of physical activity (P = .031 and .036, respectively), and exercise capacity (P = .047 for both).CONCLUSIONSSignificant improvements in lifestyle behaviors and health outcomes are possible with tailored print interventions directed toward survivors of cancer and their family members. For greater impact, more research is needed to expand this work beyond the mother-daughter dyad. Cancer 2014;120:2522–2534. © 2014 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.Obesity is a major risk factor for the incidence and mortality of several cancers. The results of this randomized controlled trial of weight loss among 136 women diagnosed with breast cancer and their biological daughters suggests that the diagnosis of cancer can be used to motivate healthy diet and exercise behaviors among survivors of cancer and their family members using mailed print interventions.
OBJECTIVE-This study aims to determine the prevalence of physical activity and obesity and their relationship to physical functioning, fatigue, and pain in endometrial cancer survivors.STUDY DESIGN-Surveys were mailed to 200 survivors of endometrial cancer diagnosed within the last five years; 61% were returned. Surveys assessed physical activity, height and weight, comorbid health problems, physical functioning, fatigue, and pain.RESULTS-Twenty-two percent exercised in the past month at the level of current public health recommendations; 41% reported no physical activity, and 38% reported some activity. Sixteen percent were overweight and 50% were obese. Both lower BMI and higher physical activity were related to better physical functioning. Higher physical activity was related to less fatigue, primarily for patients of normal BMI. CONCLUSIONS-Resultssuggest endometrial cancer survivors' obesity and inactivity contributes to poorer quality of life. This population could benefit from quality of life interventions incorporating physical activity.
e Contrary to prior case reports that described occasional clinical failures with cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infections, recent studies have demonstrated no difference in outcomes between cefazolin and antistaphylococcal penicillins for the treatment of MSSA bacteremia. While promising, these studies described low frequencies of high-inoculum infections, such as endocarditis. This retrospective study compares clinical outcomes of cefazolin versus oxacillin for complicated MSSA bacteremia at two tertiary care hospitals between January 2008 and June 2012. Fifty-nine patients treated with cefazolin and 34 patients treated with oxacillin were included. Osteoarticular (41%) and endovascular (20%) sources were the predominant sites of infection. The rates of clinical cure at the end of therapy were similar between cefazolin and oxacillin (95% versus 88%; P ؍ 0.25), but overall failure at 90 days was higher in the oxacillin arm (47% versus 24%; P ؍ 0.04). Failures were more likely to have received surgical interventions (63% versus 40%; P ؍ 0.05) and to have an osteoarticular source (57% versus 33%; P ؍ 0.04). Failures also had a longer duration of bacteremia (7 versus 3 days; P ؍ 0.0002), which was the only predictor of failure. Antibiotic selection was not predictive of failure. Rates of adverse drug events were higher in the oxacillin arm (30% versus 3%; P ؍ 0.0006), and oxacillin was more frequently discontinued due to adverse drug events (21% versus 3%; P ؍ 0.01). Cefazolin appears similar to oxacillin for the treatment of complicated MSSA bacteremia but with significantly improved safety. The higher rates of failure with oxacillin may have been confounded by other patient factors and warrant further investigation.
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