Effectiveness of Oncologist-Referred Exercise and Healthy Eating Programming as a Part of Supportive Adjuvant Care for Early Breast Cancer

Kirkham, Amy A.; Patten, Cheri L. Van; Gelmon, Karen A.; McKenzie, Donald C.; Bonsignore, Alis; Bland, Kelcey A.; Campbell, Kristin L.

doi:10.1634/theoncologist.2017-0141

Cited by 50 publications

(58 citation statements)

References 41 publications

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“…To date, the EIM approach has been adopted in several primary health care clinics as well as broadly across 3 large health care systems in the United States . To date, very few studies have used elements of EIM in the oncology care setting, but there is ample scope and a need to examine integration into cancer care. The evidence base strongly supports adoption of the EIM approach for all patients with chronic conditions, including people living with and beyond cancer .…”

Section: What Oncology Clinicians Can Do Now: Assess Advise and Refermentioning

confidence: 99%

“…Indeed, a recent publication from the American Society of Clinical Oncology recommends the “5 A's” approach that is the basis of the EIM approach noted below . The safety of these recommendations is supported by the finding of no adverse effects of exercise after cancer in general or as recommended by oncology clinicians in multiple trials and multiple meta‐analyses …”

Section: What Oncology Clinicians Can Do Now: Assess Advise and Refermentioning

confidence: 99%

“…14 Reasons for a lack of regular exercise among people living with and beyond cancer are multifactorial, but multiple studies have documented a lack of recommendation from an oncology clinician. [15][16][17] Multiple studies of breast, colorectal, prostate, and a mixed cohort of cancer survivors noted that greater than 80% of patients were interested in receiving advice from their oncology care team. [18][19][20] Despite this, studies suggest that 9% of nurses and from 19% to 23% of oncology physicians refer patients with cancer to exercise programming.…”

Section: Introductionmentioning

confidence: 99%

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Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer

Schmitz

Campbell

Stuiver

et al. 2019

CA A Cancer J Clinicians

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Multiple organizations around the world have issued evidence‐based exercise guidance for patients with cancer and cancer survivors. Recently, the American College of Sports Medicine has updated its exercise guidance for cancer prevention as well as for the prevention and treatment of a variety of cancer health‐related outcomes (eg, fatigue, anxiety, depression, function, and quality of life). Despite these guidelines, the majority of people living with and beyond cancer are not regularly physically active. Among the reasons for this is a lack of clarity on the part of those who work in oncology clinical settings of their role in assessing, advising, and referring patients to exercise. The authors propose using the American College of Sports Medicine's Exercise Is Medicine initiative to address this practice gap. The simple proposal is for clinicians to assess, advise, and refer patients to either home‐based or community‐based exercise or for further evaluation and intervention in outpatient rehabilitation. To do this will require care coordination with appropriate professionals as well as change in the behaviors of clinicians, patients, and those who deliver the rehabilitation and exercise programming. Behavior change is one of many challenges to enacting the proposed practice changes. Other implementation challenges include capacity for triage and referral, the need for a program registry, costs and compensation, and workforce development. In conclusion, there is a call to action for key stakeholders to create the infrastructure and cultural adaptations needed so that all people living with and beyond cancer can be as active as is possible for them.

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Section: What Oncology Clinicians Can Do Now: Assess Advise and Refermentioning

confidence: 99%

Section: What Oncology Clinicians Can Do Now: Assess Advise and Refermentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer

Schmitz

Campbell

Stuiver

et al. 2019

CA A Cancer J Clinicians

Self Cite

500

465

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“…For example, a nutrition and exercise intervention (supervised moderate intensity, aerobic and resistance training, 3 times/ week) during adjuvant chemotherapy in 73 breast cancer patients showed long-term effects of improved physical activity levels and quality of life 2 years after the start of therapy [18].…”

Section: Continuedmentioning

confidence: 99%

Physical Activity, Exercise and Breast Cancer - What Is the Evidence for Rehabilitation, Aftercare, and Survival A Review

Wirtz

Baumann

2018

Breast Care

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The current scientific field of exercise interventions in breast cancer is very large. Rehabilitation focuses on restoring or improving quality of life and thus on independence and participation in life. Hence, it is important to investigate exercise interventions in the setting of rehabilitation and aftercare. It is also necessary to determine the influence of physical activity or exercise therapy on the prevention of recurrence and mortality as well as on certain side effects of the disease and its medical treatment in rehabilitation. Physical activity in rehabilitation and aftercare is feasible and safe and can be used for various purposes. Against the background of reduced fatigue, chemotherapy-induced peripheral neuropathy, cancer-related cognitive impairment, arthralgia, lymphedema, recurrence, and mortality, as well as improved quality of life, different methodological approaches and evidence can be seen. Although the overall data availability has increased, there are gaps in study documentation as well as inadequate verification of scientific approaches in rehabilitation clinics and in everyday life.

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“…Therefore, the cost of delivering the exercise intervention for nine patients would have to be less than $20,462 (or $2,274 per patient) to be a cost‐effective therapy for reducing hospitalization rates. We recently reported an estimate of operating costs for a real‐world exercise and nutrition program during and after chemotherapy and radiation for early stage breast cancer to be $1,273 per patient . This high‐level cost‐effectiveness analysis is based only on the benefits for hospitalizations and does not include the numerous other health and health care improvements associated with exercise.…”

mentioning

confidence: 99%

Supervised, Multimodal Exercise: The Chemotherapy Supportive Therapy That Almost Does It All

Kirkham

2019

The Oncologist

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Delivery of full chemotherapy dose intensity with minimization of adverse chemotherapy-related events is a primary quality of care indicator in medical oncology. Clinical oncology professionals are also increasingly recognizing patient quality of life as a vital component of cancer care [1]. As such, a therapy that could maximize delivery of chemotherapy relative dose intensity (RDI), reduce treatment toxicities, and improve quality of life, with positive side effects of improved physical fitness, reduced anxiety and depression, and extended overall survival, would likely be prescribed by every medical oncologist in every cancer treatment center. Although such a therapy does not currently exist, Mijwel et al. report on a therapy that comes close in this issue of The Oncologist [2].In this article, Mijwel et al. report results of the OptiTrain trial, a 3-arm randomized trial of two different exercise interventions versus usual care, on rates of chemotherapy completion, hospitalization, and hematological toxicity [2]. The trial compared 16 weeks of high-intensity aerobic interval training (three sets of 3 minutes with 1-minute recovery) combined with either resistance training (RT-HIIT) or moderate-intensity aerobic training (AT-HIIT) to usual cancer care. Although this may sound challenging for patients, the exercise sessions took place only twice per week for 60 minutes and were closely supervised in an in-hospital exercise clinic. Patients in the exercise programs, many of whom had comorbid conditions, attended approximately two thirds of offered exercise sessions throughout chemotherapy and were typically able to complete the exercise prescription at the sessions they attended.One of the most compelling clinical outcomes of exercise for oncology care providers is thought to be the potential for exercise interventions to enhance patient tolerance of chemotherapy and thereby delivery of the planned RDI [3]. Although the rationale for exercise training-related improvement of RDI is robust (preservation of muscle mass and physical function should enhance tolerance), the current research evidence is not. A recent systematic review reported that none of the eight randomized exercise trials that have evaluated RDI have reported clinically relevant effects, although two had statistically significant effects [4]. In line with these results, the high-quality, multimodal OptiTrain interventions did not have an impact on RDI, despite the RT-HIIT intervention achieving the proposed biologic mechanism of enhanced muscle mass, strength, and physical fitness. There was no difference between either exercise group and usual care in achieved RDI, prevalence of a single dose reduction, or percentage of participants receiving ≥85% of RDI [2]. Receipt of >85% of RDI is a known threshold for achievement of chemotherapy effectiveness [5]. Notably, although approximately one quarter of all patients in the OptiTrain trial required at least one single chemotherapy dose reduction, the majority (83%) still received >85% RDI, likely thanks ...

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Effectiveness of Oncologist-Referred Exercise and Healthy Eating Programming as a Part of Supportive Adjuvant Care for Early Breast Cancer

Cited by 50 publications

References 41 publications

Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer

Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer

Physical Activity, Exercise and Breast Cancer - What Is the Evidence for Rehabilitation, Aftercare, and Survival A Review

Supervised, Multimodal Exercise: The Chemotherapy Supportive Therapy That Almost Does It All

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