The Effect of a Multimodal Intervention on Treatment-Related Symptoms in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Randomized Controlled Trial

Jarden, Mary; Nelausen, Knud Mejer; Hovgaard, Doris; Boesen, Ellen H.; Adamsen, Lis

doi:10.1016/j.jpainsymman.2008.09.005

Cited by 87 publications

(101 citation statements)

References 46 publications

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“…However, other RCTs reported no effects on fatigue during HSCT. 11,14,33 Jarden et al 19 showed that their multimodal intervention program (exercise combined with psycho-educational and relaxing components) had positively influenced the cognitive symptom cluster (fatigue is included) during hospitalization. But because of the integrated nonexercise intervention parts (progressive relaxation and psycho-education) and clustering of symptoms, an exact association between exercise and fatigue is not possible.…”

Section: Discussionmentioning

confidence: 99%

“…10 Specifically, among allo-HSCT patients, exercise seems to result in positive interventional effects not only on endurance capacity, [11][12][13][14] muscle strength, 11,14,15 and Karnofsky performance score, 12 but also on perceived physical, emotional, and social states, 16,17 fatigue, 12,17 and QoL. 11,17 Furthermore, improvements in immunologic parameters 18 and different side-effect symptom clusters 19 have been reported.…”

Section: Introductionmentioning

confidence: 99%

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Effects of a partly self-administered exercise program before, during, and after allogeneic stem cell transplantation

Wiskemann

Dreger

Schwerdtfeger³

et al. 2011

Blood

238

283

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Before, during, and after allogeneic hematopoietic stem cell transplantation (allo-HSCT), patients experience considerable physical and psychologic distress. Besides graft-versus-host disease and infections, reduced physical performance and high levels of fatigue affect patients' quality of life. This multicenter randomized controlled trial examined the effects of a partly self-administered exercise intervention before, during, and after allo-HSCT on these side effects. After randomization to an exercise and a social contact control group 105 patients trained in a homebased setting before hospital admission, during inpatient treatment and a 6-to 8-week period after discharge. Fatigue, physical performance, quality of life, and physical/psychologic distress were measured by standardized instruments at baseline, admission to, and discharge from hospital and 6 to 8 weeks after discharge. The exercise group showed significantly improvement in fatigue scores (up to 15% improvement in exercise group vs up to 28% deterioration in control; P < .01-.03), physical fitness/ functioning (P ‫؍‬ .02-.03) and global distress (P ‫؍‬ .03). All effects were at least detectable at one assessment time point after hospitalization or repeatedly. Physical fitness correlated significantly with all reported symptoms/variables. In conclusion, this partly supervised exercise intervention is beneficial for patients undergoing allo-HSCT. Because of low personnel requirements, it might be valuable to integrate such a program into standard medical care. (Blood. 2011;117(9):2604-2613)

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of a partly self-administered exercise program before, during, and after allogeneic stem cell transplantation

Wiskemann

Dreger

Schwerdtfeger³

et al. 2011

Blood

238

283

View full text Add to dashboard Cite

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“…14,38 Some of those studies also suggest that exercise can have a potential impact on prognosis-relevant factors such as hematological reconstitution 29 and immunological capacity. 30 Until now, however, no controlled study has demonstrated the significance of an exercise intervention on survival.…”

Section: Discussionmentioning

confidence: 99%

Effects of physical exercise on survival after allogeneic stem cell transplantation

Wiskemann

Kleindienst

Kuehl

et al. 2015

Intl Journal of Cancer

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Observational studies have suggested that physical activity may be associated with improved survival after cancer treatment. However, data from controlled clinical trials are required. We analyzed survival data of 103 patients from a previously published randomized controlled trial in allogeneic stem cell transplant patients who were randomized to either an exercise intervention (EX) or to a social contact control group. EX patients trained prior to hospital admission, during inpatient treatment, and for 6-8 weeks after discharge. Survival analyses were used to compare both total mortality (TM) and non-relapse mortality (NRM) after discharge and transplantation during an observation period of 2 years after transplantation. Analyses were corroborated with Cox and Fine & Gray regression models adjusting for potential confounders. After discharge, EX patients had a significantly lower TM rate than controls (12.0 vs. 28.3%, p 5 0.030) and a numerically lower NRM rate (4.0 vs. 13.5%, p 5 0.086). When the inpatient period was included, absolute risk reductions were similar but not significantly different (TM: 34.0 vs. 50.9%, p 5 0.112; NRM: 26.0 vs. 36.5%, p 5 0.293). The number needed to treat (NNT) to prevent one death with EX was about 6. Furthermore, regression analyses revealed that baseline fitness was protective against mortality. The data suggest that exercise might improve survival in patients undergoing allo-HCT. However, the results should be interpreted with caution as the study was not designed to detect differences in survival rates, and as no stratification on relevant prognostic factors was carried out.Allogeneic hematopoietic stem cell transplantation (allo-HCT) is an effective treatment option for patients with highrisk hematological malignancies such as acute leukemia. However, recipients of allo-HCT may suffer from numerous treatment-related side effects and complications, such as infections and graft-versus-host disease (GvHD), and the transplant-related mortality rate is considerable. 1 Due to the high mortality rates in myeloablative regimens (30-40% 2 ) and even in reduced intensity conditioning (RIC) regimens (20-30% 3 ), clinicians and researchers have attempted to determine variables that can be used to characterize subtypes of patients who are candidates for transplantation. 4 Several prognostic risk scores have been established to predict survival after allo-HCT. The EBMT risk score 5 is a well-known tool that predicts the risk of death after allo-HCT using a score based on age, disease stage, time interval from diagnosis to transplant, donor type and donor-recipient gender combination. Prognostic validity has also been demonstrated by the clinician-assessed Karnofsky Performance Score and by the co-morbidity score by Sorror et al. 6,7 A recently published pilot study by Wood et al. suggests that cardiopulmonary fitness, as defined by either peak oxygen uptake or the 6-minute walk distance Test (6-MWD), is a predictor of symptom severity, quality of life, and mortality in patients undergoi...

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“…87 finding improved lean muscle mass whereas another (Knols 2011) 93 found no changes. Jarden et al 91 additionally detected reduced symptom intensity for mucositis, cognitive, gastrointestinal and functional symptoms.…”

Section: Resistance Trainingmentioning

confidence: 96%

Exercise, concomitant to therapy, has a positive influence on therapy-induced side-effects in patients with haematological malignancies

Streckmann¹

2014

JOSHA

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JOSHA is a service that helps scholars, researchers, and students descover, use, and build upon a wide range of content Exercise, concomitant to therapy, has a positive influence on therapyinduced side-effects in patients with haematological malignancies discussions. Special thanks also goes to Katja Zirlik, Christiane Guderian, Barbara Nuber and the team on ward Romberg for the many enlighting lunch breaks and skiing trips that were incredibly valuable during rougher times of work, but also for their academic support and advice. Furthermore, I am very grateful to the team of sport therapists, sport students and physiotherapists that worked on the training cite for oncological patients and supported me in the implementation of the exercise intervention. Especially to Svenja Simon-Hein, from whom I was able to learn a great deal. I also greatly appreciate the support of the research assistants, the recruiting doctors, the nurses, technical lab assistants as well as the IT support in the University Hospital of Freiburg as well as my colleagues in the University of Freiburg.A special thank you goes to all the patients who participated in the study and therefore made an essential contribution to this work as well as future research. ABSTRACTExercise interventions as a supportive measure in cancer therapy are becoming more and more relevant. With cancer therapy becoming more complex and effective, higher survival rates as well as longer life-spans are being achieved. Consequently, patients' quality of life is becoming increasingly important and the management of therapy-related side-effects therefore essential. An increasing amount of studies are demonstrating, that the previously propagated rest and immobility during cancer therapy is not only counterproductive but that exercise interventions hold enormous potential regarding the management of sideeffects in supportive cancer care and should therefore be taken more seriously.Especially haemato-oncological patients have to cope with many debilitating side-effects due to the disease itself, the long and complex medical therapy as well as the associated immobility. The symptoms cause physiological, psychological and social restraints, leading to acute as well as lasting reductions in patients' quality of life. Poor health and severe side-effects such as chemotherapy-induced peripheral neuropathy (CIPN) are highly relevant, as they can cause dose reductions, disruptions or discontinuation of medical therapy, consequently impacting the clinical outcome.Although the positive effects of exercise interventions are rather well documented in entities such as breast cancer, the amount of research in haematological patients, especially concomitant to therapy, is still relatively low. For instance only one previous randomized, controlled trial (RCT) 1 has evaluated lymphoma patients. Furthermore, the potential role of exercise regarding CIPN has never been investigated previously, although it is highly prevalent in haemato-oncological patients. Previous studies on patients wit...

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The Effect of a Multimodal Intervention on Treatment-Related Symptoms in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Randomized Controlled Trial

Cited by 87 publications

References 46 publications

Effects of a partly self-administered exercise program before, during, and after allogeneic stem cell transplantation

Effects of a partly self-administered exercise program before, during, and after allogeneic stem cell transplantation

Effects of physical exercise on survival after allogeneic stem cell transplantation

Exercise, concomitant to therapy, has a positive influence on therapy-induced side-effects in patients with haematological malignancies

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