Thromboembolic events after high-intensity training duringcisplatin-based chemotherapy for testicular cancer: Casereports and review of the literature

The randomized “Testicular cancer and Aerobic and Strength Training trial” (TAST‐trial) aimed to evaluate the effect of high‐intensity interval training (HIIT) on cardiorespiratory fitness during cisplatin‐based chemotherapy (CBCT) for testicular cancer (TC). Here, we report on an unexpected high number of thromboembolic (TE) events among patients randomized to the intervention arm, and on a review of the literature on TE events in TC patients undergoing CBCT. Patients aged 18 to 60 years with a diagnosis of metastatic germ cell TC, planned for 3 to 4 CBCT cycles, were randomized to a 9 to 12 weeks exercise intervention, or to a single lifestyle counseling session. The exercise intervention included two weekly HIIT sessions, each with 2 to 4 intervals of 2 to 4 minutes at 85% to 95% of peak heart rate. The study was prematurely discontinued after inclusion of 19 of the planned 94 patients, with nine patients randomized to the intervention arm and 10 to the control arm. Three patients in the intervention arm developed TE complications; two with pulmonary embolism and one with myocardial infarction. All three patients had clinical stage IIA TC. No TE complications were observed among patients in the control arm. Our observations indicate that high‐intensity aerobic training during CBCT might increase the risk of TE events in TC patients, leading to premature closure of the TAST‐trial

Effects of a 1-Week Inpatient Course Including Information, Physical Activity, and Group Sessions for Prostate Cancer Patients

This study aims to explore the effects of a 1-week inpatient course including information, physical activity (PA), and group sessions on physical and mental health-related outcomes for prostate cancer (PCa) patients. Further to assess the patients’ satisfaction with the course. PCa patients completed a questionnaire assessing PA, fatigue, mental distress, and quality of life 1 month before (T0) and 3 months after (T1) the course. Total fatigue, physical fatigue, and PSA anxiety decreased significantly from T0 to T1. No significant changes were observed in the other measures. The majority of the participants were satisfied with the course. In spite of minor reductions in fatigue and PSA anxiety and satisfied patients, the findings indicate that a 1-week inpatient course does not influence substantially on most of the health-related outcomes in PCa patients 3 months after the course

Rehabilitation in cancer survivors - with focus on physical activity

The number of cancer survivors in the Western world has markedly increased over the last few decades. With the growing number of survivors, it has become relevant to address the health of cancer survivors and how to improve it. The malignancy, and more often the cancer treatment, might have negative effects upon physical and psychological aspects of the survivors’ health. For those who experience such adverse effects, professional assistance in addition to their own efforts might be needed in order to reach their optimal functional level. The overriding aim of this thesis was to investigate different aspects of rehabilitation in cancer survivors, with a focus on physical activity. This was examined in three different studies (data sets) and published in four separate papers. In Paper I (Study A) we examined cancer patients’ needs for rehabilitation services and factors associated with such needs. In addition we identified unmet needs for rehabilitation services and factors associated with such unmet needs. More than 1300 cancer patients with the ten most prevalent cancers received a questionnaire two-three years after diagnosis. Approximately two thirds of the participants reported a need for at least one rehabilitation service. Need for physical therapy was most reported, followed by physical training and psychological counselling. Changes in employment status due to cancer and having received chemotherapy were associated with reporting needs for all rehabilitation services. Forty percent reported unmet needs, which most frequently were reported among persons living alone, who had changed their employment status due to cancer, had received chemotherapy or reported comorbidities. In Paper II (Study B) we investigated the interest and preferences for exercise counselling and exercise programming among Norwegian cancer survivors and identified associated demographic and medical factors. More than 1200 cancer patients within five years after treatment, with six different diagnoses, completed a questionnaire. Overall, approximately 75% of the participants were somewhat interested in receiving exercise counselling at some point during their cancer trajectory. In men, the interest in exercise counselling was associated with younger age, presence of comorbidities, and having received chemotherapy. In women, the interest was associated with younger age, higher education and reduced physical activity level. The participants preferred face-to-face exercise counselling with an exercise specialist from a cancer center. Nine out of ten cancer survivors were somewhat interested in an exercise program, with walking as the preferred activity, at moderate intensity, and they wanted to start exercise immediately after end of treatment. In Paper III (Study B) we estimated the proportion of cancer survivors who were physically active after treatment and examined changes in activity level from before diagnosis to after end of treatment. We also identified medical and demographic factors associated with activity level and change in activity level. Almost 1000 patients, within five years after treatment, with six different diagnoses, completed the Godin Leisure-Time Exercise Questionnaire (GLTEQ). Exercise was reported before diagnosis (retrospectively) and after end of treatment (at time of survey). Less than half of the survivors were physically active after treatment. One third was active both before diagnosis and after treatment, whereas 40% were inactive at both time points. Fifteen percent were active before diagnosis but inactive after treatment, and 12% were inactive before diagnosis but active after treatment. Increasing age and weight, low education level, presence of comorbidity and smoking were associated with physical inactivity after treatment. Change in activity level from active to inactive was associated with presence of comorbidities, distant disease and smoking, while changing from being inactive to active was associated with a high education level. In Paper IV (Study C) we explored the effects of a 1-week inpatient course including information, physical activity (PA) and group sessions on physical and mental health-related outcomes in prostate cancer (PCa) patients. The PCa patients (N = 51) completed a questionnaire assessing PA (GLTEQ), fatigue (Fatigue Questionnaire), mental distress (Memorial Anxiety Scale for PCa and Hospital Anxiety and Depression Scale) and quality of life (QoL) (Global QoL from The European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire C30) one month before (T0) and three months after (T1) the course. Total fatigue, physical fatigue and PSA-anxiety decreased significantly from T0 to T1. No significant changes were observed for the other outcomes. In spite of minor reductions in levels of fatigue and PSA-anxiety, the findings indicate that a 1-week inpatient course does not influence substantially on the health-related outcomes in PCa patients three months after the course. In conclusion, the majority of cancer survivors reported need and interest for rehabilitation services, especially physical support as physiotherapy and exercise counselling. Several demographic and medical factors were associated with need for different rehabilitation services. Such knowledge can contribute to offer suitable rehabilitation services to specific groups of cancer survivors. In addition a significant amount reported an unmet need. Less than half of cancer survivors were physically active after treatment. In order to increase or maintain the level of PA in cancer patients, special efforts should be directed towards identified cancer survivors in risk of physically inactivity after treatment. Minor effects were observed from a 1-week inpatient course. More research is needed directed towards more homogenous group of patients with anticipated recovery capacity for documentation of effects of ongoing types of courses. The length of the interventions should also be further investigated

Gender differences in health status and benefits of a one-week educational programme for caregivers of cancer patients

Objective The aims of this study were to investigate differences between female and male caregivers’ health status before and 3 months after a one‐week educational programme, self‐reported needs for support and changes in health status over time. Methods Caregivers were partners of cancer patients aged ≥18 years who participated in the programme. Questionnaires were completed at baseline and 3 months after the programme. Results At baseline, 167 caregivers completed the questionnaire, 55% were females and the mean age 60.2 years (range 31–79). Female caregivers reported poorer vitality (p = 0.016) and more chronic fatigue compared to male caregivers (28% vs. 13%, p = 0.036). Females more frequently reported need for support: psychological counselling (21% vs. 3%, p = 0.001), group conversations (51% vs. 28%, p = 0.003), nutritional counselling (39% vs. 17%, p = 0.002) and recreational stay (46% vs. 24%, p = 0.004). Significant benefits within‐group changes were observed among female caregivers in role physical, general health, vitality, social functioning, mental and total fatigue, whereas no significant within‐group changes were observed for males. However, in adjusted analyses no significantly between‐group gender differences in mean changes were observed. Conclusion More studies are needed to better understand the differences and possible effects of programmes among female and male caregivers in order to develop relevant support

Perceived needs for different components in a rehabilitation program among cancer survivors with chronic fatigue compared to survivors without chronic fatigue

Background: Knowledge about the user’ needs is important to develop targeted rehabilitation for cancer patients with chronic fatigue (CF). The aims of the study were to examine prevalence of CF in cancer survivors attending an one-week inpatient educational program (IEP) and to identify characteristics of those with CF. Further to examine the perceived needs for different components in a rehabilitation program, need of complex rehabilitation (at least two components) and aspects of health-related quality of life (HRQoL) among survivors with CF versus those without CF. Material and methods: Cancer survivors ≥18 years, diagnosed with different types of cancer within the last 10 years and attending a one-week IEP were invited to this cross-sectional study. CF was assessed by the Fatigue Questionnaire, perceived needs by asking a question about needs for different components in a rehabilitation program and HRQoL was assessed by The Medical Outcomes Study Short Form 36. Results: Of 564 participants, 45% reported CF. Breast cancer, mixed cancer types (including small groups with different cancer types) and comorbidities increased the risk for having CF. Compared to participants without CF, the participants with CF reported more frequently need for physical training (86% vs. 65%, p < 0.001), physiotherapy (71% vs. 55%, p < 0.001) and nutrition counseling (68% vs. 53%, p = 0.001). Among participants with CF, 75% reported need for three or more components whereas 54% reported need for the same number of components among those without CF (p < 0.001). Conclusion: Almost half of the cancer survivors attending the IEP had CF. Physical training, physiotherapy and nutrition counseling were the most frequently reported needs and significantly more often observed in participants with CF than without CF. A higher percentage of those with CF reported need for a complex rehabilitation compared to those without CF. More research is necessary to obtain more knowledge to further make targeted programs to better match cancer survivors’ needs. This is an Accepted Manuscript of an article published by Taylor & Francis Group in Acta Oncologica on 11 Jan 2017, available online: http://www.tandfonline.com/10.1080/0284186X.2016.126609

Changes in fatigue, health-related quality of life and physical activity after a one-week educational program for cancer survivors

Background: Rehabilitation aims to improve function, but the effects of different programs are not clear. The aims of the present study were to: (1) compare the level of fatigue and health-related quality of life (HRQOL) of cancer survivors admitted to a one-week inpatient educational program (IEP) to the general population (NORMS), (2) examine changes in fatigue, HRQOL and physical activity after the IEP and (3) examine the proportions of survivors for female and male separately with clinically relevant improvement (>10% of maximum scale). Methods: Cancer survivors ≥18 years, diagnosed with breast-, prostate- or gastrointestinal cancer within the last 10 years, about to attend a one-week IEP were invited to an observational study with a pre-post design. The IEP included lectures, group discussions and physical activity. The participants completed a questionnaire on the arrival day (T0) and three months after the stay (T1). Fatigue was assessed by the Fatigue Questionnaire and HRQOL by Short Form-36. Results: Compared to NORMS, both female and male participants had significantly higher mean levels of fatigue and poorer HRQOL at T0 and T1. From T0 to T1, among all participants physical fatigue was reduced from 12.6 (SD 3.9) to 11.8 (SD 3.8; p < .001), mental fatigue from 6.3 (SD 2.2) to 6.0 (SD 2.2; p = .044) and total fatigue from 19.0 (SD 5.3) to 17.8 (SD 5.4; p = .001). Among female participants, 30% experienced clinically relevant improvement in physical fatigue, 28% in total fatigue and 36% in general health. Of male participants, 31% displayed a clinically relevant improvement in role limitations physical. Conclusion: Participants in the IEP reduced their levels of fatigue and improved aspects of HRQOL, more often observed among female participants than among males. Because of the lack of a control group it is not possible to conclude whether the changes were due to the IEP

Changes in fatigue, health-related quality of life and physical activity after a one-week educational program for cancer survivors

Background: Rehabilitation aims to improve function, but the effects of different programs are not clear. The aims of the present study were to: (1) compare the level of fatigue and health-related quality of life (HRQOL) of cancer survivors admitted to a one-week inpatient educational program (IEP) to the general population (NORMS), (2) examine changes in fatigue, HRQOL and physical activity after the IEP and (3) examine the proportions of survivors for female and male separately with clinically relevant improvement (>10% of maximum scale). Methods: Cancer survivors ≥18 years, diagnosed with breast-, prostate- or gastrointestinal cancer within the last 10 years, about to attend a one-week IEP were invited to an observational study with a pre-post design. The IEP included lectures, group discussions and physical activity. The participants completed a questionnaire on the arrival day (T0) and three months after the stay (T1). Fatigue was assessed by the Fatigue Questionnaire and HRQOL by Short Form-36. Results: Compared to NORMS, both female and male participants had significantly higher mean levels of fatigue and poorer HRQOL at T0 and T1. From T0 to T1, among all participants physical fatigue was reduced from 12.6 (SD 3.9) to 11.8 (SD 3.8; p < .001), mental fatigue from 6.3 (SD 2.2) to 6.0 (SD 2.2; p = .044) and total fatigue from 19.0 (SD 5.3) to 17.8 (SD 5.4; p = .001). Among female participants, 30% experienced clinically relevant improvement in physical fatigue, 28% in total fatigue and 36% in general health. Of male participants, 31% displayed a clinically relevant improvement in role limitations physical. Conclusion: Participants in the IEP reduced their levels of fatigue and improved aspects of HRQOL, more often observed among female participants than among males. Because of the lack of a control group it is not possible to conclude whether the changes were due to the IEP

Feasibility of a physical activity intervention during and shortly after chemotherapy for testicular cancer

Background Given the risk of developing acute and long-term adverse effects in patients receiving cisplatin-based chemotherapy for testicular cancer (TC), risk-reducing interventions, such as physical activity (PA), may be relevant. Limited knowledge is available on the challenges met when conducting PA intervention trials in patients with TC during and shortly after chemotherapy. The aims of the present feasibility study are therefore to determine patient recruitment, compliance and adherence to a PA intervention. Results Patients with metastatic TC referred to cisplatin-based chemotherapy were eligible. They followed an individual low-threshold PA intervention, including counseling from a personal coach during and 3 months after chemotherapy. Outcomes were recruitment rate, compliance rate and adherence to the intervention including preferences for type of PA and barriers for PA. During 8 months 12 of 18 eligible patients were invited, all consented, but three dropped out. Walking and low intensity activities were preferred and nausea and feeling unwell were the most often reported barriers towards PA. Discussion In order to achieve adequate recruitment, compliance and complete data in future PA intervention trials, close cooperation with treating physicians, individual PA plans and availability of personalized coaching are required