Sport während der Behandlung von Brustkrebs: ein systematischer Review

Bewegung und Sport nehmen in unserer Gesellschaft einen zunehmend breiten Raum ein. Zahlreiche Studien zeigen den Nutzen regelmäßiger körperlicher Aktivität in der Prävention chronischer Erkrankungen, z. B. der koronaren Herzerkrankung und in der Rehabilitation chronischer Erkrankungen, z. B. der Brustkrebserkrankung. Viele Gründe sprechen darüber hinaus auch für (gesundheitsorientiertes) Sporttreiben während der adjuvanten Therapie einer Krebserkrankung, z.B. von Brustkrebs, da diese häufig Beeinträchtigungen der somatischen und psychischen Gesundheit, der funktionalen Gesundheit und der subjektiven Gesundheit nach sich zieht. Allerdings wird in der gängigen Praxis Brustkrebspatientinnen oftmals empfohlen, körperliche Belastungen und Anstrengungen während der ambulanten Chemotherapie oder Strahlentherapie weitgehend zu vermeiden. Die vorliegende Arbeit hat sich mit der Frage auseinander gesetzt, ob Frauen, die an Brustkrebs erkrankt sind, empfohlen werden sollte auch während der adjuvanten Therapie (Chemotherapie, Strahlentherapie oder Hormontherapie) Sport zu treiben. Ziel der Arbeit war die Bestimmung der Effekte eines gesundheitsorientierten Ausdauer- und/ oder Kräftigungstrainings während der Behandlung von Brustkrebs auf die gesundheitsbezogene Fitness und Lebensqualität der Patientinnen unter Berücksichtigung möglicher Gefährdungen durch Sporttreiben (z.B. Sportverletzungen) in dieser vulnerablen Phase. Diese Frage wurde über die Durchführung eines Systematischen Reviews nach den Methoden der Cochrane Collaboration beantwortet. Hierzu wurden alle verfügbaren Primärstudien systematisch und nach expliziten Methoden identifiziert, ausgewählt und kritisch bewertet. Die Ergebnisse aus diesen Primärstudien wurden extrahiert und sowohl deskriptiv als auch mit statistischen Methoden quantitativ zusammengefasst. Die Ergebnisse dieser Arbeit beruhen auf zwei unterschiedlichen Sets von Primärstudien zum Thema - Studien zum Nutzen von Bewegung und Sport und Studien zu möglichen gesundheitlichen Schädigungen durch Sport während der Behandlung von Brustkrebs. Die Ergebnisse zeigen auf der Basis von 15 identifizierten Primärstudien mittlere Effekte des Sporttreibens während der Therapie von Brustkrebs auf aerobe Ausdauer, Kraft und die Körperzusammensetzung (z.B. Fettanteil) sowie kleine Effekte auf Fatigue, Angst und Depression. Für die Unbedenklichkeit des Sporttreibens während der adjuvanten Therapie von Brustkrebs ist nur begrenzte Evidenz vorhanden: es gibt auf der Basis der in den Review eingeschlossenen Primärstudien keine Hinweise auf ein vermehrtes Auftreten von Sportverletzungen oder Lymphödemen. Fazit dieses Reviews ist, dass Frauen, die an Brustkrebs erkrankt durchaus während der adju¬vanten Therapie Sport treiben sollten, um ihre gesundheitsbezogene Fitness gerade in dieser Phase der Erkrankung zu stärken – gerade auch dann, wenn bereits alltägliche Bewegungsanforderungen wie das Treppensteigen als sehr anstrengend erlebt werden. In zukünftigen Studien sollte die Evidenzlücke für mögliche gesundheitliche Schädigungen geschlossen werden, denn Sicherheitsbedenken können eine Barriere zum Sporttreiben sein – und zwar sowohl für die behandelnden Ärzte, die das Sporttreiben empfehlen wie auch für die Frauen selbst. Entsprechende Strukturen, dass Sport Eingang in die Akut-Versorgung der Brustkrebserkrankung finden kann, sind noch zu schaffen.Exercise has become an integral part of breast cancer rehabilitation. A growing body of evidence indicates health benefits such as increased physical fitness and reduced fatigue through exercise, not only after breast cancer treatment has finished, but during treatment as well. The aim of this systematic review was to determine the effectiveness of aerobic and resistance exercise interventions during adjuvant treatment of breast cancer with respect to physical functioning and health-related physical fitness, among other important health outcomes. The findings of controlled trial studies of aerobic, strength, and combined exercise interventions among women undergoing adjuvant treatment of breast cancer were critically evaluated and summarised. The potential harm associated with exercise in this vulnerable period was also examined and discussed. This review was conducted in co-operation with the Cochrane Breast Cancer Group, and followed the rigorous review methodology of the Cochrane Collaboration. Results indeed indicate that important physical and mental health outcomes, such as health-related physical fitness, fatigue, anxiety, and depression, can be improved through regular exercise training. There is no evidence currently in the literature showing an association of moderate physical exercise training during adjuvant treatment of breast cancer with increased risk of injuries, lymphedema, or other harm. Thus, the results of this systematic review sup¬port recommending and encouraging women undergoing adjuvant treatment of breast cancer to exercise. If the benefits of participation in exercise programmes are to be preserved over the course of cancer survivorship, sustained physical exercise is essential. Exercise adherence thus plays a vital role in maintaining the benefits associated with exercise. The review concludes that understanding the determinants of exercise adherence and the barriers to participation is important. Applying strategies for behaviour change to individual situations can help in developing and maintaining the habits associated with a healthy lifestyle. Besides developing the evidence base through further research, it is recommended that further activities should focus as well on how research findings can be translated into public health practice

Screening for sickle cell disease in newborns: a systematic review

Background!#!Sickle cell disease (SCD) is an inherited autosomal recessive disorder caused by the replacement of normal haemoglobin (HbA) by mutant Hb (sickle Hb, HbS). The sickle-shaped red blood cells lead to haemolysis and vaso-occlusion. Especially in the first years of life, patients with SCD are at high risk of life-threatening complications. SCD prevalence shows large regional variations; the disease predominantly occurs in sub-Saharan Africa. We aimed to systematically assess the evidence on the benefit of newborn screening for SCD followed by an earlier treatment start.!##!Methods!#!We systematically searched bibliographic databases (MEDLINE, EMBASE, Cochrane Databases, and the Health Technology Assessment Database), trial registries, and other sources to identify systematic reviews and randomised controlled trials (RCTs) or non-randomised trials on newborn screening for SCD. The last search was in 07/2020. Two reviewers independently reviewed abstracts and full-text articles and assessed the risk of bias of the studies included. Data were extracted by one person and checked by another. As meta-analyses were not possible, a qualitative summary of results was performed.!##!Results!#!We identified 1 eligible study with direct evidence: a Jamaican retrospective study evaluating newborn screening for SCD followed by preventive measures (prevention of infections and education of parents). The study included 500 patients with SCD (intervention group, 395; historical control group, 105). Although the results showed a high risk of bias, the difference between the intervention and the control group was very large: mortality in children decreased by a factor of about 10 in the first 5 years of life (0.02% in the intervention group vs. 0.19% in the control group, odds ratio 0.09; 95% confidence interval [0.04; 0.22], p < 0.001).!##!Conclusion!#!The results are based on a single retrospective study including historical controls. However, the decrease of mortality by a factor of 10 is unlikely to be explained by bias alone. Therefore, in terms of mortality, data from this single retrospective study included in our systematic review suggest a benefit of newborn screening for SCD (followed by preventive measures) versus no newborn screening for SCD (weak certainty of conclusions)

Single-fraction stereotactic radiosurgery versus microsurgical resection for the treatment of vestibular schwannoma: a systematic review and meta-analysis

Background: Vestibular schwannomas are benign tumours for which various treatments are available. We performed a systematic review of prospective controlled trials comparing the patient-relevant benefits and harms of single-fraction stereotactic radiosurgery (sfSRS) with microsurgical resection (MR) in patients with vestibular schwannoma. Methods: We searched for randomized controlled trials (RCTs) and non-randomized prospective controlled trials in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and study registries (last search: 09/2021) and also screened reference lists of relevant systematic reviews. Manufacturers were asked to provide unpublished data. Eligible studies investigated at least one patient-relevant outcome. We assessed the risk of bias (high or low) at the study and outcome level. If feasible, meta-analyses were performed. We graded the results into different categories (hint, indication, or proof of greater benefit or harm). Results: We identified three non-randomized prospective controlled trials of generally low quality with evaluable data on 339 patients with unilateral vestibular schwannoma. There was an indication of greater benefit of sfSRS compared with MR for facial palsy (OR 0.06, 95% CI 0.02-0.21, p < 0.001, 2 studies), hearing function (no pooled estimate available, 2 studies), and length of hospital stay (no pooled estimate available, 2 studies). We found no clinically relevant differences for mortality, vertigo, headaches, tinnitus, balance function, work disability, adverse events, and health-related quality of life. Conclusions: Our systematic review indicates that sfSRS has greater benefits than MR in patients with unilateral vestibular schwannoma. However, it is unclear whether this conclusion still holds after 2 years, as long-term studies are lacking. It is also unclear whether the effects of sfSRS are similar in patients with bilateral vestibular schwannomas. Long-term prospective studies including patients with this condition would therefore be useful

Additional file 1 of Systemic therapy in children and adolescents with mental disorders: a systematic review and meta-analysis

Supplementary file 1: Additional file 1. PRISMA 2020 Checklist. Additional file 2. Search strategies. Additional file 3. Study pool of included RCTs. Additional file 4. Characteristics of included RCTs. Additional file 5. Risk-of-bias assessment. Additional file 6. All results