Physical Activity of Surgical Lung Cancer Patients

Lung cancer is the second most diagnosed cancer and the leading cause of cancer-related death worldwide. Physical activity (PA) improves health outcomes after lung cancer treatment and PA guidelines recommend that cancer patients engage in 150 minutes of moderate PA per week. However, lung cancer patients may face multiple challenges to maintain PA, including aging, concomitant lung disease, skeletal muscle atrophy, depression, stigma, etc. Understanding the pattern and predictors of PA is a critical step in developing and implementing effective PA promotion interventions that could promote long term maintenance of PA. This three-paper dissertation focuses on PA promotion in this understudied population, and it includes a systematic review, a secondary analysis, and a pilot study. Perioperative exercise could improve health outcomes of surgical lung cancer patients, but little is known about their natural PA behaviors before and after surgery. We conducted a systematic review aimed to synthesize evidence describing the PA of surgical lung cancer patients. We included 17 studies and found that 1) 14 studies had sample sizes less than 100, 2) only 23-28% of lung cancer survivors met PA guidelines, 3) PA declined after surgery and it did not recover within 3 months following surgery, 4) perioperative PA was positively associated with exercise capacity, quality of life and reduced postoperative complications. Few studies have examined the actual volume and correlates of pre-diagnosis PA, especially using objective measures. In addition, little is known about how PA behaviors are similar/different between cancer types. We conducted a secondary analysis and compared pre-diagnosis PA and its correlates in patients with lung cancer and other types of cancer (breast, colorectal and prostate). This study used longitudinal data from the UK Biobank, which is a national cohort study with accelerometer data. We found that 1) lung cancer patients were the most physically inactive population before diagnosis, 2) younger age and faster walking pace were strong correlates of PA in all four types of cancer, while smoking status was a unique correlate in lung cancer, 3) higher pre-diagnosis moderate to vigorous PA (>1.5h) was associated with a lower all-cause mortality risk. Large longitudinal studies with objective measures are needed to better understand the PA pattern and PA recovery of lung cancer patients. However, little is known about the feasibility and acceptability of using activity monitors among lung cancer patients, especially during the intensive perioperative period. This pilot study explored the feasibility and acceptability of tracking longitudinal PA using activity monitors (before surgery, at 1 week and 6-8 weeks after surgery and obtained preliminary estimates of PA changes). We recruited 21 participants and found that: 1) it was feasible and acceptable to track PA during this intensive perioperative period, 2) PA declined after surgery and it did not recover to preoperative level within 6-8 weeks after surgery. In conclusion, the results of this dissertation contribute to our knowledge of PA in lung cancer patients. Findings highlight the potential benefits of PA before diagnosis and during perioperative period. It also suggests that lung cancer patients are physically inactive before diagnosis, before and after surgery. The identified unique PA correlates (e.g., smoking status) suggests that cancer-specific approaches are needed in PA research and practice. In addition, activity monitoring is a feasible strategy to use in larger longitudinal studies before and after lung cancer surgery.PHDNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/174670/1/weijiaoz_1.pd

Effects of perioperative exercise interventions on lung cancer patients: An overview of systematic reviews

Aims and ObjectivesTo identify, appraise and summarise systematic reviews of exercise interventions for surgical lung cancer patients.BackgroundLow exercise capacity, reduced pulmonary function, impaired health‐related quality of life and postoperative pulmonary complications are common in surgical lung cancer patients. Numerous systematic reviews address these health problems and examine the effects of exercise intervention. However, differences in the quality and scope of the systematic reviews and discordant findings from the reviews make it difficult for decisions‐makers to interpret the evidence and establish best practices in the clinical settings.DesignOverview of systematic reviews.MethodsThis overview was conducted following the PRISMA guideline. A literature search of PubMed, CINAHL, EMBASE, Cochrane Library, SPORTDiscus and PEDro was conducted (October 2019). Peer‐reviewed systematic reviews of randomised controlled trials focusing on the effects of exercise interventions for lung cancer patients who underwent surgery were included. The methodological quality of included reviews was assessed using AMSTAR 2. The results of reviews with meta‐analysis were synthesised and presented by each health outcome.ResultsSeven systematic reviews published between 2013 and 2019 were included. High/moderate‐quality evidence showed that postoperative exercise interventions could increase the exercise capacity and muscle strength, and low/very‐low‐quality evidence showed that postoperative exercise interventions may increase the physical component of health‐related quality of life and decease dyspnoea. Low‐quality evidence showed that preoperative exercise interventions may increase exercise capacity and pulmonary function, decrease the risk of postoperative pulmonary complications and reduce the length of hospital stay.ConclusionsPostoperative and preoperative exercises have the potential to improve health outcomes in surgical lung cancer patients. Further research is needed to evaluate the effects of different types of exercise and varying amounts of exercise.Relevance to clinical practiceThis study provides evidence to support the implementation of exercise interventions for surgical lung cancer patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163626/2/jocn15511_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163626/1/jocn15511.pd

Use of Digital Health Technology Among Older Adults With Cancer in the United States: Findings From a National Longitudinal Cohort Study (2015-2021)

BackgroundDespite the benefits of digital health technology use, older adults with cancer (ie, aged 65 years) have reported challenges to technology adoption. However, there has been a lack of a good understanding of their digital health technology use patterns and the associated influential factors in the past few years. ObjectiveThis study aimed to examine the trends in and factors associated with digital health technology use among older adults with cancer. MethodsThe National Health and Aging Trends Study (NHATS) data set is a national longitudinal cohort study with annual survey waves of Medicare beneficiaries 65 years and older. Participants were community-dwelling older adults who self-reported previous or current cancer diagnoses in each round. The study sample size of each round ranged from 1996 (2015) to 1131 (2021). Digital health technology use was defined as using the internet or online in the last month to order or refill prescriptions, contact medical providers, handle Medicare or other insurance matters, or get information about their health conditions. The association of sociodemographics, clinical factors (self-rated health, chronic conditions, difficulties in activities of daily living, dementia, anxiety, and depression), and physical function (Short Physical Performance Battery and grip strength) with digital health technology use was examined using design-based logistic regression. All statistical analyses accounted for the complex sample design. ResultsThe prevalence of any digital health technology use increased from 36% in 2015 to 45% in 2019. In 2020-2021, which was amid the COVID-19 pandemic, it ranged from 51% to 52%. In terms of each digital health technology use behavior, in 2015, overall, 28% of older cancer survivors used digital health technology to obtain health information, followed by contacting clinicians (19%), filling prescriptions (14%), and handling insurance (11%). Greater use of digital health technology was associated with younger age, being White, having a college or higher education, having a higher income, having more comorbidities, nondementia, and having a higher gait speed. ConclusionsDigital health technology use in older adults with cancer has gradually increased, particularly during the COVID-19 pandemic. However, socioeconomic and racial disparities have remained in older cancer survivors. Additionally, older adults with cancer may have some unique features associated with digital health technology use; for example, their use of digital health may be increased by their comorbidities (ie, health care needs) and reduced by their frailty

Factors associated with balance function in patients with knee osteoarthritis: An integrative review

This integrative review is to identify the factors associated with balance function in patients with knee osteoarthritis and explore the relationship between these factors and balance function. Osteoarthritis commonly occurs in elderly people. Patients with knee osteoarthritis have balance impairment, and maintaining knee stability is important for such patients to prevent accidental injuries caused by falling. Therefore, it is important to clarify the factors related to balance function in patients with knee osteoarthritis. The PubMed, Science Direct, CINAHL, Ovid, ProQuest, CNKI, WanFang databases were searched, and relevant articles published up to December 2015 were included. Twenty articles were included in the analysis. Age, gender, dominant limb, foot length, knee alignment, diurnal variation, and meniscus tears were the non-modifiable factors, whereas body mass index, knee pain, muscle strength, joint range of motion, severity, and cognitive loading were the modifiable factors. Knee sleeve and custom-molded insoles showed protective effects against knee osteoarthritis. Keywords: Aged, Chronic disease, Osteoarthritis, Knee, Postural balanc

Symptom clusters in adults with post-COVID-19 : a cross-sectional survey

More than 100 symptoms have been reported for post-coronavirus disease 2019 (COVID-19) and this study aimed to organize self-reported symptoms by identifying symptom clusters. We used a cross-sectional survey with a convenience sample of 491 adults who reported experiencing prolonged symptoms of COVID. A list of 25 symptoms of post-COVID-19 was used to measure the symptoms, and exploratory factor analysis was undertaken to identify symptom clusters for people with symptoms lasting 5 to 8 weeks and 9 weeks or longer. Six symptom clusters were identified for each of the two groups, and five clusters were similar across both groups: respiratory, general viral, smell/taste, cognitive cardiac, and mental health. The >9-week group reported symptoms primarily from two factors: respiratory-muscular and mental health. Post-COVID-19 symptom clusters differ across timeframes. Symptom clusters were useful in establishing coherent patterns of multiple complex symptoms

Substance use and the self-management of persistent symptoms of COVID-19

Background: Understanding the self-management practices of persistent symptoms of SARS-Cov-2 (COVID-19) is critical given the misinformation that has been presented about this disease in the U.S. The purpose of this descriptive study is to assess the self-management of persistent symptoms of COVID-19 with commonly used and misused substances (i.e., alcohol, marijuana and commonly prescribed medications) among adults in the U.S. Methods: The data for this study comes from a cross-sectional survey of U.S. adults that was designed to broadly assess symptom burden, persistent symptom patterns, self-efficacy for symptom management and self-management strategies among people who experienced persistent/Long COVID. Multiple logistic regression analyses were used to assess how symptom length of COVID-19 was associated with the use of several substances to manage these persistent symptoms. Results: The analysis found that adults who had COVID-19 symptoms that persisted for 13 weeks or longer had higher rates of using alcohol (27.3%), marijuana (30.9%) and prescription tranquilizers (21.4%) to manage these symptoms when compared to their adult peers who had COVID-19 symptoms persist for only 4 weeks or less. For instance, the odds of indicating the use of marijuana (AOR = 4.21 95% CI = 1.68,10.5) to manage COVID-19 related symptoms was roughly four times higher for respondents who had COVID-19 symptoms persist for 13 weeks or longer when compared to respondents whose COVID-19 symptoms persisted for only 4 weeks or less. Conclusion: The findings suggest that screening of substance use disorders should be considered among healthcare providers who are treating adults who have persistent symptoms of COVID-19

Bidirectional association between knee osteoarthritis and depressive symptoms: evidence from a nationwide population-based cohort

Abstract Background Both knee osteoarthritis (KOA) and depressive symptoms (DS) are major public health issues affecting the quality of life. This study aimed to examine the association between KOA and DS. Methods Data were gathered from the China Health and Retirement Longitudinal Study in 2011–2015 which surveyed middle-aged to elderly individuals and their spouses in 28 provinces in China. An adjusted Cox proportional hazards regression model was used to estimate hazard ratios (HRs). Results The analysis for baseline KOA and the subsequent risk of DS was based on 2582 participants without baseline DS. During the follow-up, KOA patients were more likely to have DS than non-KOA participants (adjusted HR = 1.38: 95% CI = 1.23 to 1.83). The analysis for baseline DS and the subsequent risk of KOA was based on 4293 participants without baseline KOA, those with DS were more likely to develop KOA than non-DS participants (adjusted HR = 1.51: 95% CI = 1.26 to 1.81). Subgroup analysis showed sex and age had no significant moderating effect on the KOA-DS association. Conclusions Our results provide evidence that the association between KOA and DS is bidirectional. Therefore, primary prevention and management of KOA and DS should consider this relationship.http://deepblue.lib.umich.edu/bitstream/2027.42/173633/1/12891_2022_Article_5137.pd

Comparison of Pre-Diagnosis Physical Activity and Its Correlates between Lung and Other Cancer Patients: Accelerometer Data from the UK Biobank Prospective Cohort

Purpose: Physical activity (PA) plays an important role in health outcomes for people with cancer, and pre-diagnosis PA influences PA behaviors after cancer treatment. Less is known about the PA of lung cancer patients, and the strong history of smoking could influence pre-diagnosis levels of PA and place them at risk for health problems. This study aimed to compare pre-diagnosis PA and its correlates in patients with lung cancer and other types of cancer (female breast, colorectal, and prostate cancer) and examine the relationship between pre-diagnosis PA and all-cause mortality. Methods: This study used data from the UK Biobank, which is a national cohort study with accelerometry data. We included 2662 participants and used adjusted linear regressions and survival analyses. Results: Male and female lung cancer groups spent a mean of 78 and 91 min/day in pre-diagnosis moderate to vigorous PA (MVPA), respectively; this is lower than the 3 other types of cancer (p p p < 0.01). Higher levels of pre-diagnosis MVPA (≥1.5 h/day) were associated with a significantly lower all-cause mortality risk. Conclusions: The present study suggests that lung cancer patients are the most inactive population before diagnosis. The identified difference in correlates of PA suggest that cancer-specific approaches are needed in PA research and practices. This study also highlights the importance of high PA for individuals with high cancer risk

Chemoradiation versus oesophagectomy for locally advanced oesophageal cancer in Chinese patients: study protocol for a randomised controlled trial

Abstract Background Surgery is the gold standard treatment for local advanced disease, while definitive concurrent chemoradiotherapy (DCRT) is recommended for those who are medically unable to tolerate major surgery or medically fit patients who decline surgery. The primary aim of this trial is to compare the outcomes in Chinese patients with oesophageal squamous cell cancer with locally advanced resectable disease who have received either surgery or DCRT. Methods/design One hundred ninety-six patients with T1bN + M0 or T2-4aN0-2 M0 oesophageal squamous cell cancer will be randomised to the DCRT group or the surgery group. In the DCRT group, patients will be given intensity-modulated radiation therapy (IMRT) with 50 Gy/25 fractions and basic chemotherapy with 5-fluorouracil regimens. In the surgery group, patients will receive neoadjuvant chemoradiotherapy (NCRT) and standard oesophagectomy. Five years of follow-up will be scheduled for patients. The primary endpoints are 2-year/5-year overall survival; the secondary endpoints are 2-year/5-year progression-free survival, treatment-related adverse events and the patients’ quality of life. The main evaluation methods include oesophagoscopy, endoscopic ultrasonography and biopsy, oesophageal barium meal, computed tomography, positron emission tomography-computed tomography, blood tests and questionnaires. Discussion The preponderant oesophageal cancer pathology type is dramatically different in western Caucasian and Asian oesophageal cancer patients: Caucasian patients present with 80% adenocarcinomas, and Asians patients present with 95% squamous cell carcinomas. This phenomenon needs more in-depth studies to elucidate the differences in these populations. Based on the results of this study, we will show whether DCRT will benefit patients more than oesophagectomy. This study will contribute more evidence to the management of oesophageal squamous cell cancer. Trial registration ClinicalTrials.gov, NCT02972372. Registered on 26 November 2016

Genome-wide identification, structural characterization and gene expression analysis of the WRKY transcription factor family in pea (Pisum sativum L.)

Abstract Background The WRKY gene family is one of the largest families of transcription factors in higher plants, and WRKY transcription factors play important roles in plant growth and development as well as in response to abiotic stresses; however, the WRKY gene family in pea has not been systematically reported. Results In this study, 89 pea WRKY genes were identified and named according to the random distribution of PsWRKY genes on seven chromosomes. The gene family was found to have nine pairs of tandem duplicates and 19 pairs of segment duplicates. Phylogenetic analyses of the PsWRKY and 60 Arabidopsis WRKY proteins were performed to determine their homology, and the PsWRKYs were classified into seven subfamilies. Analysis of the physicochemical properties, motif composition, and gene structure of pea WRKYs revealed significant differences in the physicochemical properties within the PsWRKY family; however, their gene structure and protein-conserved motifs were highly conserved among the subfamilies. To further investigate the evolutionary relationships of the PsWRKY family, we constructed comparative syntenic maps of pea with representative monocotyledonous and dicotyledonous plants and found that it was most recently homologous to the dicotyledonous WRKY gene families. Cis-acting element analysis of PsWRKY genes revealed that this gene family can respond to hormones, such as abscisic acid (ABA), indole-3-acetic acid (IAA), gibberellin (GA), methyl jasmonate (MeJA), and salicylic acid (SA). Further analysis of the expression of 14 PsWRKY genes from different subfamilies in different tissues and fruit developmental stages, as well as under five different hormone treatments, revealed differences in their expression patterns in the different tissues and fruit developmental stages, as well as under hormone treatments, suggesting that PsWRKY genes may have different physiological functions and respond to hormones. Conclusions In this study, we systematically identified WRKY genes in pea for the first time and further investigated their physicochemical properties, evolution, and expression patterns, providing a theoretical basis for future studies on the functional characterization of pea WRKY genes during plant growth and development