Randomized controlled trial of the effects of aerobic exercise on physical functioning and quality of life in lymphoma patients

Purpose Lymphoma patients commonly experience declines in physical functioning and quality of life (QoL) that may be reversed with exercise training. Patients and Methods We conducted a randomized controlled trial in Edmonton, Alberta, Canada, between 2005 and 2008 that stratified 122 lymphoma patients by major disease type and current treatment status and randomly assigned them to usual care (UC; n 62) or 12 weeks of supervised aerobic exercise training (AET; n 60). Our primary end point was patient-rated physical functioning assessed by the Trial Outcome Index-Anemia. Secondary end points were overall QoL, psychosocial functioning, cardiovascular fitness, and body composition. Results Follow-up assessment for our primary end point was 96% (117 of 122) at postintervention and 90% (110 of 122) at 6-month follow-up. Median adherence to the supervised exercise program was 92%. At postintervention, AET was superior to UC for patient-rated physical functioning (mean group difference, 9.0; 95% CI, 2.0 to 16.0; P .012), overall QoL (P .021), fatigue (P .013), happiness (P .004), depression (P .005), general health (P .001), cardiovascular fitness (P .001), and lean body mass (P .008). Change in peak cardiovascular fitness mediated the change in patient-rated physical functioning. AET did not interfere with chemotherapy completion rate or treatment response. At 6-month follow-up, AET was still borderline or significantly superior to UC for overall QoL (P .054), happiness (P .034), and depression (P .009) without an increased risk of disease recurrence/progression. Conclusion AET significantly improved important patient-rated outcomes and objective physical functioning in lymphoma patients without interfering with medical treatments or response. Exercise training to improve cardiovascular fitness should be considered in the management of lymphoma patients

Systematic Review of the Risk of Adverse Outcomes Associated with Vascular Endothelial Growth Factor Inhibitors for the Treatment of Cancer

<div><p>Background</p><p>Anti-angiogenic therapy targeted at vascular endothelial growth factor (VEGF) is now used to treat several types of cancer. We did a systematic review of randomized controlled trials (RCTs) to summarize the adverse effects of vascular endothelial growth factor inhibitors (VEGFi), focusing on those with vascular pathogenesis.</p><p>Methods and Findings</p><p>We searched MEDLINE, EMBASE and Cochrane Library until April 19, 2012 to identify parallel RCTs comparing a VEGFi with a control among adults with any cancer. We pooled the risk of mortality, vascular events (myocardial infarction, stroke, heart failure, and thromboembolism), hypertension and new proteinuria using random-effects models and calculated unadjusted relative risk (RR). We also did meta-regression and assessed publication bias. We retrieved 83 comparisons from 72 studies (n = 38,078) on 11 different VEGFi from 7901 identified citations. The risk of mortality was significantly lower among VEGFi recipients than controls (pooled RR 0.96, 95% confidence interval [CI] 0.94 to 0.98, I² = 0%, tau2 = 0; risk difference 2%). Compared to controls, VEGFi recipients had significantly higher risk of myocardial infarction (MI) (RR 3.54, 95% CI 1.61 to 7.80, I² = 0%, tau2 = 0), arterial thrombotic events (RR 1.80, 95% CI 1.24 to 2.59, I² = 0%, tau2 = 0); hypertension (RR 3.46, 95% CI 2.89 to 4.15, I² = 58%, tau2 = 0.16), and new proteinuria (RR 2.51, 95% CI 1.60 to 3.94, I² = 87%, tau2 = 0.65). The absolute risk difference was 0.8% for MI, 1% for arterial thrombotic events, 15% for hypertension and 12% for new proteinuria. Meta-regression did not suggest any statistically significant modifiers of the association between VEGFi treatment and any of the vascular events. Limitations include heterogeneity across the trials.</p><p>Conclusions</p><p>VEGFi increases the risk of MI, hypertension, arterial thromboembolism and proteinuria. The absolute magnitude of the excess risk appears clinically relevant, as the number needed to harm ranges from 7 to 125. These adverse events must be weighed against the lower mortality associated with VEGFi treatment.</p></div

Risk of bias of included studies.

<p>The responses for each question in this risk of bias tool are represented by different colors, segmented along a horizontal bar. Light gray depicts the percent of studies responding with the smallest risk of bias. Medium gray depicts the percent of studies responding with a moderate or unclear risk of bias. Dark gray indicates the greatest risk of bias. The responses to “Concealed treatment allocation?” are adequate, inadequate and unclear. The responses to “Double-blinded?”, “Intention-to-treat?” and “Interim/preliminary analysis not done?” are yes, unclear and no. The responses to “Withdrawals/dropouts described” are yes, no or partial. The responses to “Total lost to follow up <10%” are yes, no or not reported. The responses to “Funding?” are government, private or mixed/other funding sources.</p

Effect of treatment with VEGFi on hypertension and proteinuria.

<p>Effect of treatment with VEGFi on hypertension and proteinuria.</p

Pooled effect of treatment with VEGFi on clinical outcomes.

<p>*For all-cause mortality, the value presented is number needed to treat (NNT); however for all other outcomes number needed to harm (NNH) is presented. # 8 trials presented either only any thrombotic events or specified arterial and/or venous thromosis and/or pulmonary embolism in addition to any thrombotic events; therefore the included trials (in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0101145#pone-0101145-g004" target="_blank">figure 4</a>) and number of participants for any thrombotic events differed from the arterial, venous thrombosis or pulmonary embolism events.</p

Effect of treatment with VEGFi on all-cause mortality, cardiovascular events and thrombosis.

<p>Effect of treatment with VEGFi on all-cause mortality, cardiovascular events and thrombosis.</p

Brief description of included randomized trials.

<p>NSCLC: non-small-cell lung cancer; RCC: renal cell carcinoma; SCLC: small-cell lung cancer; FOLFOX 4: oxaliplatin, leucovorin, fluorouracil; FU/LV:fluorouracil & leucovorin; IFL: irinotecan, bolus fluorouracil, leucovorin; XELOX: capecitabine & oxaliplatin; HAI Hepatic arterial infusion</p>$<p>Comparison between another arm and control was not eligible.</p><p>There are 74 rows for 72 studies reported in text: two studies, Martin 2011 had two arms Motesanib and bevacizumab comparing with placebo, Robert 2011 had two arms of capecitabine and taxane-based/anthracycline-based comparing bevacizumab versus placebo in each arm.</p><p>*These are two different trials published in the same year by the same author: Spigel et al in 2011 used bevacizumab for extensive stage small cell lung cancer in one trial and sorafenib for advanced non–small-cell lung cancer in another trial. Likewise, Escudier et al in 2007 used neovastat in metastatic renal cell carcinoma in one trial and sorafenib in advanced clear-cell renal-cell carcinoma in another trial.</p

Effects of supervised exercise on motivational outcomes and longer-term behaviour

Introduction: Supervised exercise may have positive effects on motivation and continued exercise in cancer survivors, but few randomized controlled trials have examined this issue. Here, we report the motivational outcomes and longer-term exercise behavior from the Healthy Exercise for Lymphoma Patients trial. Methods: Lymphoma patients were randomly assigned to 12 wk of supervised aerobic exercise (SUP, n = 60) or usual care (UC, n = 62). Motivational outcomes from the theory of planned behavior were assessed at baseline, after intervention, and at 6-month follow-up using standardized measures. Exercise behavior was self-reported at baseline and 6-month follow-up using the Godin Leisure Time Exercise Questionnaire. Results: Data were available from 95% of participants after intervention and 90% at 6-month follow-up. SUP attended a median of 92% of the supervised exercise sessions. After intervention, SUP was superior to UC for intention (+0.41 (+0.09 to +0.72), P = 0.012) and perceived behavioral control (+0.36 (+0.01 to +0.72), P = 0.047) and borderline superior for self-efficacy (+0.35 (j0.02 to +0.72), P = 0.060). At 6-month follow-up, SUP reported significantly more exercise minutes compared with UC (+133 (+38 to +227), P = 0.006), and a higher percentage of SUP participants were meeting public health exercise guidelines (+25.6% (+8.2% to +43.0%), P = 0.004). Path analysis showed that perceived behavioral control partially mediated the effects of supervised exercise (group assignment) on exercise behavior at 6-month follow-up (meeting exercise guidelines). Conclusions: Supervised exercise has motivational effects in lymphoma patients and improves longer-term exercise behavior. Strategies to further enhance the motivational value of supervised exercise are warranted

Additional file 3 of Implementation of electronic prospective surveillance models in cancer care: a scoping review

Additional file 3. Adapted ERIC descriptions for implementation strategies used in the included interventions

Additional file 5 of Implementation of electronic prospective surveillance models in cancer care: a scoping review

Additional file 5. Description of electronic prospective surveillance model system features