Purpose

Approximately two-thirds of women are overweight at breast cancer (BC) diagnosis, with further weight gain frequently reported during and after treatment. Excess body weight (body fat) and low physical activity (PA) are modifiable risk factors linked to poorer survival outcomes after early-stage BC-treatment. Co-design techniques were used to explore this behaviourally complex issue with BC-survivors and healthcare professionals (HCPs) to determine what is needed to effectively support women to lose weight after early-stage BC-treatment.

Methods

Initial focus groups (FG) were conducted with n=16 BC-survivors and n=21 HCPs. Framework analysis of the data indicated disparities between what HCPs think and what BC-survivors want. Data informed the content of two-stage successive interactive co-design workshops (n=9 BC-survivors who had attended previous FGs). Workshop 1 activities explored BC-survivors’ preferences in relation to: i) techniques to motivate change; ii)approaches to overcome challenges to intervention attendance; iii)core components of the intervention. Workshop 2 activities focussed on: i)language and graphics of support and educational materials; ii)delivery mechanisms; iii)refinement of workshop 1 ideas.

Results / findings

Workshop 1 revealed the need to feel happier and more positive, less angry and to experience successful weight loss.  To achieve this the intervention should address: i)self-confidence and self-esteem; ii) reassurance of safe PA and diet for BC-survivors; iii) improving knowledge about one's body and what was happening to it since treatment.

Workshop 2 revealed: i)certain elements of the intervention such as self-monitoring techniques, should be optional and personalised; ii)content should be as visual as possible and centre around side-effect management; iii)mood is as important to track as PA and diet; iv)terminology should be non-medicalised e.g. Eating Well and Moving Well not diet and PA; v)one-to-one facilitator support is as important as group peer-support.

Conclusions

Revealing previously unconsidered themes, the co-design process used BC-survivors’ own perspectives to strengthen the development of a practically implementable weight management intervention.  Tailored to the bespoke needs and wants of overweight women recovering from early-stage BC-treatment, the effectiveness of this intervention in building the skills and confidence needed for clinically meaningful weight loss and sustainable health behaviour change will be tested in a RCT.

Purpose: Pre-operative cardiopulmonary fitness is increasingly being recognised as an important factor influencing post-operative recovery outcomes in cancer patients. The aim of this study was to explore patient perspectives of pre-operative vigorous intensity aerobic interval exercise in bladder cancer patients awaiting radical cystectomy. 

Methods: Patients (N=60) were randomised (1:1) to a supervised exercise or a standard treatment (only) control group shortly after decision to operate. Participants in the exercise group were offered supervised vigorous intensity aerobic interval exercise on a cycle ergometer (Monark 824E; Varberg, Sweden) twice-weekly, in addition to standard treatment. Focus groups involving a purposive convenience sample of 14 patients who had been randomised to the exercise arm (mean age ± SD: 72.3 ± 6.0 y) were undertaken after recovery from surgery in a hospital education department. Focus group transcripts were transcribed verbatim before two independent researchers read and analysed the transcripts using framework analysis. 

Results/findings: Three themes emerged from the framework analysis which contextualise the perceptions and experiences of participants: (i) Motivational factors; (ii) Perceived benefits of participation; (iii) Perceptions of programme design. Important motivational factors for engaging in the exercise prehabilitation were: social support, previous exercise experience and objective measures of progression (reflecting physiological adaptations). Patients experienced physical, psychological, and psychosocial health benefits and enjoyed participation, however, challenges associated with travelling to the centre, the discomfort of cycle ergometer exercise and need for clear and concise information from healthcare providers to ensure adequate preparation for supervised exercise were highlighted. 

Conclusions: This qualitative study provides new insights into the perspectives and experiences of patients with bladder cancer regarding participation in pre-operative vigorous intensity aerobic exercise. The exercise programme provided physical, psychological and social benefits. Supervised exercise, objective improvement, and peer and family support all contributed to motivation to engage with pre-operative high intensity aerobic interval exercise. Individuals may require further support after radical cystectomy to continue with exercise.

Purpose: Globally, the population is ageing and the prevalence of cancer is increasing. In 2018, the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) published their third expert report on Diet, Nutrition, Physical Activity and Cancer. Subsequently, a standardised scoring system was developed to assess adherence to cancer prevention recommendations¹. The aim of this study was to investigate data driven dietary patterns, adherence to WCRF/AICR recommendations and associations with socio-demographic factors in adults 65-74 years living in Auckland, New Zealand.

Methods: This cross-sectional study used community-dwelling participants from the Researching Eating, Activity and Cognitive Health (REACH) cohort. Participants completed a demographic questionnaire, validated 109-item food frequency questionnaire and International Physical Activity Questionnaire-Short Form. Weight, height and waist circumference were measured. A score for each participant was constructed using the WCRF/AICR recommendations¹. Dietary patterns (DPs) were derived using principal component analysis (PCA). Associations between DPs, the WCRF/AICR score and sex, age, deprivation and living situation were investigated using linear regression analysis. 

Results/findings: The mean±SD WCRF/AICR score of participants (n=367; 235 females) was 4.29±1.08 (possible score 7; higher score reflects adherence to recommendations). Two DPs explained 14% of the variance in dietary intake. The first DP ‘healthy’ was categorised by high intakes of vegetables, nuts and seeds, legumes, wholegrains, meat alternatives, fruit, fish, seafood and spices. The second DP ‘Western’ was categorised by processed meats, sauces and dressings, biscuits and cakes, fast food, confectionary, vegetable oils, cheese and beer. Higher adherence to the WCRF/AICR score was positively associated with a ‘healthy’ DP (r=0.51; p<0.001) and negatively associated with the ‘Western’ DP (r=-0.38; p<0.001). Females were more likely to follow the WCRF/AICR recommendations (p=0.001) and healthy DP (p<0.001), while the ‘Western’ DP was associated with being male (p<0.001), living with others (p=0.019) and younger age (p=0.027).  

Conclusions: Scores on PCA-derived DPs were associated with adherence to WCRF/AICR recommendations. Participant sex was associated with both DPs and adherence to WCRF/AICR recommendations. Age and living situation were associated with the ‘Western’ DP. Socio-demographic factors should be considered in lifestyle interventions aimed at reducing cancer risk. 

¹Shams-White MM et al. Nutrients. 2019; 11(7).

Background: Childhood acute lymphoblastic leukemia (ALL) survivors’ increased risk for adverse health outcomes (e.g., cardiovascular problems, metabolic disease) could be mitigated through healthy lifestyle behaviors (e.g., balanced diet). Nonetheless, >70% of adult survivors do not meet survivorship dietary recommendations. ALL treatment may amplify risk for restricted dietary preferences and poor food intake self-regulation that ultimately contribute to survivors’ suboptimal diets. This relationship has yet to be examined in research. This study aims to (1) characterize differences in picky eating, food intake self-regulation, and dietary quality between survivors and peer controls; and (2) examine the associations between these eating behaviors and dietary quality in survivors relative to peer controls. Methods: Participants were 32 survivors (M_age = 8.79 ± 2.70), 32 age-/sex-matched peer controls (M_age = 8.59 ± 2.64), and their caregivers. Children’s dietary quality (Healthy Eating Index-2015) was calculated from three 24-hour dietary recalls. Parents completed the Child Eating Behavior Questionnaire-Food Fussiness subscale and the Child Self-Regulation in Eating Questionnaire. Results: Independent samples T-tests revealed survivors to exhibit significantly greater picky eating than peer controls but have comparable food intake self-regulation and dietary quality. Linear regressions showed survivors’ increased picky eating related to worse overall dietary quality (β = -.39, p < .05, R² = .15) but not food intake self-regulation (β = .11, p > .05, R² = .01). Peer controls’ poorer food intake self-regulation (β = .51, p < .01, R² = .26), but not picky eating (β = -.35, p > .05, R² = .09), related to worse dietary quality. Conclusions: Survivors consumed comparably poor quality diets to peer controls. However, dietary quality is of particular concern for survivors given baseline risk for adverse health outcomes and survivors exhibited greater picky eating. Study results provide preliminary support for different eating behaviors contributing objectively poor dietary quality in children with and without an ALL history. If replicated longitudinally, these findings suggest that interventions to support optimal dietary quality in the context of childhood ALL may benefit from targeting picky eating rather than food intake self-regulation.

Purpose The ActWELL RCT aims to test the effectiveness of a 12-month, volunteer coach delivered, weight management (diet and physical activity) programme in post-menopausal women with a BMI>25 kg/m2 attending routine breast cancer screening appointments.

The novel intervention incorporated increased motivation for weight management (by raising awareness of breast cancer risk within screening) combined with increased capability for lifestyle change (via a volunteer coach delivered personalised programme) and enhanced opportunities for greater physical activity (via local leisure centres).  The programme was delivered in two individual, face to face sessions and 9 support calls by volunteer coaches (recruited and managed by the charity Breast Cancer Now). 

We report results on participant responses to the acceptability of intervention components with specific reference to volunteer coaches.

Methods Following all data collection procedures intervention participants were invited to complete an anonymous exit questionnaire about the intervention components using  5- scale categorical responses (very helpful to very unhelpful) and to describe the most useful component of the intervention.  In addition, qualitative interviews were undertaken by independent researchers and a thematic analysis was undertaken to explore intervention experiences.

Results  Volunteer coaches (n=45) delivered 528 coaching sessions and 1940 support calls to 279 women allocated to the intervention group.

Exit questionnaires were returned by 167 (70%) of intervention participants who completed follow up measures. The coach visits were described as very helpful by 55% with a further 34% reporting these as helpful. Of the 10 components described as the most useful, the coach was most frequently cited (46%). Interview data from 24 women indicated that coaches were generally highly regarded. Four main areas were highlighted:  the coach’s personality or manner, ability to empathise, the support provided throughout the programme, and their ability to understand how to motivate change.  In discussion on future changes to the programme many reported a desire for more frequent or extended coach contact.

Conclusions The use of volunteer coaches to deliver a weight management programme is viewed favourably by overweight and obese post-menopausal. women. 

Purpose: Analyse the effects of Pilates method intervention on quality of life, sleep quality, fatigue, depressive symptoms and self-esteem in breast cancer women undergoing hormone therapy.

Methods: Randomized clinical trial including 35 breast cancer women undergoing hormone therapy from Oncology Research Center (CEPON) in the South of Brazil. These women were allocated in two groups: the intervention group (n=18) and the control group (n=17). The intervention group received 16 weeks of Pilates method, 2x week for 60 minutes the session, and the control group attended three group meetings with lectures about physical and mental health. The data collection occurred pre and post-intervention using a questionnaire, including the quality of life by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ C30), the sleep quality by the Pittsburgh Sleep Quality Index, the fatigue by the Functional Assessment of Cancer Therapy-Fatigue (FACT-F), the depressive symptoms by the Beck Depression Inventory (BDI) and the self-esteem by the Rosenberg Self-Esteem Scale. For analysis, it was used the Anova Two way with repeated measures and Sydak test for comparison (p<0.05).

Results: After the 16 weeks of intervention the Pilates group showed better scores for the global status of quality of life (p<0.001), the physical function of QOL (p=0.006), decreased fatigue levels (p=0.014), and increased the self-esteem (p=0.011). The control group also presented better scores for the global status of quality of life (p=0.006). In the sleep quality and depressive symptoms, none of the groups demonstrated any significant improvement (p>0.05).  

Conclusion: Pilates method is a viable and effective type of physical activity that can help improve the psychological aspects of breast cancer women undergoing hormone therapy. In addition, the control group demonstrated improvements in self-perception of global health, showing the importance of lectures and educational programs for these women. Programs regarding physical activity are very important in helping these women restore emotional and social well-being and must be implemented in all oncology facilities. (Clinical Trials - NCT03194997)

Purpose: Survivors of cancer experience poorer health-related quality of life, greater psychologic distress and more mental health needs compared to individuals without a cancer diagnosis. Identifying strategies to optimise psychological well-being (PWB) for this population is of clinical importance. The aim of this study was to determine the long-term effects of the MedEx IMPACT (IMprove Physical Activity (PA) after Cancer Treatment) trial, a patient-centred, evidenced-based and theoretically-informed PA behaviour change (BC) intervention, on cancer survivors’ long-term levels of depression and PWB. The intervention was delivered through a community-based exercise rehabilitation programme for survivors of cancer called ‘MedEx Move On’ (MMO). 

Methods: Adults who had completed adjunctive cancer therapy, were referred to MMO. Participants in the control group (CG) attended two 60-minute supervised exercise classes each week for 12 weeks. In addition to this, participants in the intervention group (IG) also received: i) an independent exercise programme, ii) 4 PA information sessions and iii) a 1:1 exercise consultation. Depression and PWB were measured using the Patient Health Questionnaire (PHQ-8), the Satisfaction with Life Scale (SWLS) and the short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) respectively, at baseline (T1), programme completion (T2 - week 12) and 3 month follow-up (T3). Linear mixed-model analyses of variance were conducted to investigate time and treatment effects. 

Results: One-hundred and ninety-one survivors of cancer were recruited (CG, n= 87; IG, n=104; mean age 56 ± 10 yrs, 73% female). Cancer diagnoses were breast (60%), colorectal (16%), prostate (13%) and other (11%). On average, participants attended 66% of the supervised exercise classes (CG= 67±22%; IG=65±27%). 51% of participants completed the trial. There was a substantial main effect for time for all measures, with both groups showing statistically significant improvements from T1 to T2, which were maintained at T3 (p<.05). No statistically significant differences for the outcome measures were identified between CG and IG (p>.05). 

Conclusions: Participation in a 12-week community-based exercise rehabilitation programme has a positive long-term effect on cancer survivors’ levels of depression and PWB. The inclusion of additional BC strategies to the supervised exercise classes did not augment the benefits achieved.