Purpose This individual participant data meta-analysis (IPD-MA) assesses exercise effects on self... more Purpose This individual participant data meta-analysis (IPD-MA) assesses exercise effects on self-reported cognitive functioning (CF) and investigates whether effects differ by patient-, intervention-, and exercise-related characteristics. Methods IPD from 16 exercise RCTs, including 1987 patients across multiple types of non-metastatic cancer, was pooled. A one-stage IPD-MA using linear mixed-effect models was performed to assess exercise effects on self-reported CF (z-score) and to identify whether the effect was moderated by sociodemographic, clinical, intervention-and exercise-related characteristics, or fatigue, depression, anxiety, and self-reported CF levels at start of the intervention (i.e., baseline). Models were adjusted for baseline CF and included a random intercept at study level to account for clustering of patients within studies. A sensitivity analysis was performed in patients who reported cognitive problems at baseline. Results Minimal significant beneficial exercise effects on self-reported CF (β=−0.09 [−0.16; −0.02]) were observed, with slightly larger effects when the intervention was delivered post-treatment (n=745, β=−0.13 [−0.24; −0.02]), and no significant effect during cancer treatment (n=1,162, β=−0.08 [−0.18; 0.02]). Larger effects were observed in interventions of 12 weeks or shorter (β=−0.14 [−0.25; −0.04]) or 24 weeks or longer (β=−0.18 [−0.32; −0.02]), whereas no effects were observed in interventions of 12-24 weeks (β=0.01 [−0.13; 0.15]). Exercise interventions were most beneficial when provided to patients without anxiety symptoms (β=−0.10 [−0.19; −0.02]) or after completion of treatment in patients with cognitive problems (β=−0.19 [−0.31; −0.06]). No other significant moderators were identified. Conclusions This cross-cancer IPD meta-analysis observed small beneficial exercise effects on self-reported CF when the intervention was delivered post-treatment, especially in patients who reported cognitive problems at baseline. Implications for Cancer Survivors This study provides some evidence to support the prescription of exercise to improve cognitive functioning. Sufficiently powered trials are warranted to make more definitive recommendations and include these in the exercise guidelines for cancer survivors.
Background - Fatigue is one of the most common and disabling complaints in patients with breast c... more Background - Fatigue is one of the most common and disabling complaints in patients with breast cancer and can effectively be reduced by physical exercise, with small to moderate effect sizes. To identify heterogeneity in responses to exercise and to further personalize exercise prescriptions, moderators of exercise effects on fatigue should be investigated. However, most randomized controlled trials (RCTs) are not adequately powered for such analyses. Therefore we conducted meta-analyses using the individual patient data of several exercise RCTs. The aim is to investigate the effect and moderators of physical exercise on cancer-related fatigue in patients with breast cancer. Methods - Within the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) consortium, principal investigators of 34 exercise RCTs worldwide have shared their individual patient data. Twenty-two of these RCTs included patients with breast cancer with a total sample size of 3,061. Different ques...
PurposeHormonal receptor (HR) positive breast tumors are common. Adjuvant hormonal therapy (AHT) ... more PurposeHormonal receptor (HR) positive breast tumors are common. Adjuvant hormonal therapy (AHT) with Tamoxifen or Aromatase Inhibitors (AIs) is beneficial depending on the stage of the tumor. Despite the fact that AHT has been shown to improve survival and recurrence, Dutch adherence rates, which were mostly dependent on Tamoxifen prescriptions until 2006, plummeted from 80% after one year to 50% after five years. Nonadherence with AHT reduces its effectiveness. This research presents more recent adherence statistics (from 2006 to 2016) as well as factors that influence AHT adherence. In addition to Tamoxifen data, AIs are now included in prescriptions.MethodsThe Netherlands Cancer Registry (NCR) was used to find women with early-stage breast cancer who started AHT within a year of surgery and were linked to the PHARMO Database Network. The Kaplan-Meier approach was used to measure AHT adherence five years after treatment was started, with a 60-day gap between refills as our primar...
Background: Cancer survivors are eager to stay working but often experience disease-related probl... more Background: Cancer survivors are eager to stay working but often experience disease-related problems. This study assessed the effectiveness of a work-module within a multi-module eHealth intervention (KankerNazorgWijzer) meant to help dealing with impaired cognitive, physical, emotional functioning and practical issues. Methods: A RCT (n=463) compared Usual Care (UC) and the intervention (ExpC) among cancer survivors. Work-related outcomes (6-months): job satisfaction, work limitations, productivity loss. We only included workers. Findings: Most participants were women (85%) with breast cancer (79%). Baseline job satisfaction was high (M=4.1; scale 1-5) with little work limitations. Multiple regression analyses revealed no intervention effects on work outcomes (p-values >.22). Within the ExpC group work-module users reported more increase in weekly working hours compared to non-users (UC: M=6.7; ExpC: M=10.9. p=.049) and appreciated the module (M=7.0; scale 1-10). Discussion: Pre...
Praktijkondersteuners krijgen steeds meer te maken met mensen die kanker krijgen en dit overleven... more Praktijkondersteuners krijgen steeds meer te maken met mensen die kanker krijgen en dit overleven. Na behandeling worden voormalig kankerpatienten geconfronteerd met problemen zoals vermoeidheid, angst en somberheid en met nieuwe uitdagingen zoals het verbeteren van leefstijl. Ze kunnen de Kanker Nazorg Wijzer gebruiken zonder hulp van zorgverleners om problemen te verminderen en te werken aan een gezonde leefstijl. Patienten waarderen het programma effectief en positief. Wat is het, wat zij de effecten en waarom kun je het als praktijkondersteuners gebruiken?
Background: While a healthy lifestyle is beneficial for cancer survivors, adherence to recommenda... more Background: While a healthy lifestyle is beneficial for cancer survivors, adherence to recommendations is low. We assessed the contribution of distal (socio-demographic, cancer-related, psychological), and proximal factors (attitude, social support, self-efficacy), and intention in explaining smoking, physical activity, alcohol, fruit, and vegetable consumption. Methods: Cancer survivors (N = 255; 70.7% females; mean age 60.6 years) participated in this cross-sectional survey. Findings: Higher fruit consumption was only correlated with a stronger intention (B=56; R2 = .574). Higher vegetable consumption was correlated with a stronger intention (B=37.22) and longer period after cancer treatment (B=1.06; R2 = .440). Adherence to fruit (54.8%) and vegetable (27.4%) recommendations was lowest of all behaviors and mutual correlation was weak (rs= .24, p < .001). Strongest correlates of other lifestyle behaviors were self-efficacy and attitude. Unhealthy behaviors were correlated with ...
Background: Online interventions are proven effective in changing lifestyle behaviors and therefo... more Background: Online interventions are proven effective in changing lifestyle behaviors and therefore can be beneficial for cancer survivors. We assessed the online ‘Kanker Nazorg Wijzer (KNW)’ (Cancer Aftercare Guide) on diet, physical activity, and smoking outcomes. Methods: Survivors participated in a RCT (intervention [IC]: n = 232, 79.3% females, mean age 55.6 years; usual-care control [UC]: n = 231, 80.5% females; mean age 56.1 years). We analyzed baseline and 6 months data (n=325; 70.2%) obtained from online questionnaires using multilevel analysis. Findings: IC reported significant higher vegetable (B = 14.08, p = .003) and whole wheat bread (B = 0.43, p = .05) consumption and a nearly significant increase in days per week activity (IC = .34 days, UC = .20 days; B = .29, p = .09). A higher proportion of smokers (11.1%) quit smoking in IC (UC = 3.1%). Comparative tests were impossible due to the small numbers. Discussion: Preliminary results indicate the KNW to be effective in ...
Background: Since eHealth can be a valuable tool for addressing frequently occurring psychosocial... more Background: Since eHealth can be a valuable tool for addressing frequently occurring psychosocial problems in the population of cancer survivors, we developed the ‘Kanker Nazorg Wijzer’ (KNW; Cancer Aftercare Guide). This is an online tailored intervention aimed at increasing survivors’ quality of life by tackling frequently experienced problems. Methods: As part of a RCT, quality of life (EORTC QLQ-C30), psychological distress (HADS), and fatigue (CIS) at 6 months were compared between the intervention (n = 186) and control (n = 149) group, controlling for baseline values. MANCOVAs tested overall effects, ANCOVAs subscale effects. Findings: MANCOVAs only revealed an effect for psychological distress. Results of the ANCOVAs showed that the intervention group reported higher emotional functioning (QLQ-C30; p = .03, ƞ2 = .009), lower anxiety (HADS; p = .03, ƞ2 = .007) and depression (HADS; p = .01, ƞ2 = .011), less subjective fatigue (CIS; p = .03, ƞ2 = .007) and higher motivation for...
Background: Unmet information needs increase emotional distress for cancer survivors and subseque... more Background: Unmet information needs increase emotional distress for cancer survivors and subsequently hamper patients’ adjustment to their illness. The Cancer Survivor Unmet Needs measure (CaSUN) is a self-reported instrument by Hodgkinson et al. to assess survivors’ reported care needs. The Extended CaSUN-NL entailed the original items plus items related to work and lifestyle. Validity of both will be described. Methods: Survivors (N=255, aged >18; mean age 60.6 years, female 69%; breast cancer 59%) came from 8 hospitals. CaSUN-NL was applied twice (six-week interval, 92.9% retest response) and cross-sectional analyses (e.g. factor analyses, associations with MAC, HADS, QLQ-C30) were conducted. Findings: Respondents reported 8 (5 unmet/3 met) needs on average. Factor analyses revealed 5 factors. Total needs related significantly with MAC r=.50, HADS anxiety r= .55, HADS depression r=. 52, global health (QoL) r=- .54 and age r=-.25. Test-retest correlations were low ( .93). Discu...
Archives of Physical Medicine and Rehabilitation, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Current Opinion in Supportive & Palliative Care, 2019
Purpose of review A great proportion of people affected by cancer experience psychological distre... more Purpose of review A great proportion of people affected by cancer experience psychological distress. To reduce pressure on limited health-management resources available, evidence-based eHealth or online interventions can fill an important gap by making psychosocial care more easily accessible. However, evidence of their effectiveness is mixed. This present review provides an update on the effectiveness of online interventions in reducing psychological distress in patients with cancer by including studies published from January 2018 to September 2019. Recent findings Thirty-three publications describing online interventions were included in the review, including web-based, blended care, telehealth, mHealth, and other online interventions. There was great heterogeneity across studies. The evidence of online interventions' effectiveness in reducing distress was mixed; there was partial support for reduction in psychological distress and depression, but limited evidence for reducing anxiety. Some important limitations should be taken into account when interpreting the results.
Current Opinion in Supportive & Palliative Care, 2019
Purpose of review The present review describes recent research on online psychosocial interventio... more Purpose of review The present review describes recent research on online psychosocial interventions for posttreatment cancer survivors from January 2018 to June 2019. Recent findings Twenty-three studies were included in the review (the majority included were feasibility studies and only five randomized controlled trials had large samples). Websites were the most common platforms for intervention delivery (9/23) and cognitive behavioral therapy was the most frequently used therapeutic approach (11/23). Three interventions based on this framework and delivered via websites or combined website-telehealth platforms showed to be effective in improving psychosocial issues (fear of cancer recurrence, insomnia, sleep quality, and prospective memory failures) in posttreatment cancer survivors. Web-based self-compassion writing was also found to be effective in addressing body image distress and body appreciation in breast cancer survivors. Feasibility studies mostly showed online interventi...
Medicine & Science in Sports & Exercise, 2019
Purpose Fatigue is a common and potentially disabling symptom in patients with cancer. It can oft... more Purpose Fatigue is a common and potentially disabling symptom in patients with cancer. It can often be effectively reduced by exercise. Yet, effects of exercise interventions might differ across subgroups. We conducted a meta-analysis using individual patient data of randomized controlled trials (RCT) to investigate moderators of exercise intervention effects on cancer-related fatigue. Methods We used individual patient data from 31 exercise RCT worldwide, representing 4366 patients, of whom 3846 had complete fatigue data. We performed a one-step individual patient data meta-analysis, using linear mixed-effect models to analyze the effects of exercise interventions on fatigue (z score) and to identify demographic, clinical, intervention- and exercise-related moderators. Models were adjusted for baseline fatigue and included a random intercept on study level to account for clustering of patients within studies. We identified potential moderators by testing their interaction with grou...
To evaluate the effects of exercise interventions on sleep disturbances and sleep quality in pati... more To evaluate the effects of exercise interventions on sleep disturbances and sleep quality in patients with mixed cancer diagnoses, and identify demographic, clinical, and intervention-related moderators of these effects. Methods Individual patient data (IPD) and aggregated meta-analyses of randomized controlled trials (RCTs). Using data from the Predicting OptimaL cAncer RehabIlitation and Supportive care project, IPD of 2173 adults (mean age = 54.8) with cancer from 17 RCTs were analyzed. A complementary systematic search was conducted (until November 2018) to study the overall effects and test the representativeness of analyzed IPD. Effect sizes of exercise effects on self-reported sleep outcomes were calculated for all included RCTs. Linear mixed-effect models were used to evaluate the effects of exercise on post-intervention outcome values, adjusting for baseline values. Moderator effects were studied by testing interactions for demographic, clinical and intervention-related characteristics. Results For all 27 eligible RCTs from the updated search, exercise interventions significantly decreased sleep disturbances in adults with cancer (g =-0.09, 95% CI [-0.16;-0.02]). No significant effect was obtained for sleep quality. RCTs included in IPD analyses constituted a representative sample of the published literature. The intervention effects on sleep disturbances were not significantly moderated by any demographic, clinical, or intervention-related factor, nor by sleep disturbances. Conclusions This meta-analysis provides some evidence that, compared to control conditions, exercise interventions may improve sleep disturbances, but not sleep quality, in cancer patients, although this effect is of a small magnitude. Among the investigated variables, none was found to significantly moderate the effect of exercise interventions on sleep disturbances.
Abstract The aim of this cross-sectional observational study was to investigate adherence rate an... more Abstract The aim of this cross-sectional observational study was to investigate adherence rate and factors influencing the adherence in following home-based activity advice, in patients referred to a physiotherapy clinic for non-specific low back pain. Research suggests that inadequate adherence to home-based activity advice during an intervention period may diminish treatment outcomes. Factors negatively influencing adherence appeared to be related to a person's beliefs and perceptions. Perceived barriers, low self-efficacy and unbeneficial illness beliefs have been consistent predictors for non-adherence across studies. 51 patients who reported non-specific low back pain were advised to walk daily. Physical activity was measured with a validated triaxial seismic accelerometer. The effect of multiple patient-related determinants on the rate of adherence was studied. Only four out of 51 patients (8%) fully adhered to the walking advice. In this study, there were no significant effects of patient-related determinants on the rate of adherence. Factors negatively influencing adherence behaviour were lack of time, weather conditions and increasing low back pain. In conclusion, patient adherence in following home-based activity advice for non-specific low back pain outside the clinical setting is poor.
Purpose This individual participant data meta-analysis (IPD-MA) assesses exercise effects on self... more Purpose This individual participant data meta-analysis (IPD-MA) assesses exercise effects on self-reported cognitive functioning (CF) and investigates whether effects differ by patient-, intervention-, and exercise-related characteristics. Methods IPD from 16 exercise RCTs, including 1987 patients across multiple types of non-metastatic cancer, was pooled. A one-stage IPD-MA using linear mixed-effect models was performed to assess exercise effects on self-reported CF (z-score) and to identify whether the effect was moderated by sociodemographic, clinical, intervention-and exercise-related characteristics, or fatigue, depression, anxiety, and self-reported CF levels at start of the intervention (i.e., baseline). Models were adjusted for baseline CF and included a random intercept at study level to account for clustering of patients within studies. A sensitivity analysis was performed in patients who reported cognitive problems at baseline. Results Minimal significant beneficial exercise effects on self-reported CF (β=−0.09 [−0.16; −0.02]) were observed, with slightly larger effects when the intervention was delivered post-treatment (n=745, β=−0.13 [−0.24; −0.02]), and no significant effect during cancer treatment (n=1,162, β=−0.08 [−0.18; 0.02]). Larger effects were observed in interventions of 12 weeks or shorter (β=−0.14 [−0.25; −0.04]) or 24 weeks or longer (β=−0.18 [−0.32; −0.02]), whereas no effects were observed in interventions of 12-24 weeks (β=0.01 [−0.13; 0.15]). Exercise interventions were most beneficial when provided to patients without anxiety symptoms (β=−0.10 [−0.19; −0.02]) or after completion of treatment in patients with cognitive problems (β=−0.19 [−0.31; −0.06]). No other significant moderators were identified. Conclusions This cross-cancer IPD meta-analysis observed small beneficial exercise effects on self-reported CF when the intervention was delivered post-treatment, especially in patients who reported cognitive problems at baseline. Implications for Cancer Survivors This study provides some evidence to support the prescription of exercise to improve cognitive functioning. Sufficiently powered trials are warranted to make more definitive recommendations and include these in the exercise guidelines for cancer survivors.
Background - Fatigue is one of the most common and disabling complaints in patients with breast c... more Background - Fatigue is one of the most common and disabling complaints in patients with breast cancer and can effectively be reduced by physical exercise, with small to moderate effect sizes. To identify heterogeneity in responses to exercise and to further personalize exercise prescriptions, moderators of exercise effects on fatigue should be investigated. However, most randomized controlled trials (RCTs) are not adequately powered for such analyses. Therefore we conducted meta-analyses using the individual patient data of several exercise RCTs. The aim is to investigate the effect and moderators of physical exercise on cancer-related fatigue in patients with breast cancer. Methods - Within the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) consortium, principal investigators of 34 exercise RCTs worldwide have shared their individual patient data. Twenty-two of these RCTs included patients with breast cancer with a total sample size of 3,061. Different ques...
PurposeHormonal receptor (HR) positive breast tumors are common. Adjuvant hormonal therapy (AHT) ... more PurposeHormonal receptor (HR) positive breast tumors are common. Adjuvant hormonal therapy (AHT) with Tamoxifen or Aromatase Inhibitors (AIs) is beneficial depending on the stage of the tumor. Despite the fact that AHT has been shown to improve survival and recurrence, Dutch adherence rates, which were mostly dependent on Tamoxifen prescriptions until 2006, plummeted from 80% after one year to 50% after five years. Nonadherence with AHT reduces its effectiveness. This research presents more recent adherence statistics (from 2006 to 2016) as well as factors that influence AHT adherence. In addition to Tamoxifen data, AIs are now included in prescriptions.MethodsThe Netherlands Cancer Registry (NCR) was used to find women with early-stage breast cancer who started AHT within a year of surgery and were linked to the PHARMO Database Network. The Kaplan-Meier approach was used to measure AHT adherence five years after treatment was started, with a 60-day gap between refills as our primar...
Background: Cancer survivors are eager to stay working but often experience disease-related probl... more Background: Cancer survivors are eager to stay working but often experience disease-related problems. This study assessed the effectiveness of a work-module within a multi-module eHealth intervention (KankerNazorgWijzer) meant to help dealing with impaired cognitive, physical, emotional functioning and practical issues. Methods: A RCT (n=463) compared Usual Care (UC) and the intervention (ExpC) among cancer survivors. Work-related outcomes (6-months): job satisfaction, work limitations, productivity loss. We only included workers. Findings: Most participants were women (85%) with breast cancer (79%). Baseline job satisfaction was high (M=4.1; scale 1-5) with little work limitations. Multiple regression analyses revealed no intervention effects on work outcomes (p-values >.22). Within the ExpC group work-module users reported more increase in weekly working hours compared to non-users (UC: M=6.7; ExpC: M=10.9. p=.049) and appreciated the module (M=7.0; scale 1-10). Discussion: Pre...
Praktijkondersteuners krijgen steeds meer te maken met mensen die kanker krijgen en dit overleven... more Praktijkondersteuners krijgen steeds meer te maken met mensen die kanker krijgen en dit overleven. Na behandeling worden voormalig kankerpatienten geconfronteerd met problemen zoals vermoeidheid, angst en somberheid en met nieuwe uitdagingen zoals het verbeteren van leefstijl. Ze kunnen de Kanker Nazorg Wijzer gebruiken zonder hulp van zorgverleners om problemen te verminderen en te werken aan een gezonde leefstijl. Patienten waarderen het programma effectief en positief. Wat is het, wat zij de effecten en waarom kun je het als praktijkondersteuners gebruiken?
Background: While a healthy lifestyle is beneficial for cancer survivors, adherence to recommenda... more Background: While a healthy lifestyle is beneficial for cancer survivors, adherence to recommendations is low. We assessed the contribution of distal (socio-demographic, cancer-related, psychological), and proximal factors (attitude, social support, self-efficacy), and intention in explaining smoking, physical activity, alcohol, fruit, and vegetable consumption. Methods: Cancer survivors (N = 255; 70.7% females; mean age 60.6 years) participated in this cross-sectional survey. Findings: Higher fruit consumption was only correlated with a stronger intention (B=56; R2 = .574). Higher vegetable consumption was correlated with a stronger intention (B=37.22) and longer period after cancer treatment (B=1.06; R2 = .440). Adherence to fruit (54.8%) and vegetable (27.4%) recommendations was lowest of all behaviors and mutual correlation was weak (rs= .24, p < .001). Strongest correlates of other lifestyle behaviors were self-efficacy and attitude. Unhealthy behaviors were correlated with ...
Background: Online interventions are proven effective in changing lifestyle behaviors and therefo... more Background: Online interventions are proven effective in changing lifestyle behaviors and therefore can be beneficial for cancer survivors. We assessed the online ‘Kanker Nazorg Wijzer (KNW)’ (Cancer Aftercare Guide) on diet, physical activity, and smoking outcomes. Methods: Survivors participated in a RCT (intervention [IC]: n = 232, 79.3% females, mean age 55.6 years; usual-care control [UC]: n = 231, 80.5% females; mean age 56.1 years). We analyzed baseline and 6 months data (n=325; 70.2%) obtained from online questionnaires using multilevel analysis. Findings: IC reported significant higher vegetable (B = 14.08, p = .003) and whole wheat bread (B = 0.43, p = .05) consumption and a nearly significant increase in days per week activity (IC = .34 days, UC = .20 days; B = .29, p = .09). A higher proportion of smokers (11.1%) quit smoking in IC (UC = 3.1%). Comparative tests were impossible due to the small numbers. Discussion: Preliminary results indicate the KNW to be effective in ...
Background: Since eHealth can be a valuable tool for addressing frequently occurring psychosocial... more Background: Since eHealth can be a valuable tool for addressing frequently occurring psychosocial problems in the population of cancer survivors, we developed the ‘Kanker Nazorg Wijzer’ (KNW; Cancer Aftercare Guide). This is an online tailored intervention aimed at increasing survivors’ quality of life by tackling frequently experienced problems. Methods: As part of a RCT, quality of life (EORTC QLQ-C30), psychological distress (HADS), and fatigue (CIS) at 6 months were compared between the intervention (n = 186) and control (n = 149) group, controlling for baseline values. MANCOVAs tested overall effects, ANCOVAs subscale effects. Findings: MANCOVAs only revealed an effect for psychological distress. Results of the ANCOVAs showed that the intervention group reported higher emotional functioning (QLQ-C30; p = .03, ƞ2 = .009), lower anxiety (HADS; p = .03, ƞ2 = .007) and depression (HADS; p = .01, ƞ2 = .011), less subjective fatigue (CIS; p = .03, ƞ2 = .007) and higher motivation for...
Background: Unmet information needs increase emotional distress for cancer survivors and subseque... more Background: Unmet information needs increase emotional distress for cancer survivors and subsequently hamper patients’ adjustment to their illness. The Cancer Survivor Unmet Needs measure (CaSUN) is a self-reported instrument by Hodgkinson et al. to assess survivors’ reported care needs. The Extended CaSUN-NL entailed the original items plus items related to work and lifestyle. Validity of both will be described. Methods: Survivors (N=255, aged >18; mean age 60.6 years, female 69%; breast cancer 59%) came from 8 hospitals. CaSUN-NL was applied twice (six-week interval, 92.9% retest response) and cross-sectional analyses (e.g. factor analyses, associations with MAC, HADS, QLQ-C30) were conducted. Findings: Respondents reported 8 (5 unmet/3 met) needs on average. Factor analyses revealed 5 factors. Total needs related significantly with MAC r=.50, HADS anxiety r= .55, HADS depression r=. 52, global health (QoL) r=- .54 and age r=-.25. Test-retest correlations were low ( .93). Discu...
Archives of Physical Medicine and Rehabilitation, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Current Opinion in Supportive & Palliative Care, 2019
Purpose of review A great proportion of people affected by cancer experience psychological distre... more Purpose of review A great proportion of people affected by cancer experience psychological distress. To reduce pressure on limited health-management resources available, evidence-based eHealth or online interventions can fill an important gap by making psychosocial care more easily accessible. However, evidence of their effectiveness is mixed. This present review provides an update on the effectiveness of online interventions in reducing psychological distress in patients with cancer by including studies published from January 2018 to September 2019. Recent findings Thirty-three publications describing online interventions were included in the review, including web-based, blended care, telehealth, mHealth, and other online interventions. There was great heterogeneity across studies. The evidence of online interventions' effectiveness in reducing distress was mixed; there was partial support for reduction in psychological distress and depression, but limited evidence for reducing anxiety. Some important limitations should be taken into account when interpreting the results.
Current Opinion in Supportive & Palliative Care, 2019
Purpose of review The present review describes recent research on online psychosocial interventio... more Purpose of review The present review describes recent research on online psychosocial interventions for posttreatment cancer survivors from January 2018 to June 2019. Recent findings Twenty-three studies were included in the review (the majority included were feasibility studies and only five randomized controlled trials had large samples). Websites were the most common platforms for intervention delivery (9/23) and cognitive behavioral therapy was the most frequently used therapeutic approach (11/23). Three interventions based on this framework and delivered via websites or combined website-telehealth platforms showed to be effective in improving psychosocial issues (fear of cancer recurrence, insomnia, sleep quality, and prospective memory failures) in posttreatment cancer survivors. Web-based self-compassion writing was also found to be effective in addressing body image distress and body appreciation in breast cancer survivors. Feasibility studies mostly showed online interventi...
Medicine & Science in Sports & Exercise, 2019
Purpose Fatigue is a common and potentially disabling symptom in patients with cancer. It can oft... more Purpose Fatigue is a common and potentially disabling symptom in patients with cancer. It can often be effectively reduced by exercise. Yet, effects of exercise interventions might differ across subgroups. We conducted a meta-analysis using individual patient data of randomized controlled trials (RCT) to investigate moderators of exercise intervention effects on cancer-related fatigue. Methods We used individual patient data from 31 exercise RCT worldwide, representing 4366 patients, of whom 3846 had complete fatigue data. We performed a one-step individual patient data meta-analysis, using linear mixed-effect models to analyze the effects of exercise interventions on fatigue (z score) and to identify demographic, clinical, intervention- and exercise-related moderators. Models were adjusted for baseline fatigue and included a random intercept on study level to account for clustering of patients within studies. We identified potential moderators by testing their interaction with grou...
To evaluate the effects of exercise interventions on sleep disturbances and sleep quality in pati... more To evaluate the effects of exercise interventions on sleep disturbances and sleep quality in patients with mixed cancer diagnoses, and identify demographic, clinical, and intervention-related moderators of these effects. Methods Individual patient data (IPD) and aggregated meta-analyses of randomized controlled trials (RCTs). Using data from the Predicting OptimaL cAncer RehabIlitation and Supportive care project, IPD of 2173 adults (mean age = 54.8) with cancer from 17 RCTs were analyzed. A complementary systematic search was conducted (until November 2018) to study the overall effects and test the representativeness of analyzed IPD. Effect sizes of exercise effects on self-reported sleep outcomes were calculated for all included RCTs. Linear mixed-effect models were used to evaluate the effects of exercise on post-intervention outcome values, adjusting for baseline values. Moderator effects were studied by testing interactions for demographic, clinical and intervention-related characteristics. Results For all 27 eligible RCTs from the updated search, exercise interventions significantly decreased sleep disturbances in adults with cancer (g =-0.09, 95% CI [-0.16;-0.02]). No significant effect was obtained for sleep quality. RCTs included in IPD analyses constituted a representative sample of the published literature. The intervention effects on sleep disturbances were not significantly moderated by any demographic, clinical, or intervention-related factor, nor by sleep disturbances. Conclusions This meta-analysis provides some evidence that, compared to control conditions, exercise interventions may improve sleep disturbances, but not sleep quality, in cancer patients, although this effect is of a small magnitude. Among the investigated variables, none was found to significantly moderate the effect of exercise interventions on sleep disturbances.
Abstract The aim of this cross-sectional observational study was to investigate adherence rate an... more Abstract The aim of this cross-sectional observational study was to investigate adherence rate and factors influencing the adherence in following home-based activity advice, in patients referred to a physiotherapy clinic for non-specific low back pain. Research suggests that inadequate adherence to home-based activity advice during an intervention period may diminish treatment outcomes. Factors negatively influencing adherence appeared to be related to a person's beliefs and perceptions. Perceived barriers, low self-efficacy and unbeneficial illness beliefs have been consistent predictors for non-adherence across studies. 51 patients who reported non-specific low back pain were advised to walk daily. Physical activity was measured with a validated triaxial seismic accelerometer. The effect of multiple patient-related determinants on the rate of adherence was studied. Only four out of 51 patients (8%) fully adhered to the walking advice. In this study, there were no significant effects of patient-related determinants on the rate of adherence. Factors negatively influencing adherence behaviour were lack of time, weather conditions and increasing low back pain. In conclusion, patient adherence in following home-based activity advice for non-specific low back pain outside the clinical setting is poor.
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