Health-related quality of life and distress in cancer patients: results from a large randomised study Intensive lifestyle changes may affect the progression of prostate cancer. Addressing the needs of young breast cancer survivors at the 5 year milestone: can a short-term, low intensity intervention produce change? Randomized Controlled Trial of a Structured Training Program in Breast Cancer Patients with Tumor-Related Chronic Fatigue Change in self-efficacy partially mediates the effects of the FRESH START intervention on cancer survivors' dietary outcomes. Malignant melanoma. Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. A randomized trial to increase physical activity in breast cancer survivors. Adjustment to cancer in the 8 years following diagnosis: a longitudinal study comparing cancer survivors with healthy individuals. Main outcomes of the FRESH START trial: a sequentially tailored, diet and exercise mailed print intervention among breast and prostate cancer survivors. Design of FRESH START: a randomized trial of exercise and diet among cancer survivors. Quality of Life After Self-Management Cancer Rehabilitation: A Randomized Controlled Trial Comparing Physical and Cognitive-Behavioral Training Versus Physical Training Differences in Baseline Characteristics and Outcomes at 1- and 2-Year Follow-up of Cancer Survivors Accrued via Self-Referral versus Cancer Registry in the FRESH START Diet and Exercise Trial Active for Life After Cancer: a randomized trial examining a lifestyle physical activity program for prostate cancer patients. A Brief Intervention for Fatigue Management in Breast Cancer Survivors Long-term effects on cancer survivors’ quality of life of physical training versus physical training combined with cognitive-behavioral therapy: results from a randomized trial “Between Men”: A psychosocial rehabilitation programme for men with prostate cancer Leading the Way in Exercise and Diet (Project LEAD): intervening to improve function among older breast and prostate cancer survivors. Lifestyle and health-related quality of life of men with prostate cancer managed with active surveillance. Lifestyle intervention development study to improve physical function in older adults with cancer: outcomes from Project LEAD. "Between men": patient perceptions and priorities in a rehabilitation program for men with prostate cancer. Quality of life intervention for prostate cancer patients: design and baseline characteristics of the active for life after cancer trial. A multidimensional cancer rehabilitation program for cancer survivors: effectiveness on health-related quality of life. Motivational Interviewing to Increase Physical Activity in Long-Term Cancer Survivors: A Randomized Controlled Trial Clinical events in prostate cancer lifestyle trial: results from two years of follow-up. Improved physical fitness of cancer survivors: A randomised controlled trial comparing physical training with physical and cognitive-behavioural training Improving the quality of life of patients with prostate carcinoma The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: physical fitness and quality of life outcomes. Effects of a Step-by-Step Inpatient Rehabilitation Programme on Quality of Life in Breast Cancer Patients. A Prospective Randomised Study Cancer-Related Fatigue and Rehabilitation: A Randomized Controlled Multicenter Trial Comparing Physical Training Combined With Cognitive-Behavioral Therapy With Physical Training Only and With No Intervention
To compare the effectiveness of individual support , group rehabilitation and a combination of the two in improving health-related quality of life ( HRQOL ) and psychological well-being in cancer patients during 24 months after diagnosis , as compared with st and ard care ( SC ) . Furthermore , to compare the study sample and a r and om sample of the Swedish population with regard to HRQOL . A total of 481 consecutive patients , newly diagnosed with cancer , were r and omly assigned to one of the four alternatives . Data on HRQOL and psychological well-being were collected at baseline and after 3 , 6 , 12 and 24 months . The interventions did not improve HRQOL or psychological well-being , as compared with SC . At 3 months , the study sample reported an HRQOL comparable with the normal population . Many cancer patients are able to manage their cancer-related concerns with the support available from SC . However , it is reasonable to assume that the findings suffer from a lack of data from especially vulnerable patients and a possible Hawthorne effect . It can not be concluded that cancer patients have no need for additional psychosocial interventions . Future projects should include screening and target interventions for those at risk for significant and prolonged psychological distress PURPOSE Men with prostate cancer are often advised to make changes in diet and lifestyle , although the impact of these changes has not been well documented . Therefore , we evaluated the effects of comprehensive lifestyle changes on prostate specific antigen ( PSA ) , treatment trends and serum stimulated LNCaP cell growth in men with early , biopsy proven prostate cancer after 1 year . MATERIAL S AND METHODS Patient recruitment was limited to men who had chosen not to undergo any conventional treatment , which provided an unusual opportunity to have a nonintervention r and omized control group to avoid the confounding effects of interventions such as radiation , surgery or and rogen deprivation therapy . A total of 93 volunteers with serum PSA 4 to 10 ng/ml and cancer Gleason scores less than 7 were r and omly assigned to an experimental group that was asked to make comprehensive lifestyle changes or to a usual care control group . RESULTS None of the experimental group patients but 6 control patients underwent conventional treatment due to an increase in PSA and /or progression of disease on magnetic resonance imaging . PSA decreased 4 % in the experimental group but increased 6 % in the control group ( p = 0.016 ) . The growth of LNCaP prostate cancer cells ( American Type Culture Collection , Manassas , Virginia ) was inhibited almost 8 times more by serum from the experimental than from the control group ( 70 % vs 9 % , p < 0.001 ) . Changes in serum PSA and also in LNCaP cell growth were significantly associated with the degree of change in diet and lifestyle . CONCLUSIONS Intensive lifestyle changes may affect the progression of early , low grade prostate cancer in men . Further studies and longer term followup are warranted Background Today , the 5-year relative survival rate for cancer is 65 % and there are 10.5 million survivors . The largest group of survivors are those of breast cancer . Reductions in mortality are occurring at a greater rate for women under age 50 at diagnosis than among older women . Aims Our goal was to design a socio-educational intervention for 5-year survivors aged 50 or younger at diagnosis and test the hypotheses that women in the intervention group would show greater improvement than controls with respect to ( 1 ) knowledge of breast cancer , its treatment , and long-term health concerns ; ( 2 ) lifestyle habits ( i.e. , exercise and diet ) ; and ( 3 ) communication with family and physicians . Methods Using a r and omized controlled trial with a pre-post design , 404 women who were 5 years from diagnosis and cancer-free ( response rate 54 % ) were r and omly assigned to an intervention or delayed intervention ( control ) group and were assessed at pre-test ( baseline ) and 6 months later ( 96 % retention ) . The intervention consisted of three 6-h workshops over a 3 month period . Four series of workshops were held at different geographical areas in the greater San Francisco Bay Area . The workshops included activities and information to promote physical , social , emotional , and spiritual well-being . The intervention design was based on findings from focus groups and a survey of 185 cancer-free 5-year survivors that assessed changes since the early months after diagnosis in physical , social , emotional , and spiritual concerns ( response rate 73 % ) . Results Consistent with our first hypothesis , at post-test , women in the intervention group , on average , had greater knowledge regarding breast cancer , its treatment , and their own future health than did those in the control group ( p = 0.015 ) . Hypothesis 2 was partially supported as women in the intervention group were more likely than the control group to report an increased amount of physical activity ( p = 0.036 ) , but not significant dietary changes . Social support was related to increased self report of physical activity . With the exception of the last series of workshops , the intervention group did not report improved communications with family , friends , and physicians ( hypothesis 3 ) . Conclusions A short-term intervention can affect knowledge levels and physical activity but not diet or communication in the family . Implication s for Cancer SurvivorsThe intervention was related to greater knowledge related to breast cancer , and increased report of physical activity . The program was not related to changes in reported diet or family communication Cancer-related fatigue is the most disabling symptom experienced by breast cancer patients following the cancer treatment . The positive effects of physical activity in the rehabilitation of breast cancer patients are documented in several studies . In a r and omized controlled study the effects of a structured physical training program on fatigue and health-related quality of life were evaluated . Patients and Methods : 63 breast cancer patients with cancer-related chronic fatigue were r and omized at the beginning of the inpatient rehabilitation . The control group received the st and ard complex rehabilitation program , the intervention group a structured physical training program and additional muscle strength and aerobic exercises . The effects of the treatment were evaluated by question naires at the start of rehabilitation ( t1 ) , end of rehabilitation ( t2 ) , and 3 months after t2 ( t3 ) . Isometric muscle strength and aerobic capacity were evaluated at t1 and t2 . Results : There was an improvement of muscle strength at the end of rehabilitation for both groups . The increase from t1 to t2 was significantly higher for the training group . The scores for global quality of life , physical well-being , and functionality increased from t1 to t2 , but further improvement in the follow-up ( t3 ) was only observed in the training group . The cancer-related fatigue was significantly reduced in the training group from t1 to t3 , however , not in the control group . Conclusions : Structured physical training programs initiated during inpatient rehabilitation and continuously practice d in the time thereafter can improve symptoms of chronic fatigue and quality of life in breast cancer patients OBJECTIVE This study examined change in self-efficacy as a mediator of the effects of a mailed print intervention on the dietary and exercise practice s of newly diagnosed breast and prostate cancer survivors . METHOD A total of 543 breast and prostate cancer patients were recruited from 39 states and two provinces within North America . Participants were r and omly assigned to receive a 10-month program of tailored mailed print material s that aim ed to increase fruit and vegetable consumption , reduce fat intake , and /or increase exercise or a 10-month program of publically available material s on diet and exercise . Telephone surveys conducted at baseline and 1 year assessed dietary practice s , physical activity , and self-efficacy for engaging in these health behaviors . RESULTS Results indicated that changes in self-efficacy for fat restriction and eating more fruits and vegetables were significant mediators of the intervention 's effects on dietary outcomes at 1-year follow-up . The intervention did not significantly affect self-efficacy for exercise ; however , a significant , positive relationship was found between self-efficacy for exercise and exercise duration at follow-up . CONCLUSIONS Findings are largely consistent with Social Cognitive Theory and support the use of strategies to increase self-efficacy in health promotion interventions for cancer survivors OBJECTIVES We evaluated recurrence and survival for 68 patients with malignant melanoma who participated in a 6-week structured psychiatric group intervention 5 to 6 years earlier , shortly after their diagnosis and initial surgical treatment . We also explored the role of several factors as possible predictors of outcome . DESIGN This was a r and omized controlled experimental study . The Cox proportion hazards regression model was used to quantify the relationship between treatment and the outcomes adjusted by the covariates ( age , sex , Breslow depth , tumor site , baseline Profile of Mood States Total Mood Disturbance , baseline active-behavioral coping , baseline natural killer cell activity , and treatment [ ie , group intervention ] ) . The stepwise procedure was used for covariate selection . RESULTS For control patients , there was a trend for recurrence ( 13/34 ) and a statistically significant greater rate of death ( 10/34 ) than for experimental patients ( 7/34 and 3/34 , respectively ) . We found that being male and having a greater Breslow depth predicted greater recurrence and poorer survival . Analysis of multiple covariates found that only Breslow depth and treatment ( ie , group intervention ) were significant . Adjusting for Breslow depth , treatment effect remained significant . Finally , baseline affective distress and baseline coping were significant psychobehavioral predictors for recurrence and survival . Surprisingly , higher levels of baseline distress as well as baseline coping and enhancement of active-behavioral coping over time were predictive of lower rates of recurrence and death . CONCLUSION Psychiatric interventions that enhance effective coping and reduce affective distress appear to have beneficial effects on survival but are not proposed as an alternative or independent treatment for cancer or any other illness or disease . However , the exact nature of this relationship warrants further investigation PURPOSE Interventions to increase physical activity among breast cancer survivors are needed to improve health and quality of life and possibly to reduce the risk of disease recurrence and early mortality . Therefore , we report the feasibility and preliminary outcomes of a pilot r and omized trial design ed to increase physical activity in sedentary breast cancer survivors receiving hormone therapy . METHODS Forty-one sedentary women on estrogen receptor modulators or aromatase inhibitors for stage I , II , or IIIA breast cancer were r and omly assigned to receive a 12-wk multidisciplinary physical activity behavior change intervention or usual care . RESULTS Recruitment was 34 % , intervention adherence was 99 % , and complete follow-up data were obtained on 93 % . Most participants ( 93 % ) were white with mean age of 53 + /- 9 yr . Differences favoring the intervention group were noted for accelerometer physical activity counts ( mean difference = 72,103 ; 95 % confidence interval ( CI ) = 25,383 - 119,000 ; effect size ( d ) = 1.02 ; P = 0.004 ) , aerobic fitness ( mean difference = 2.9 ; 95 % CI = -0.1 to 5.8 ; d = 0.64 ; P = 0.058 ) , back/leg muscle strength ( mean difference = 12.3 ; 95 % CI = 0.4 - 15.9 ; d = 0.81 ; P = 0.017 ) , waist-to-hip ratio ( mean difference = -0.05 ; 95 % CI = -0.01 to -0.08 ; d = -0.77 ; P = 0.018 ) , and social well-being ( mean difference = 2.0 ; 95 % CI = 0.3 - 3.8 ; d = 0.76 ; P = 0.03 ) . However , the intervention group also reported a greater increase in joint stiffness ( mean difference = 1.1 ; 95 % CI = 0.1 - 2.2 ; d = 0.70 ; P = 0.04 ) . CONCLUSIONS A behavior change intervention for breast cancer survivors based on the social cognitive theory is feasible and results in potentially meaningful improvements in physical activity and selected health outcomes . Confirmation in a larger study is warranted This longitudinal study examined the long-term impact of a diagnosis of cancer on physical and psychological functioning , by comparing 8-year cancer survivors ( n = 206 ) to a r and omly selected sample of similar-aged references without cancer ( n = 120 ) in the Netherl and s. Comparisons were made at three fixed points in time : 3 months ( T1 ) , 15 months ( T2 ) , and 8 years ( T3 ) after diagnosis . The results showed that , at 8 years after diagnosis , cancer survivors and references do not differ significantly in the level of depressive symptoms , anxiety , life satisfaction , self-esteem , social support , and marital satisfaction . However , survivors reported more physical symptoms , and those with a recurrence of cancer also reported more limitations in household and social activities . Most improvements in functioning were found in the year following diagnosis . Intriguingly , we found no evidence that cancer survivors experienced more positive changes in the self , relationships , or life in general than references , even though many cancer survivors attributed these changes to the cancer experience . In the discussion , we address the role of finding positive meaning in the process of adjustment to cancer PURPOSE Cancer survivors are at increased risk for cardiovascular disease , diabetes , osteoporosis , and second primary tumors . Healthful lifestyle practice s may improve the health and well-being of survivors . The FRESH START trial tested the efficacy of sequentially tailored versus st and ardized mailed material s on improving cancer survivors ' diet and exercise behaviors . METHODS Five hundred forty-three individuals with newly diagnosed locoregional breast or prostate cancer were recruited from 39 states and two provinces within North America . Participants were r and omly assigned either to a 10-month program of tailored mailed print material s promoting fruit and vegetable ( F&V ) consumption , reducing total/saturated fat intake , and /or increasing exercise or to a 10-month program of nontailored mailed material s on diet and exercise available in the public domain . Telephone surveys conducted at baseline and 1 year assessed body mass index ( BMI ) , dietary consumption , physical activity , and other psychosocial/behavioral indices . Clinical assessment s were conducted on a 23 % sub sample ; information was used to vali date self-reports . RESULTS Five hundred nineteen participants completed the 1-year follow-up ( 4.4 % attrition ; sample characteristics : 57 + /- 10.8 years old , 83 % white , 56 % female , 64 % overweight/obese , and 0 % underweight ) . Although both arms significantly improved their lifestyle behaviors ( P < .05 ) , significantly greater gains occurred in the FRESH START intervention versus the control arm ( practice of two or more goal behaviors : + 34 % v + 18 % , P < .0001 ; exercise minutes per week : + 59.3 v + 39.2 minutes , P = .02 ; F&V per day : + 1.1 v + 0.6 servings , P = .01 ; total fat : -4.4 % v -2.1 % , P < .0001 ; saturated fat : -1.3 % v -0.3 % , P < .0001 ; and BMI : -0.3 v + 0.1 kg/m2 , respectively , P = .004 ) . CONCLUSION Mailed material interventions , especially those that are tailored , are effective in promoting healthful lifestyle changes among cancer survivors . Further study is needed to determine sustainability , cost to benefit , and generalizability to other cancer population PURPOSE FRESH START is a r and omized controlled trial that will test whether a personally tailored , distance-medicine-based program will increase exercise and fruit and vegetable consumption , and decrease fat intake of individuals recently diagnosed with breast or prostate cancer . METHODS Early-stage breast and prostate cancer cases ( N= 530 ) will be identified within 9 months of diagnosis from hospital cancer registries and large oncologic practice s throughout the United States . These individuals will be sent a letter of invitation and screened for eligibility . After a baseline telephone interview , participants will be r and omized into one of two arms that receive material s aim ed at increasing exercise and fruit and vegetable intake , and decreasing dietary fat : 1 ) . an experimental arm that receives a workbook and a series of six 4-page newsletters delivered every 7 wk and personally tailored on type of cancer , cancer coping style , race , age , self-efficacy , stage of readiness , and barriers and /or progress toward goal behavior ( i.e. , > or= 30 min of exercise at least 5 d.wk , > or= 5 servings of vegetables and fruit per day , and < or= 30 % of calories from fat ) ; or 2 ) . a control arm that receives a series of nontailored health brochures . Follow-up interviews scheduled 1 and 2 yr postbaseline will determine short- and long-term efficacy and the effects of the interventions on other endpoints ( quality of life , perceived health , etc . ) . Factors , such as gender , race , and social support , also will be explored to determine potential interactions with program efficacy . CONCLUSION Given the growing number of cancer survivors , distance-medicine-based interventions addressing multiple behaviors and targeting this high-risk group have the potential to make a positive and broad public health impact Objective : To conduct a r and omized controlled trial and compare the effects on cancer survivors ’ quality of life in a 12-week group-based multidisciplinary self-management rehabilitation program , combining physical training ( twice weekly ) and cognitive-behavioral training ( once weekly ) with those of a 12-week group-based physical training ( twice weekly ) . In addition , both interventions were compared with no intervention . Methods : Participants ( all cancer types , medical treatment completed ≥3 months ago ) were r and omly assigned to multidisciplinary rehabilitation ( n = 76 ) or physical training ( n = 71 ) . The nonintervention comparison group consisted of 62 patients on a waiting list . Quality of life was measured using the R AND -36 . The rehabilitation groups were measured at baseline , after rehabilitation , and 3-month follow-up , and the nonintervention group was measured at baseline and 12 weeks later . Results : The effects of multidisciplinary rehabilitation did not outperform those of physical training in role limitations due to emotional problem ( primary outcome ) or any other domains of quality of life ( all p > .05 ) . Compared with no intervention , participants in both rehabilitation groups showed significant and clinical ly relevant improvements in role limitations due to physical problem ( primary outcome ; effect size ( ES ) = 0.66 ) , and in physical functioning ( ES = 0.48 ) , vitality ( ES = 0.54 ) , and health change ( ES = 0.76 ) ( all p < .01 ) . Conclusions : Adding a cognitive-behavioral training to group-based self-management physical training did not have additional beneficial effects on  cancer survivors  ’ quality of life . Compared with the nonintervention group , the group-based self-management rehabilitation improved cancer survivors ’ quality of life . PT = physical training ; CBT = cognitive-behavioral training ; PT+CBT = physical training plus cognitive-behavioral training ; WLC = waiting-list comparison ; QoL = quality of life ; ANOVA = analysis of variance ; ES = effect size Participant accrual to research studies is a challenge ; oftentimes , advertisements are used to supplement cases ascertained through clinic caseloads and cancer registries . It is unknown , however , if cases ascertained through these two sources differ . In this study , we compared self-referred ( n = 209 ) and registry-ascertained ( n = 334 ) participants enrolled in FRESH START , a r and omized controlled trial promoting a healthy diet and increased exercise among breast and prostate cancer survivors . The two groups were compared on baseline characteristics , adherence , attrition , and outcomes by study arm . Compared with participants enrolled from registries , self-referrals were significantly younger ( 54.1 ± 10.4 versus 58.7 ± 10.7 years ) , more likely to have later-stage disease and to have received chemotherapy ( 40 % versus 19 % ) , and more likely to report “ fighting spirit ” coping styles ( 50 % versus 30 % ) , lower quality -of-life ( 88.2 ± 15.1 versus 92.0 ± 12.9 ) , fewer comorbid conditions ( 1.87 ± 1.60 versus 2.24 ± 1.78 ) , and lower consumption of five or more daily servings of fruits and vegetables ( 35 % versus 45 % ; P values < 0.05 ) . Although no differences in behavior change were observed between self-referred and registry-ascertained cases assigned to the tailored intervention arm , this was not the case within the attention control arm . Among those who received the attention control intervention of st and ardized material s in the public domain , self-referred versus registry-ascertained participants showed significantly greater increases in exercise at 1-year follow-up and significantly greater increases in fruit and vegetable consumption at both 1- and 2-year follow-up ( P values < 0.05 ) . Several differences exist between self-referred and registry-ascertained participants , including motivation to respond to st and ardized educational material s , which appears significantly greater in self-referred population s. ( Cancer Epidemiol Biomarkers Prev 2008;17(5):1288–94 BACKGROUND Active for Life After Cancer is a r and omized trial evaluating the efficacy of a 6-month group-based lifestyle physical activity program ( Lifestyle ) for prostate cancer patients to improve quality of life ( QOL ) including physical and emotional functioning compared to a group-based Educational Support Program and a St and ard Care Program ( no group ) . METHOD A total of 134 prostate cancer patients receiving continuous and rogen-ablation were r and omly assigned to one of the three study conditions . RESULTS Results indicated no significant improvements in QOL at 6 or 12 months . Both group-based programs were positively received and yielded good attendance and retention . Lifestyle participants demonstrated significant improvements in most theoretical mediators proposed by the Transtheoretical Model and Social Cognitive Theory to affect physical activity . Despite these improvements , no significant changes were found for most physical activity measures . CONCLUSIONS Results suggest a lifestyle program focusing on cognitive-behavioral skills training alone is insufficient for promoting routine physical activity in these patients The purpose of this r and omized control trial was to verify the effectiveness of a brief group intervention that combines stress management psycho-education and physical activity ( ie , independent variable ) intervention in reducing fatigue and improving energy level , quality of life ( mental and physical ) , fitness ( VO2submax ) , and emotional distress ( ie , dependent variables ) in breast cancer survivors . This study applied Lazarus and Folkman stress-coping theoretical framework , as well as Salmon 's unifying theory of physical activity . Eighty-seven French-speaking women who had completed their treatments for nonmetastatic breast cancer at a university hospital in Quebec City , Canada , were r and omly assigned to either the group intervention ( experimental ) or the usual-care ( control ) condition . Data were collected at baseline , postintervention , and at 3-month follow-up . The 4-week group intervention was cofacilitated by 2 nurses . Results showed that participants in the intervention group showed greater improvement in fatigue , energy level , and emotional distress at 3-month follow-up , and physical quality of life at postintervention , compared with the participants in the control group . These results suggest that a brief psycho-educational group intervention focusing on active coping strategies and physical activity is beneficial to cancer survivors after breast cancer treatments Background We compared the effect of a 12-week group-based multidisciplinary self-management rehabilitation program , combining physical training ( twice weekly ) and cognitive-behavioral therapy ( once weekly ) with the effect of 12-week group-based physical training ( twice weekly ) on cancer survivors ’ quality of life  over a 1-year period . Material s and methods One hundred forty-seven survivors [ 48.8 ± 10.9 years ( mean ± SD ) , all cancer types , medical treatment ≥3 months ago ] were r and omly assigned to either physical training ( PT , n = 71 ) or to physical training plus cognitive-behavioral therapy ( PT + CBT , n = 76 ) . Quality of life and physical activity levels were measured before and immediately after the intervention and at 3- and 9-month post-intervention using the European Organization for Research and Treatment of Cancer Quality of Life Question naire C30 question naire and the Physical Activity Scale for the Elderly , respectively . Results Multilevel linear mixed-effects models revealed no differential pattern in change of quality of life and physical activity between PT and PT + CBT . In both PT and PT + CBT , quality of life and physical activity were significantly and clinical ly relevantly improved immediately following the intervention and also at 3- and 9-month post-intervention compared to pre-intervention ( p < 0.001 ) . ConclusionS elf-management physical training had substantial and durable positive effects on cancer survivors ’ quality of life . Participants maintained physical activity levels once the program was completed . Combining physical training with our cognitive-behavioral intervention did not add to these beneficial effects of physical training neither in the short-term nor in the long-term . Physical training should be implemented within the framework of st and ard care for cancer survivors The aim of this study was to evaluate the effect of  psychosocial rehabilitation  on newly diagnosed prostate cancer patients . The “ Between Men ” programme consisted of seven weekly sessions of physical training ( Phys ) alone , information ( Info ) alone or physical training plus information ( PhysInfo ) .  After diagnoses , patients ( n = 211 ) were consecutively included , stratified and r and omised to one of four groups : Phys , Info , PhysInfo or st and ard care control ( C ) . A nurse specialised in urology , an urologist and a physiotherapist performed the interventions . Patients were followed up during one year with mailed st and ardised question naires . It could not be assumed that the “ Between Men ” programme had any effect on patients ’ anxiety and depression ( HADS ) . Health-related quality of life ( HRQOL ) was associated with stage of disease but not with psychosocial intervention . Thus , Physical Function ( PF ) , Role Function ( RF ) and Fatigue ( FA ) were inferior among patients with , than without , metastases of prostate cancer both at baseline and at the 12-month follow-up . This r and omized study did not demonstrate any significant effect of psychosocial rehabilitation  among prostate cancer patients . Considering the low rate ( 1/2 ) , of included/eligible patients a less complicated design ( intervention versus control ) would have been preferred in order to increase power The U.S. population is aging , bringing with it an increased prevalence of chronic disease and concomitant declines in physical function . The risk of developing cancer increases significantly with age , and functional decline is much more likely once a cancer diagnosis is rendered . Thus , functional status in later life is a key concern , one that is heightened among elders who have been diagnosed with cancer . To date , however , there have been few trials that have exclusively addressed issues related to cancer survivorship among older cancer patients , and to our knowledge , none has focused on preserving or enhancing physical functioning . This paper describes the study design and method ological considerations of a r and omized controlled trial to determine if a personally tailored workbook and telephone counseling program can positively affect physical activity and dietary behaviors and ultimately the physical functioning of up to 420 older men and women newly diagnosed with breast or prostate cancer . This trial is unique because the cancer diagnosis is used not only as a marker of risk for functional decline , but also as a " teachable moment " - an opportune time when elders may be more receptive to making beneficial lifestyle changes . Undoubtedly , as cure rates for cancer increase and intersect with ever-growing numbers of elderly , there will be numerous opportunities to provide and test interventions within this vulnerable population and to target functional status as a primary outcome . In reporting our methods , we hope to give others " a leg up , " so that they can hurdle with greater ease the barriers we experienced , and thus advance the field more rapidly OBJECTIVES To assess the impact of lifestyle on health-related quality of life ( HR-QOL ) , perceived stress , and self-reported sexual function in men with early-stage prostate cancer electing active surveillance . METHODS A total of 44 intervention and 49 usual-care control participants were enrolled in a r and omized clinical trial examining the effects of lifestyle changes on prostate cancer progression . The intervention consisted of a low-fat , vegan diet , exercise , and stress management . Participants completed the Medical Outcomes Study Short Form-36 Health Status Survey ( a measure of mental and physical HR-QOL ) , the Perceived Stress Scale , the Sexual Function subscale of the University of California , Los Angeles , Prostate Cancer Index , and  measures of lifestyle behaviors  ( to yield an overall lifestyle  index ) at baseline and 12 months . The data were analyzed using analysis of variance for repeated measures . The relationship between lifestyle and QOL was also analyzed using multiple linear regression analyses . RESULTS Intervention participants had significantly improved their lifestyle compared with controls at 12 months . The quality -of-life scores were high across groups and time points . However , a healthier lifestyle was related to better QOL at baseline . Participants in both groups who reported a healthier lifestyle also reported better mental and physical HR-QOL and sexual function . Furthermore , participants whose lifestyle improved over time showed enhanced physical HR-QOL and decreased perceived stress . CONCLUSIONS Men who choose active surveillance for early-stage prostate cancer are able to make comprehensive lifestyle changes . Although the average QOL was already high in this sample , individuals who improved their lifestyle enhanced their QOL further PURPOSE Declines in physical functioning ( PF ) among elderly cancer patients threaten quality of life and the ability to maintain independence . Adherence to healthy lifestyle behaviors may prevent functional decline . PATIENTS AND METHODS Project Leading the Way in Exercise and Diet ( LEAD ) , an intervention development study of the Pepper Older Americans Independence Center , aim ed to determine whether breast and prostate cancer survivors ( age 65 + years ) assigned to a 6-month home-based diet and exercise intervention  experienced improvements in PF when compared with an attention control arm receiving general health information . An accrual target was set at 420 , and PF ( Short Form-36 subscale ) , physical activity ( Community Healthy Activities Models Program for Seniors ) , and diet quality ( index from 3-day recalls ) were assessed at baseline and at 6 and 12 months ( 6 months after intervention ) . RESULTS This developmental project did not achieve its accrual target ( N = 182 ) ; however , PF change scores were in the direction and of the magnitude projected . Baseline to 6-month change scores in the intervention versus the control arms were as follows : PF , + 3.1 v -0.5 ( P = .23 ) ; physical activity energy expenditure , + 111 kcal/wk v -400 kcal/wk ( P = .13 ) ; and diet quality index , + 2.2 v -2.9 ( P = .003 ) , respectively . Differences between arms diminished during the postintervention period . CONCLUSION These findings suggest that home-based diet and exercise interventions hold promise in improving lifestyle behaviors among older cancer survivors , changes that trend toward improved PF . Future studies should incorporate larger sample sizes and interventions that sustain long-term effects and also take into account secular trends ; these efforts will require adequate planning and re sources to overcome the numerous barriers to intervening in this difficult to reach yet vulnerable population The objective of the study is to compare consumer aspects of an informative , a physical , and a combined informative and physical rehabilitation program included in the " Between men " project for newly diagnosed prostate cancer patients . A consecutive series of patients was r and omized . Programs were especially developed for prostate cancer patients . The format was 7 weekly sessions . The results show that the perceived benefits of relaxation was greater in the combination group than in the physical training group only . In comparison with the physical group more patients in the informative groups ( information and information+physical training ) rated the knowledge received as very important . The majority of patients ( 90 % ) was of the opinion that the " Between men " programs , should be continued . Independent of the actual program given , patients opted for the combination program or information alone but not the physical training alone program Prostate cancer patients receiving and rogen ablation therapy  experience significant physical and psychological sequelae associated with their disease and treatment . Because physical activity improves physical and psychological well-being , a lifestyle physical activity intervention may help slow or reverse the associated decline in quality of life ( QOL ) . No studies have evaluated an intervention to improve multiple QOL domains in patients receiving and rogen ablation therapy . Active for Life After Cancer is a three-group r and omized controlled trial design ed to evaluate the effectiveness of a lifestyle physical activity intervention ( Lifestyle Program ) in improving QOL . The Lifestyle Program , a 6-month behavioral skills training group , is compared to an Educational Support Program and St and ard Care . The purpose of this paper is to describe the design of the r and omized trial and present baseline data that will characterize the QOL of the sample . Challenges to recruitment for the trial also will be presented and discussed OBJECTIVE A multidimensional rehabilitation program for cancer survivors was developed to overcome cancer-related problems and to improve quality of life . The two purpose s of the study were to describe the effectiveness of the program and to obtain information about patient preferences for multi or mono dimensional rehabilitation programs . METHODS SUBJECTS cancer survivors with different diagnoses , and cancer-related physical and psychosocial problems . INTERVENTION a 15-week rehabilitation program including individual exercise , sports , psycho-education , and information . Group-wise r and omization was implemented by assigning one half of the patients to the complete program while the other half were allowed to choose which program components they considered relevant . MEASURES Health-Related Quality of Life [ R AND -36 and Rotterdam Symptom Check List ( RSCL ) ] , exercise capacity ( symptom limited bicycle ergometry ) , muscle force ( h and -held dynamometry ) , and patient preferences . Measurements were performed before ( T0 ) and after the rehabilitation program ( T1 ) , and at a 3-month follow-up ( T2 ) . RESULTS After the rehabilitation program , cancer survivors ( n=63 ) displayed statistically significant improvements on health-related quality of life with effect sizes ( ES ) varying from 0.38 to 0.99 ( R AND -36 ) and from -0.34 to -0.57 ( RSCL ) , most persistent at 3-month follow-up . Furthermore , statistically significant improvements in exercise capacity and muscle force of upper and lower extremities were displayed after rehabilitation . If offered a choice , 80 % of the patients prior to start and 58 % of the patients after completion of the program indicated that they preferred the entire multidimensional program . CONCLUSION A multidimensional rehabilitation program has statistically and clinical ly relevant beneficial effects on health-related quality of life , exercise capacity , and muscle force in cancer patients with different diagnoses . Furthermore , if offered the choice , the majority of cancer survivors seem to prefer multidimensional programs to programs with only one component Background : Physical activity can confer many benefits on cancer survivors , including relief of persistent symptoms related to cancer treatment . Objectives : To evaluate the effect of a motivational interviewing ( MI ) intervention on increasing physical activity ( Community Healthy Activities Model Program for Seniors question naire ) and improving aerobic fitness ( 6-minute walk ) , health ( Medical Outcomes Study Short-Form 36 ) , and fatigue ( Schwartz Cancer Fatigue Scale ) in cancer survivors . A secondary purpose was to evaluate whether the effect of MI on physical activities depended on self-efficacy . Methods : Fifty-six physically inactive adult cancer survivors ( mean = 42 months since completion of treatment ) were assigned r and omly to intervention and control groups . The MI intervention consisted of one in-person counseling session followed by two MI telephone calls over 6 months . Control group participants received two telephone calls without MI content . Outcomes were measured at baseline , 3 months , and 6 months , and were analyzed using multilevel modeling . Results : The results of the MI intervention explained significant group differences in regular physical activities ( measured in caloric expenditure per week ) , controlling for time since completion of cancer treatment ( p < .05 ) . Aerobic fitness , physical and mental health , and fatigue were not different between groups . In the intervention group , individuals with high self-efficacy for exercise at baseline increased their physical activity more than those with low self-efficacy ( p < .05 ) . In the control group , increases in physical activity did not depend on self-efficacy . Discussion : Use of MI may increase physical activity in long-term cancer survivors , especially in persons with high self-efficacy for exercise . Multilevel modeling analysis revealed individual changes that would not have been shown by analysis of group means . Future studies with larger sample s or more intense MI interventions may show changes in aerobic fitness , physical and mental health , and fatigue OBJECTIVES Previous research has demonstrated that patients with prostate cancer participating in the Prostate Cancer Lifestyle Trial had a reduction in prostate-specific antigen ( PSA ) levels , inhibition of LNCaP cell growth , and fewer prostate cancer-related clinical events at the end of 1 year compared with controls . The aim of this study was to examine the clinical events in this trial during a 2-year period . METHODS The Prostate Cancer Lifestyle Trial was a 1-year r and omized controlled clinical trial of 93 patients with early-stage prostate cancer ( Gleason score < 7 , PSA 4 - 10 ng/mL ) undergoing active surveillance . The patients in the experimental arm were encouraged to adopt a low-fat , plant-based diet , to exercise and practice stress management , and to attend group support sessions . The control patients received the usual care . RESULTS By 2 years of follow-up , 13 of 49 ( 27 % ) control patients and 2 of 43 ( 5 % ) experimental patients had undergone conventional prostate cancer treatment ( radical prostatectomy , radiotherapy , or and rogen deprivation , P < .05 ) . No differences were found between the groups in other clinical events ( eg , cardiac ) , and no deaths occurred . Three of the treated control patients but none of the treated experimental patients had a PSA level of > or=10 ng/mL , and 1 treated control patient but no treated experimental patients had a PSA velocity of > 2 ng/mL/y before treatment . No significant differences were found between the untreated experimental and untreated control patients in PSA change or velocity at the end of 2 years . CONCLUSIONS Patients with early-stage prostate cancer choosing active surveillance might be able to avoid or delay conventional treatment for at least 2 years by making changes in their diet and lifestyle We compared the effect of a group-based 12-week supervised exercise programme , i.e. aerobic and resistance exercise , and group sports , with that of the same programme combined with cognitive-behavioural training on physical fitness and activity of cancer survivors . One hundred and forty seven cancer survivors ( all cancer types , medical treatment ≥3 months ago ) were r and omly assigned to physical training ( PT , n=71 ) or PT plus cognitive-behavioural training ( PT+CBT , n=76 ) . Maximal aerobic capacity , muscle strength and physical activity were assessed at baseline and post-intervention . Analyses using multilevel linear mixed-effects models showed that cancer survivors ’ physical fitness increased significantly in PT and PT+CBT from baseline to post-intervention . Changes did not differ between PT and PT+CBT . Physical fitness of cancer survivors was improved following an intensive physical training programme . Adding a structured cognitive-behavioural intervention did not enhance the effect Treatments for clinical ly localized prostate carcinoma are accompanied by sexual , urinary , and bowel dysfunction and other sequelae that can result in significant distress and reduced well being . Methods capable of improving quality of life are needed that can be integrated into clinical practice . To address this need , a nurse‐driven , cancer care intervention was developed and tested Physical exercise has been shown to enhance quality of life ( QOL ) in cancer survivors using pretest-posttest design s and compared to usual care ( i.e. no intervention ) . In the present study , we conducted a r and omized controlled trial to determine if exercise could improve QOL in cancer survivors beyond the known benefits of group psychotherapy ( GP ) . We matched 22 GP classes ( N=108 ) on content and then r and omly assigned 11 ( n=48 ) to GP alone and 11 ( n=60 ) to GP plus home-based , moderate-intensity exercise ( GP+EX ) . Participants completed a physical fitness test and QOL measures ( e.g. Functional Assessment of Cancer Therapy scales ) at the beginning and end of GP classes ( about 10 weeks ) . We had excellent recruitment ( 81 % ) , retention ( 89 % ) , and adherence ( 84 % ) rates and a modest contamination ( 22 % ) rate . Using intention-to-treat repeated measures analyses of variance , we found significant Time by Condition interactions for functional well-being , fatigue , and sum of skinfolds . We also found borderline significant interactions for physical well-being , satisfaction with life , and flexibility . All interactions favored the GP+EX condition . We conclude that a home-based , moderate intensity exercise program may im-prove QOL in cancer survivors beyond the benefits of GP , particularly in relation to physical and functional well-being The aim of this study was to compare a conventional oncological inpatient rehabilitation programme with an inpatient step-by-step rehabilitation programme with regard to quality of life in breast cancer patients . Patients and Methods : Women with the diagnosis of breast cancer were r and omly assigned to either the step-by-step programme ( group A : 3-week rehabilitation plus 4 and 8 months later a 1-week sojourn each time ) or the conventional rehabilitation programme ( group B : 4- week stay and no further interventions afterwards ) . Quality of life was assessed with the QLQ-C30 of the EORTC at t0 ( beginning of the study ) , t1 ( end of 3- or 4-week stay ) and t2 ( 12 months after t0 , end of study ) . Results : Between t0 and t1 , a tendency ( 0.1 > p = 0.05 ) could be shown in group B towards better improvement in global quality of life and emotional function . In the subgroup of patients that had impaired functions of quality of life at t0 , superiority in group B reached significance ( p < 0.05 ) for emotional and cognitive function at t1 . Between t1 and t2 , cognitive function improved further in group A , but diminished in group B. For the subgroup of patients with impaired cognitive function at t0 , this difference between both groups became significant ( p = 0.0098 ) . Conclusions : Although not generally superior to conventional inpatient rehabilitation programmes , the analysed stepby- step rehabilitation provided marked benefits for patients with cognitive impairments Background Research suggests that cancer rehabilitation reduces fatigue in survivors of cancer . To date , it is unclear what type of rehabilitation is most beneficial . Objective This r and omized controlled trial compared the effect on cancer-related fatigue of physical training combined with cognitive behavioral therapy with physical training alone and with no intervention . Design In this multicenter r and omized controlled trial , 147 survivors of cancer were r and omly assigned to a group that received physical training combined with cognitive-behavioral therapy ( PT+CBT group , n=76 ) or to a group that received physical training alone ( PT group , n=71 ) . In addition , a nonintervention control group ( WLC group ) consisting of 62 survivors of cancer who were on the waiting lists of rehabilitation centers elsewhere was included . Setting The study was conducted at 4 rehabilitation centers in the Netherl and s. Patients All patients were survivors of cancer . Intervention Physical training consisting of 2 hours of individual training and group sports took place twice weekly , and cognitive-behavioral therapy took place once weekly for 2 hours . Measurements Fatigue was assessed with the Multidimensional Fatigue Inventory before and immediately after intervention ( 12 weeks after enrollment ) . The WLC group completed question naires at the same time points . Results Baseline fatigue did not differ significantly among the 3 groups . Over time , levels of fatigue significantly decreased in all domains in all groups , except in mental fatigue in the WLC group . Analyses of variance of postintervention fatigue showed statistically significant group effects on general fatigue , on physical and mental fatigue , and on reduced activation but not on reduced motivation . Compared with the WLC group , the PT group reported significantly greater decline in 4 domains of fatigue , whereas the PT+CBT group reported significantly greater decline in physical fatigue only . No significant differences in decline in fatigue were found between the PT+CBT and PT groups . Conclusions Physical training combined with cognitive-behavioral therapy and physical training alone had significant and beneficial effects on fatigue compared with no intervention . Physical training was equally effective as or more effective than physical training combined with cognitive-behavioral therapy in reducing cancer-related fatigue , suggesting that cognitive-behavioral therapy did not have additional beneficial effects beyond the benefits of physical training
BACKGROUND Multidimensional rehabilitation programmes ( MDRPs ) have developed in response to the growing number of people living with and surviving cancer .
MDRPs comprise a physical component and a psychosocial component .
Studies of the effectiveness of these programmes have not been review ed and synthesis ed .
OBJECTIVES To conduct a systematic review of studies examining the effectiveness of MDRPs in terms of maintaining or improving the physical and psychosocial well-being of adult cancer survivors .