Do Adult Survivors of Cancer Benefit from Increasing Their Physical Activity?

May 20th, 2021 in Hot Topics, International News

Author: Karen Kane McDonnell PhD, RN, Associate Professor, Co-Director, Cancer Survivorship Center, College of Nursing, University of South California, United States

Survivors of cancer should avoid inactivity and be as physically active as possible (Campbell et al., 2019); however, exercise remains underutilized in cancer care programs.

Physical activity (PA) is an important behavior for the prevention and management of numerous acute and chronic diseases (Courneya & Friedenreich, 2010). The number of cancer survivors is rising worldwide, propelled by advances in early detection and treatment and the aging of the population. The predicted global cancer burden is expected to exceed 27 million new cancer cases per year by 2040, a 50% increase in the estimated number of new cancer cases in 2018 (Wild, Weiderpass, & Stewart, 2020). Many cancer survivors are motivated to seek information and advice about PA to improve their response to treatment, facilitate recovery, reduce their risk of recurrence, and improve their quality of life (QOL) (Rock et al., 2012).

Exercise is defined as “a physical activity causing an increase in energy expenditure and involving a planned or structured movement of the body performed in a systematic manner in terms of frequency, intensity, and duration, and designed to maintain or enhance health-related outcomes” (Campbell et al., 2019). For over five decades, PA has been tested as an intervention strategy to help survivors with cancer prepare for, manage side effects of, and recover after treatments. The field that considers PA and cancer survivorship together—exercise oncology—has exploded. The literature now contains thousands of studies about the effects of PA in survivors of cancer; these studies have, in turn, generated dozens of systematic reviews, several sets of international guidelines, and calls for the integration of PA programs into clinical and community cancer care (Courneya, 2017).

PA recommendations vary across the cancer continuum and remain an important area of research. PA interventions have been shown effective in treating both the physical and psychological impairments associated with some cancers and their treatments, with potential for improving overall outcomes. Despite mounting evidence of its benefits, PA is still underutilized due to lack of awareness and knowledge among health-care providers, survivors of cancer, and survivors’ family members (who are often also caregivers) (Maddocks, 2020).

International Guidelines on Exercise and Cancer

Several organizations have put forth guidelines that include specific PA recommendations for cancer survivors; these guidelines include the American College of Sports Medicine’s (ACSM) International Multidisciplinary Roundtable on Exercise and Cancer (Campbell et al, 2019); Exercise and Sports Science Australia’s (ESSA) exercise and cancer position statement (Hayes, Newton, Spence, & Galvão, 2019); and the American Cancer Society’s (ACS) Nutrition and Physical Activity Guidelines for Cancer Survivors, (Rock et al., 2012). See Table 1.

In 2018, the second ACSM Roundtable on Exercise and Cancer was assembled to advance their previous recommendations beyond public health guidelines and progress toward prescriptive programs specific to cancer type, treatment, and outcomes (Campbell et al., 2019). The Roundtable reaffirmed that PA, exercise testing, and training are generally safe for survivors of cancer and that every survivor should avoid inactivity. Also, the group determined that adequate evidence exists that specific doses of aerobic, resistance, or combined aerobic-plus-resistance training could improve common cancer-related health challenges, including anxiety, depression, fatigue, reduced physical functioning, and health-related QOL.

ESSA incorporated current scientific evidence, coupled with clinical experience and exercise science principles, to update its position statement on cancer-specific exercise prescriptions in 2019 (Hayes et al., 2019). ESSA recommends a process for developing targeted exercise prescriptions. The ESSA framework includes patient assessment, determination of coexisting health issues, identification of patient capacity and intervention suitability, creation of an exercise prescription according to survivor-driven exercise-related goals, and reassessment.

The ACS’s guidelines address both PA and nutrition for the full continuum of cancer survivors, including those in treatment and recovery, long-term disease-fee living, living with stable disease, and living with advanced disease (Rock et al., 2012). The ACS notes that it is important to remember that survivors across the entire cancer survivorship continuum have different PA needs and challenges, including unique motives, barriers, and preferences.

Summary: The Evidence and Implications for Practice

Overall, evidence exists supporting the implementation of an exercise prescription for survivors of cancer due to its role in reducing morbidity, improving day-to-day physical function and QOL, and improving the potential for survival—all with a low risk of harm. However, the strength of the evidence in relation to exercise safety, feasibility, and benefit depends on cancer type and outcome of interest. While for some survivors, multimodal, moderate- to high-intensity exercise will be appropriate, others will not be able to tolerate such PA levels. Because of the wide-ranging variances across the cancer continuum, there is no set prescription and total weekly dosage of PA that is considered evidence-based for all survivors. Consequently, PA prescriptions need to be targeted and individualized according to survivor- and cancer-specific considerations (Campbell et all., 2019; Hayes et al., 2019; Rock et al., 2012).

For survivors to maintain or improve physical function and possibly reduce cancer-related toxicities, oncology nurses must be prepared to discuss the short- and long-term benefits of PA (Mustian, Lin, Cole, Loh, & Magnuson, 2020). Ideally, oncology providers should partner closely with exercise professionals (like physical therapists or certified cancer exercise trainers) to help identify risks and contraindications that may affect exercise safety and tolerance, and to create individualized exercise prescriptions to meet the unique needs of survivors with various cancer types and disease stages. Lack of knowledge, resource funding, facilities, programs, qualified staff, and exercise specialists in cancer care may be barriers in many settings.

With international guidelines as a springboard, we urge oncology nurses to initiate discussion of PA recommendations for survivors with their colleagues and regularly incorporate those recommendations into their care plans. In addition, more exercise intervention studies with diverse groups of survivors in various settings, including the home, community, and hospital, are needed to grow the evidence base and gain widespread acceptance among professional and the lay communities.

References

Campbell, K. L., Winters-Stone, K. M., Wiskemann, J., May, A. M., Schwartz, A. L., Courneya, K. S., . . . Schmitz, K. H. (2019). Exercise guidelines for cancer survivors: Consensus statement from international multidisciplinary roundtable. Medicine and Science in Sports and Exercise, 51(11), 2375–2390.
Courneya, K. S. (2017). Exercise guidelines for cancer survivors: Are fitness and quality-of-life benefits enough to change practice? Current Oncology, 24(1), 8.

Courneya, K. S., & Friedenreich, C. M. (2010). Physical activity and cancer: An introduction. In K. S. Courneya & C. M. Friedenreich (Eds.), Physical Activity and Cancer (pp. 1–10). Berlin, Germany: Springer.

Hayes, S. C., Newton, R. U., Spence, R. R., & Galvão, D. A. (2019). The Exercise and Sports Science Australia position statement: Exercise medicine in cancer management. Journal of Science and Medicine in Sport, 22(11), 1175–1199.

Maddocks, M. (2020). Physical activity and exercise training in cancer patients. Clinical Nutrition ESPEN, 40, 1–6.

Mustian K., Lin, P. J., Cole, C., Loh, K. P., & Magnuson, A. (2020). Exercise and the older cancer survivor. In M. Extermann (Ed.), Geriatric Oncology (pp. 917–938). Berlin, Germany: Springer.

Rock, C. L., Doyle, C., Demark‐Wahnefried, W., Meyerhardt, J., Courneya, K. S., Schwartz, A. L., . . . Gansler, T. (2012). Nutrition and physical activity guidelines for cancer survivors. CA: A Cancer Journal for Clinicians, 62(4), 242–274.

Wild, C. P., Weiderpass, E., & Stewart, B. W. (2020). World cancer report: Cancer research for cancer prevention. Lyon, France: International Agency for Research on Cancer [IARC]. Retrieved from the IARC website: http://publications.iarc.fr/586.

Disclosure: Karen Kane McDonnell is supported by the American Cancer Society under award number MRSG-17-152-01 and the Bristol Myers Squibb Foundation. The content is solely the responsibility of the author and does not represent the official views of the American Cancer Society or the Bristol Myers Squibb Foundation.

I Am and I Will: Science Popularization for Better Cancer Care

February 23rd, 2021 in International News

Author: Xiangyu Liu, Yongyi Chen, Xianghua Xu
Institutions: Hunan Cancer Hospital, Palliative Care Committee of China Anti-Cancer Association

February 4 is the 22nd World Cancer Day. In order to spread health knowledge and create the atmosphere of scientific prevention of cancer, Hunan Cancer Hospital has initiated a series of theme events highlighting caring for cancer patients and fighting cancer together.

The channels and forms of this theme popularization of science were diversified which combined in-hospital and out-of-hospital, online and offline together. Online activities included six topics including theme publicity, in-depth interviews, expert popular science posters, expert popular science videos, expert popular science articles, and ten H5 questions regarding anti-cancer rumors. Offline activities include three major contents: cancer prevention popular science brochures, publicity columns, and electronic screen posters. This event has obtained high social attention with the online web browsing over millions.

[Theme publicity] Focusing on cancer whole course management

Dr. Yazhou Xiao, the president of Hunan Cancer Hospital, advocated a whole-course management chain for cancer patients consisting of cancer prevention, early screening, comprehensive treatment, and rehabilitation. He called upon the whole society to make concentrate efforts on caring for cancer patients.

Theme publicity of Dr. Yazhou Xiao

[In-Depth Interview] Dignity in the last journey of life

Hunan Cancer Hospital is the chairman unit of the Palliative Care Committee of the Chinese Nursing Association. In recent years, Hunan Cancer Hospital has included palliative care in the strategic plan and the national regional cancer center construction project. A three-level linkage palliative care service system of hospital-community-home has been built, and a four-in-one palliative care service model of physical-psychological-social-spiritual has been formed. Cancer patients at the end of life are cared for with love, warm, and compassion, so as to realize the good end, good farewell, and good living to end-of-life cancer patients and their families.

In-Depth Interview of Dr. Yongyi Chen

[In-Depth Interview] Psychological healing of cancer patients

The spiritual care of Hunan Cancer Hospital started in 2005. After more than ten years of development, the hospital has set up the formal spiritual care department and psychological clinics which equipped with full-time spiritual care workers. Medical humanity is expressed, understanding and sharing is shared, accompanying and comfort is delivered. Hundreds of patients have obtained mutual strength of support and realized the meaning and value of life. They have actively made changes and growth post traumatic and stressful events.

In-Depth Interview of Dr. Xiaohong Liu

[Expert popular science posters + expert popular science videos + H5] A feast of medical science popularization has been created by experts

Science Popularization of 11 types of tumors including lung cancer, breast cancer, colorectal cancer, prostate cancer, brain tumor, lymphoma, cervical cancer, liver cancer, gastric cancer, esophageal cancer and thyroid cancer were detailed explicated by 19 experts. Many health education materials on nutrition intake, medication guidance, cancer prevention and rehabilitation, etc were written by cancer nurses for cancer patients and the public.

In the fight against cancer, everyone is not alone, every cancer patient should be treated scientifically, and every healthy person should establish the consciousness of self-conscious cancer prevention and early screening. Hunan Cancer Hospital takes all patients as the center, the cancer science popularization as the fulcrum, the expert team as the support, gives full play to the specialist wisdom, warms up patients in the fight against cancer, advocates the cancer care much closer to patients and the public.

The acceptability and feasibility of an educational programme on cervical cancer prevention in Chinese- and non-Chinese-speaking female adolescent students in secondary schools

January 5th, 2021 in International News

Authors: Ms. Jenny YS Chan (Undergraduate Nursing Student), Dr. Dorothy NS Chan (RN, PhD), and Dr. Winnie KW So (RN, PhD) from The Nethersole School of Nursing, Faculty of Medicine, the Chinese University of Hong Kong

Cervical cancer is commonly affecting women globally and in Hong Kong (Hong Kong Cancer Registry, 2019; International Agency for Research on Cancer, 2016). Cervical cancer is majorly caused by the Human Papillomavirus (HPV) (Centre for Health Protection, 2018). Fortunately, the risk of having cervical cancer could be significantly lowered especially in females aged below 24 through HPV vaccination (Department of Health, 2018). Despite the effectiveness of vaccines, the uptake rate is generally low. A previous survey revealed that only around 12% of the secondary school students had received HPV vaccination (Family Planning Association, 2017). To boost vaccination uptake, some schools have organized educational programmes about HPV vaccination (Yuen, Lee, Chan, Tran, & Sayko, 2018). However, students who attended these programmes are mostly local Chinese speaking (CS) students, missing out the non-Chinese speaking (NCS) students (a group rapidly expanding in the past decades) (Census & Statistics Department, 2017). In view of the phenomenon, non-Chinese speaking students should have equal opportunities in accessing HPV vaccination and obtaining relevant knowledge to maintain health.

Therefore, we designed a one-group pretest and posttest study to examine the acceptability and feasibility in implementing an educational programme on cervical cancer prevention in a secondary school with CS and NCS students. We also aim to improve participants’ knowledge about cervical cancer and HPV vaccines, and their intention to vaccination. The programme was conducted in March to April 2019. It had two major parts: a 40-minute health talk and a 40-minute tutorial.  In the health talk, we introduced what cervical cancer was and emphasized on how to prevent it. While in the tutorial, we emphasized on introducing HPV vaccination and explaining myths about it to the participants through an interactive matching game. A health booklet about cervical cancer and HPV vaccination was then distributed and discussed. All teaching material was adjusted in a culturally sensitive way, for instance, simple sketching and laymen terms were used instead of detailed anatomical pictures and medical jargons, to minimize events of embarrassment.

A total of 27 grade 10-11 CS (n=11) and NCS (n=16) girls were recruited. Most of the students were satisfied with the programme and agreed that the programme content was easily understood. All NCS and most CS students reported that the programme was very good and interesting. It was noticed that there was a positive change in participants’ knowledge towards HPV vaccine and an apparent increase in intention after the programme.

Reflecting in this project, it succeeded in proving the feasibility of implementing such educational programmes for CS and NCS school-aged girls. At first, we were quite worried about the responses, however, it turned out that most participants were satisfied with the programme. However, we only evaluated the immediate intention of participants, there were no actual follow-up verifications in the change of HPV vaccine uptake rate. In the future, we would hope to conduct follow-up verification studies to enhance the impact of this programme and further expand the scope of the programme to more secondary schools with NCS students in Hong Kong.

References:

Census and Statistics Department. (2017). 2016 Population By-census. Thematic report: Ethnic minorities. Retrieved from https://www.statistics.gov.hk/pub/B11201002016XXXXB0100.pdf

Centre for Health Protection (2018). Joint Consensus Recommendation on the Use of 9-valent Human Papillomavirus Vaccine in Prevention of Cervical Cancer in Hong Kong. Retrieved from https://www.chp.gov.hk/files/pdf/joint_consensus_recommendation_on_the_use_of_9_valent_human_papillomavirus_vaccine_in_prevention_of_cervical_cancer_in_hong_.pdf

Department of Health (2018). Human Papillomavirus (HPV) Vaccine. Retrieved from https://www.cervicalscreening.gov.hk/english/hum/hum_ccv.html

Hong Kong Cancer Registry, Hospital Authority (2019). Leading cancer sites in Hong Kong 2017. Retrieved from https://www3.ha.org.hk/cancereg/pdf/top10/rank_2017.pdf

International Agency for Research on Cancer. (2016). Cancer fact sheets: Cervical cancer. Retrieved from http://gco.iarc.fr/today/data/pdf/fact-sheets/cancers/cancer-fact-sheets-16.pdf

The Family Planning Association of Hong Kong (2017). Press releases: Report of Youth Sexuality Study 2017. Retrieved from https://www.famplan.org.hk/en/media-centre/press-releases/detail/fpahk-report-on-youth-sexuality-study

Yuen, W.W.Y., Li, A., Chan, P.K.S., Trans, L., & Sayko, E. (2018). Uptake of human papillomavirus (HPV) vaccination in Hong Kong: Facilitators and barriers among adolescent girls and their parents. PLoS One, 13(3), e0194159.

2020 Chinese Conference on Oncology (CCO) Cancer Nursing Forum Successfully Held

December 30th, 2020 in Editorial Office, International News

Authors: Zhenqi Lu, Yongyi Chen, Xiaoju Zhang
Institutions: Cancer Nursing Committee of Chinese Anti-Cancer Association

The Cancer Nursing Forum, organized by the Cancer Nursing Committee of Chinese Conference on Oncology (CCO), was successfully held in Guangzhou, China on November 14, 2020. The Forum had drawn nearly 500 participants expertise at cancer nursing from across the country to celebrate and advance the development of the oncology nursing profession.

The keynote speaker Dr. Yumei Wang, director of Shengjing Hospital of China Medical University, showcased a speech about the topic of “Palliative Care – Guarding the Dignity of Life of Cancer Patients”. Palliative care requires a professional team, thus Dr. Wang believes her team work with the purpose of “Influence life with life, warm the heart with heart” can bring dignity to more patients. Then, Professor Changrong Yuan, another keynote speaker from School of Nursing, Fudan University, emphasized the importance of Patient-Reported Outcome (PRO) in the process of cancer care. Patient-Reported Outcomes come directly from patients’ self-reports on their health status, functional status, and treatment feelings, which can evaluate patients’ status more efficiently and comprehensively. The third speaker, Tong Yingge, a professor of School of Medicine, Hangzhou Normal University, introduced the application of five pain assessment tools. She exemplified specific clinical cases to demonstrate how to form the structural elements, process elements and outcome elements of pain management in cancer patients. After that, Professor Qian Lu, coming from the School of Nursing, Peking University, presented the method to construct a risk prediction model and an early warning model of breast cancer-related lymphedema (BRCL). She aimed to achieve the early screening of BRCL with the help of models and machine learning methods.

Director of Cancer Nursing Committee of Chinese Anti-Cancer Association: Zhenqi Lu
Huiying Qin, Director of Nursing Department of Sun Yat-sen University Cancer Center
Director of Nursing Department of Sun Yat-sen University Cancer Center: Huiying Qin
2020 Chinese Conference on Oncology (CCO) Cancer Nursing Forum
A scene from the 2020 Chinese Conference on Oncology (CCO) Cancer Nursing Forum

As to distinctive management, Li Liu, deputy director of Sun Yat-sen University Cancer Center, established the “Internet-Nursing Service” platform. By organizing standard training and giving management in the whole process, Liu attempted to meet patients’ needs with limited medical resources and achieve the integration of medical and nursing services in the community. Besides, Lijun Chen, director of Guangxi Medical University Affiliated Tumor Hospital, displayed a cancer follow-up information system subsequently. She set up a professional follow-up team and carried out standard follow-up practice. In addition, Zhimin Liu, a head nurse of The Fourth Hospital of Hebei Medical University and Hebei Cancer Hospital introduced the diversified management of “the warm sun studio” in the medical oncology department. The project combined with their own characteristics and showed the humanistic care in various forms.

At this conference, eight excellent representatives were selected from 1,983 manuscript submissions, to share their views on how to promote cancer patient care, improve the quality of life, and deepen the meaning of cancer care.

The conference assembled plenty of domestic experts in the field of cancer care, showcasing cutting-edge research concepts, academic achievements and discussing the future development of cancer care.

A good end, a good farewell, and a good living

June 23rd, 2020 in International News

Palliative care reflections in the COVID-19 pandemic

Authors: Xuying Li, Yongyi Chen, Boyong Shen, Xianghua Xu
Institutions: Hunan Cancer Hospital

In the late spring, flowers are like brocade, the sun is shining. During the vigorous spring which is full of warm, the cold has passed away! Nothing can stand in the way of spring! But this winter and spring transition in 2020 is destined to be forever engraved in the hearts of all people, becoming an untouchable pain.

The novel coronavirus raged all over the world in hard times. From February 11 to March 22 this year, I had led totally 16 medical health care professionals in the Hunan Medical Team supporting Huanggang City in Hubei Province in China. We were mainly responsible for the treatment of COVID-19 patients. Most of the team members were assigned to the intensive care units. Patients in these areas were in severe and critical condition. Some of them even had no chance to have a farewell with their loved ones before dying. What’s more, in order to avoid transmission of infection, they were immediately put into the body bag for cremation. Their family members couldn’t see them for a last glance. What a pain which cannot be healed for a long time. I often think, as one of the palliative care workers, what can I do for my patients facing inadequate preparation and limited conditions? How to help the terminally ill patients say apologies, gratitude, love, and goodbye to the people they care? How to achieve a good end, a good farewell, and a good living that palliative care advocate?

There was an old lady lived in the ICU, who developed respiratory failure combined COVID-19 and heart failure. She had experienced three rescues and was pulled back from the brink of death each time. Occasionally she woke up, opened her eyes, looked at me, and stared outside the window. I understood that for her, the unfamiliar surroundings, no family’s company, medical staff wearing layers of protective equipment made her afraid and lonely. Considering she was unable to speak on a ventilator, I asked her to express her needs with winks. When I asked her if she wanted a video with her family, she closed her eyes deeply. Then I took the department’s dedicated mobile phone, videoed on her daughter. I told the daughter that her mother’s waking time was less and less, I hoped she could seize the opportunity to talk with her mother and express apologies, gratitude, and love to her. Daughter cried out gently: “Mom, due to the isolation requirement, please forgive me that I can’t do filial piety at your bedside, I will take good care of my brother and maintain a good family order. Your lifetime is toil and did not enjoy a few days of happiness. I feel so regrettable that I often make you angry inside. Please do cooperate with the treatment. We will wait for you forever.” The patient closed her eyes with tears slipped across her face soundlessly.

Two days later, the patient’s heart rate and blood pressure dropped with the blood oxygen couldn’t be measured. She lost her consciousness and was in a coma. The doctor telephoned her daughter once again, told her that it might be hard to save back this time. The daughter said that her mother believed in Buddhism, hope the health care workers could find the bodhisattva’s red rope which was kept in her mom’s duffel bag. She hoped this red rope could be accompanied by her mother until the last moment. I found the red rope and wrapped in the wrist of the patient. The video was linked to the daughter and other family members, her daughter began to cry at the moment. As a nurse expertise at palliative care, I knew it was time for the family members say goodbye to the patient. I reminded the daughter that her mother could still hear what happened although not able to express. Her mother would be fearful and worried if they kept crying. The daughter understood what I meant, and let all the family members said a few words to the patient through video. Finally, the patient passed away in everyone’s memory peacefully. The daughter requested that according to the local custom, she wanted her mother grabbed some money in hand at the last moment, which will be decent. We wiped the body of the patient with water and disinfectant twice, combed her hair, changed new clothes for her. We found 10 RMB in the belongings of the dead and put it into her hand. After the death of nursing, we connected the daughter again. Her daughter tears were streaming down her face and she thanked us through the video when she saw her mother’s tidy hair, serene countenance, clean clothes, as well as the money holding in the hands. She extended her gratitude for all we had done for her mother in this particular period. A brief funeral was arranged. Paramedics bowed collectively to the patient three times with her favourite Buddhist music downloaded online. I burst into tears when the undertaker’s workers transferred her to the funeral home. I said in my heart silently, “There is no pain on the road to life grandma.”

The implementation of palliative care is never a single kind of thought, nor should be only one mode, but should be based on human nature combined with the actual situation, adjusting measures to local conditions and varying from person to person. In Chinese traditional culture, it is a taboo to talk about death. The sudden epidemic of COVID-19 doesn’t give any psychological preparation to a lot of patients and their family. Numbers of patients had to cease their happy life abruptly and passed away without dying words for their loved ones. For infection control considerations, their family members couldn’t company the patients, which will be the lifelong regret and guilt for the deceased’s families.

Under the global pandemic of COVID-19, the work of palliative care has the work of hospice care has changed. Online communications could be utilized for the family meetings, group consultations, the family visits to reduce regrets between the patients and family members. We could adopt online psychosocial interventions not only to comfort the isolation of emotion but also let the families participate in the patients’ treatment, understand and fulfil the patients’ last wishes. In this process, the medical staff has become the ties between the network platform, patients, and families. Although there are many alternatives for an in-person meet, medical staff is still the biggest source of support for patients and their families. When everyone is scared of COVID-19, in addition to trying our best to rescue patients, all health care workers should do our best to let the deceased rest in peace and reassure the living. In the midst of life and death, it is the shining light of humanity of palliative cares that giving life a warm ferry!