CAPO Digest

Digest Commentator:

Paquito Bernard a,b,c , Josée Savard a,b,c

• Université Laval Cancer Research Center, Québec, Québec, Canada
  
• School of Psychology, Université Laval, Québec, Québec, Canada
  
• CHU de Québec – Université Laval Research Center, Québec, Québec, Canada
  

Edited by: Jennifer Brunet, School of Human Kinetics, University of Ottawa, Mary Ann O’Brien, Department of Family and Community Medicine, University of Toronto

Park et al. (2015) examined the effects of oncologists’ exercise recommendations among breast and colorectal cancer survivors. The investigators assigned participants, after completion of cancer treatments, to one of three conditions: control (i.e., conventional consultation); exercise recommendations only (i.e., emphasizing possible benefits from moderate intensity physical activity on risk of cancer recurrence); exercise recommendations with motivation tools (i.e., DVDs, diary and pedometers) plus one educational session administered by an exercise specialist. DVDs presented 3 sets of different resistance exercises without equipment. Participants recorded steps walked by day in diary. Self-reported physical activity assessed 4 weeks after brief intervention was the primary outcome. Quality of life was also measured with European Organization for Research and Treatment of Cancer (EORTC) QLQ C-30 questionnaire.

121 breast cancer survivors and 41 colorectal cancer survivors were recruited. The study retention rate was good (80%). Intent-to-treat analyses indicated that the addition of motivation tools and one educational session to the oncologist’s exercise recommendation significantly increased self-reported duration of moderate intensity exercise and duration of total exercise as compared to the control group. Participants who received the motivation tools and one educational session in addition to the exercise recommendations increase their total exercise time by almost 80 minutes per week. Participants who were assigned to the control group or who only received oncologist’s exercise recommendations did not significantly modify their exercise behaviours. No between-group difference was found on global quality of life.

This recent investigation shows that oncologists’ recommendations to increase exercise may not enough to change breast cancer survivors and colorectal cancer survivors’ exercise behaviour, which supports the idea that exercise recommendations should be accompanied by adapted motivational tools and a consultation with an exercise specialist.

Why we liked this article: Unfortunately, too often, physical activity promotion in oncology is conceptualized as a simple prescription from the oncologist. But physical activity is a complex health behaviour and becoming physically active is an important challenge for cancer survivors. This study highlights that a tailored  intervention is effective. This investigation also suggests that integrating exercise specialists in oncology services may be important.

Park, J.-H., Lee, J., Oh, M., Park, H., Chae, J., Kim, D.-I., … Jeon, J. Y. (2015). The effect of oncologists’ exercise recommendations on the level of exercise and quality of life in survivors of breast and colorectal cancer: A randomized controlled trial. Cancer, 121(16), 2740‑2748. http://doi.org/10.1002/cncr.29400

CAPO Digests are summaries of recent psychosocial oncology research which have been published in peer-reviewed journals in and out of the main psychosocial oncology outlets that may be of interest to CAPO members.  We hope you enjoy these Digests. If you are interested in submitting a Digest please contact the CAPO office at [email protected]

Digest Commentator: Josée Savard, Ph.D., School of Psychology, Université Laval, CHU de Québec-Université Laval Research Center, and Université Laval Cancer Research Center

Edited by: Jennifer Brunet, School of Human Kinetics, University of Ottawa

Childhood trauma is far too common as some research indicates that 45% of primary care patients have experienced some form of abuse during their childhood. In people diagnosed with cancer, childhood adversity has previously been found to be associated with higher levels of symptoms such as fatigue, psychological distress, and stress. This article reports on a pilot longitudinal study aiming to explore associations of childhood trauma with fatigue, depression, and stress in women undergoing radiotherapy for breast cancer. Another goal, more groundbreaking, was to investigate the possible role of inflammation.

Twenty women with 0-IIIA breast cancer about to receive whole-breast radiotherapy were enrolled in this study. They were evaluated 1 week before radiation (T1), week 6 of radiation (T2) and 6 weeks after radiation (T3). At each time point, participants completed the Multidimensional Fatigue Inventory, the Inventory of Depression Symptomatology and the Perceived Stress Scale (PSS). Peripheral blood draws were taken at T1 to measure various markers of inflammation. At T3, participants filled out the Childhood Trauma Questionnaire (CTQ), a 28-item questionnaire that assesses a history of childhood physical, sexual, and emotional abuse, and physical and emotional neglect.

Eight participants (40%) reported a history of childhood trauma (CTQ+). CTQ+ women obtained significantly higher fatigue, depression, and stress scores across all time points than women who did not report childhood abuse and neglect (CTQ-), although post hoc analyses indicated that differences between both groups of women were significant at T1 only. In addition, after controlling for some potential confounding variables (e.g., age, education, marital status), the differences in levels of cancer-related symptoms between CTQ+ and CTQ- women generally diminished, except for PSS scores. Analyses also indicated that radiotherapy did not significantly exacerbate any of the symptoms differentially in CTQ+ women as compared to CTQ- women. More severe symptoms of fatigue, depression and stress were associated with higher baseline levels of several inflammatory markers, namely c-reactive protein, interleukin (IL)-6 and IL-1 receptor agonist, but only in CTQ+ women. Overall, although replication with a larger sample is warranted, this study suggests that childhood trauma is a significant risk factor for cancer-related psychological distress and that inflammation could constitute a mechanism through which early negative experiences may have such a detrimental effect.

Why I liked this article: While this is a small-scale pilot study and mediation could not really be tested, I liked that it was a first attempt to identify inflammation as a possible underlying biological mechanism linking childhood trauma with cancer-related psychological symptoms. In terms of clinical implications, this literature generally suggests that patients with a history of childhood adversity constitute a high-risk group for psychological distress before and after cancer treatment that could be specifically targeted in a screening and prevention program. Moreover, if the role of inflammatory processes is confirmed in future research, it could inspire the development of new pharmacological and non-pharmacological treatment avenues directly targeting inflammation.

Article. Han, T. J., Felger, J. C., Lee, A., Mister, D., Miller, A. H., & Torres, M. A. (2015). Association of childhood trauma with fatigue, depression, stress, and inflammation in breast cancer patients undergoing radiotherapy. Psycho-Oncology. doi:10.1002/pon.3831

Journal website: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-1611

Digest Commentators:

Adina Coroiu1 & Elena Ivanova2

1Department of Educational and Counselling Psychology, McGill University

2Department of Psychology, McGill University

Edited by: Jennifer Brunet, School of Human Kinetics, University of Ottawa

Physical activity (PA) is a widely studied topic within psycho-oncology, with over 9,000 articles recently identified on the subject by Kampshoff and colleagues. Despite the growing interest in PA, a valid measure to quantify and determine if cancer survivors’ levels of PA meet the recommended levels of at least 150 minutes of moderate activity or at least 75 minutes of vigorous activity is lacking. Amireault, Godin, Lacombe, and Sabiston (2015) addressed this gap in the literature by validating the Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ). The GSLTPAQ is a brief self-report measure that assesses the duration, intensity (i.e., mild, moderate, and vigorous), and frequency of PA performed during the past 7 days. This scale can be used to classify individuals into two activity categories: active (scores ≥ 24) or insufficiently active (scores ≤ 23). The GSLTPAQ is an ideal measure to quantify and compare cancer survivors’ levels of PA against the recommended levels of PA due to its brief format and low administration burden. If validated, this questionnaire could be used in studies seeking to understand the impact of PA behavior on physical and psychosocial health outcomes, as well as in epidemiological studies to determine the prevalence of (in)activity in this clinical population.

In their study, Amireault and colleagues compared PA data obtained using the GSLTPAQ with PA data obtained using accelerometers (GT3X, Actigraph, Pensacola, Florida), with the aim of assessing the accuracy of the GSLTPAQ to classify cancer survivors’ activity levels according to the aforementioned PA guidelines. A total of 199 adult women with a first diagnosis of breast cancer were recruited from various hospitals in Montreal, QC. They were asked to wear an accelerometer (i.e., a physical activity monitoring device) for 7 consecutive days and complete the GSLTPAQ. Based on the accelerometer data, 27.2% of the sample were active. This percentage was lower than the percentage obtained using the GSLTPAQ (i.e., 33.8%). Further, 75.3% of sample were correctly categorized using the GSLTPAQ as being insufficiently active, that is as notmeeting PA guidelines. A smaller percentage, however, were correctly categorized as active (58.5%), that is as meeting PA guidelines.Overall, the authors suggested that the GSLTPAQ is more accurate at identifying insufficiently active women than at identifying active women.

Why we liked this article: We liked this article because the GSLTPAQ has research and practical implications, and the authors established its validity for use with breast cancer survivors. The practical and research implications include: low administration burden, minimum training demands, and low cost, which makes the GSLTPAQ feasible to use for large-scale studies. Further, this measure has clinical utility in that it can be used as a screener to identify inactive breast cancer survivors who would benefit from interventions designed to increase physical activity levels.

Article: Amireault, S., Godin, G., Lacombe, J., & Sabiston, C. M. (2015). Validation of the Godin-Shephard Leisure-Time Physical Activity Questionnaire classification coding system using accelerometer assessment among breast cancer survivors. Journal of Cancer Survivorship, 1-9. doi: 10.1007/s11764-015-0430-6

Journal Website: http://link.springer.com/article/10.1007/s11764-015-0430-6

Digest Commentators: Beth Edwards, PhD Candidate, Dalla Lana School of Public Health, University of Toronto & Lynn R Gauthier, Postdoctoral Fellow, ELLICSR Health Wellness and Cancer Survivorship Centre, Princess Margaret Cancer Centre, University Health Network

With the aging population and focus on community-based care, more older patients and their caregivers will manage cancer pain at home. Age-related comorbidities and functional decline add to pain management complexity. Little is known about how older patients and caregivers navigate these challenges. Therefore, McPherson et al. conducted a study to describe the roles and perceptions of older cancer patients and their caregivers managing cancer pain at home.

Using a qualitative descriptive approach with an inductive thematic analysis, they analyzed data collected through semi-structured interviews with 18 patients and 15 caregivers. Although the goal was to understand pain management among patient-caregiver dyads, interviews were primarily conducted with patients and caregivers separately. Patients were 65 years of age or older, had advanced cancer, experienced pain for at least 1 month, and received home palliative care. Most patients required assistance with daily activities and had moderate pain. Most caregivers lived with and were partners of the patients they cared for.

A qualitative approach is especially suited to understanding such a complex phenomenon. McPherson et al. clearly outlined their methods including interview guides, detailed analytic description, and appropriate references. As such, this article is appropriate for those interested in qualitative research approaches, as well as those interested in understanding the challenges of pain management among older patients and caregivers.

Analysis revealed two main themes related to pain assessment and management, with four subthemes each. Briefly, in one theme, patients and caregivers discussed challenges related to “adopting roles in pain assessment”. While patients adopted the lead role, they were not always forthcoming about reporting pain. Caregivers adopted the communication role when patients did not communicate with healthcare professionals. Elsewhere within this theme, patients described the multidimensional experience of pain. Some did not use the word “pain”, but used words like “discomfort”, “cramp”, and “ache”. They also described their reluctance to burden caregivers, especially when caregivers had health challenges themselves. Caregivers described verbal and nonverbal cues and relied on their personal history with the patient to assess pain. Some caregivers’ assessments were impacted by their own pain and health history. In the other theme, caregivers described patients’ desire to remain in control of pain management, but age-related impairments and treatment side effects made self-management difficult. Patients described reluctance towards pharmacological management, whereas caregivers remained open to pharmacological approaches. Some patients described a desire to sacrifice pain control to avoid analgesic side effects. Both patients and caregivers discussed fears of addiction and beliefs that pain is an inevitable consequence of aging and cancer. Here, an interesting dyadic analysis revealed that patient and caregiver pain management goals were not always congruent. Cognitive impairment was identified throughout as a challenge to pain assessment and management.

These data outline for healthcare professionals the challenges faced by older patients and their caregivers managing pain at home, including the impact of functional limitations, cognitive impairment, and the potential impact of caregivers’ own health challenges. As a result, this study clearly identifies an urgent need for education to address fears of addiction and side effects, and beliefs about the inevitability of pain as well as future research to further elucidate dyadic coping with cancer pain across the adult lifespan.

McPherson, C.J., Hadjistavropoulos, T., Devereaux, A., Lobchuk, M. (2014). A qualitative investigation of the roles and perspectives of older patients with advanced cancer and their family caregivers in managing pain in the home. BMC Palliative Care, 13(39). http://dx.doi.org/10.1186/1472-684X-13-39

Journal website: http://www.biomedcentral.com/bmcpalliatcare

Written by: Keith Wilson, PhD, CPsych, Department of Psychology, The Ottawa Hospital Rehabilitation Centre

Psychosocial oncology has done a good job of documenting the 10% – 20% prevalence of major depression (MD) among people with cancer, as well as the fact that MD accounts for a disproportionate amount of suffering. Where we have lagged is in demonstrating that we can treat MD with a sensible, evidence-based, practical and efficient intervention suitable for integration into oncology settings. With this study by Sharpe et al., we may finally have caught up.

“Depression Care for People with Cancer” consists, in part, of a brief (up to 10 sessions), manualised psychotherapy that draws on the cognitive-behavioural strategies of behavioural activation and problem-solving. In this trial, the therapy was administered by nurses who received rigorous training in these therapeutic techniques. The nurse-therapists were supervised by psychiatrists, who also consulted on medications and worked with patients who were not improving.

Sharpe et al. randomized 500 patients diagnosed with MD at three Scottish cancer centres to receive either the Depression Care for People with Cancer program or usual care (which could include referral to existing psychosocial oncology services). The trial endpoint was depression status at 24 weeks, but patients were followed for almost a year.

The authors describe the results as “striking”. Among patients who received the Depression Care for People with Cancer program, 62% reached the pre-specified primary outcome of a 50% reduction in depression symptoms. In contrast, only 17% of those receiving usual care achieved this degree of improvement. Moreover, a third of patients receiving the Depression Care for People with Cancer program met criteria for full remission of MD, compared to only 4% of those receiving usual care. In addition to these statistically robust differences in depression itself, secondary outcomes of anxiety, pain, fatigue, social participation, and quality of life were all reliably better for those receiving the Depression Care for People with Cancer program, and sustained over the duration of follow-up. Interestingly, the researchers also kept careful records of the time spent administering the intervention. They calculated the cost as £613 – about $1,100 Canadian.

Why I like this article: It is rare in psychosocial research to read individual studies that have the potential to be game-changers for an entire field, but this work comes close. Methodologically, this is a textbook example of how to design a rigorous clinical trial of a complex intervention. The findings should be appreciated widely by everyone involved in cancer care. If this treatment was available in a pill form that could reduce the suffering of that many people, for that duration of time, in multiple dimensions of distress, at such a low cost, we can speculate that it would quickly become a routine standard of care. Our challenge now is to translate this compelling research knowledge into genuine and widely available integrated care in cancer treatment programs.

Article: Sharpe, M., Walker, J., Hansen, C.H., Martin, P., Symeonides, S., Gourley, C., Wall, L., Weller, D., Murray, G., for the SMaRT (Symptom Management Research Trials) Oncology-2 Team. (2014). Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial. Lancet, 384, 1099-1108.

Journal Website: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61231-9/abstract

Digest commentator: Andrea Feldstain, Ph.D. Candidate, University of Ottawa; Resident in Clinical Psychology, Alberta Health Services

The field of palliative care is advancing, developing, and innovating. In the past few decades, it has evolved from care at end-of-life to a practice seeking to relieve or prevent suffering as early as diagnosis. Palliative care can entail symptom control, improving quality of life, increasing engagement of patients in their own care, potentially extending life expectancy, and/or increasing comfort when dying. However, the integration of palliative care into the full cancer trajectory is still a work in progress, as exemplified in the selected article.

Wentlandt and colleagues (2014) examined the referral practices to palliative care of pediatric oncologists versus adult oncologists. To compare these two groups, the researchers surveyed the majority of Canadian medical, radiation, surgical, and pediatric oncologists. Topics discussed included the availability of specialized palliative care services (i.e., inpatient consultation, inpatient units, outpatient clinics), referral practices (e.g., timing of referrals, life expectancy at time of referral), and attitudes (e.g., referring to palliative care adds too many care providers, uncomfortable referring before end-of-life).

Their study provides some good news in that both pediatric oncologists and adult oncologists perceived excellent access to at least one form of specialized palliative care, with consultation being the most available and outpatient services being the least available. In addition, the majority of pediatric oncologists and adult oncologists reported they were comfortable referring patients to palliative care as early as at diagnosis (87% and 70%, respectively). Unfortunately, despite perceiving excellent access and confidence, the bad news is that this is not reflected in practice. Both pediatric oncologists (79%) and adult oncologists (84%) reported that the large majority of their palliative care referrals were for patients with uncontrolled symptoms and a life expectancy of 1 to 6 months. Approximately 90% of pediatric oncologists and adult oncologists reported they would refer patients with uncontrolled symptoms for a prognosis of less than 1 year but only 57% would refer for uncontrolled symptoms and a prognosis of greater than 1 year. Less than 1% reported having referred patients with a prognosis of greater than 1 year (0% pediatric oncologists; 0.6% adult oncologists). So, why is there this discrepancy between perceptions and practice?

Two possible explanations can be found in Wentlandt and colleagues’ (2014) Table 4. On one hand, they found that oncologists may believe they can provide palliative treatment themselves. On the other hand, they found some may avoid palliative care referrals because they believe their patients associate palliative care with impending death. The majority of pediatric oncologists (58%) reported that they would refer earlier if palliative care was renamed Supportive Care, while adult oncologists were equally split. This is unfortunate because (1) it robs patients/caregivers of the expertise of palliative care, (2) misconceptions of palliative care could be easily clarified with a discussion, and (3) delaying referrals until disease is terminal reinforces this misconception. Although pediatric oncologists and adult oncologists both seem aware of the evolving scope of palliative care practice and associated benefits, referral practices have yet to catch up. Echoing Wentlandt et al.’s (2014) suggestion, more education and advocacy is needed as this may be a more viable option than hiding behind a new name.

Article: Wentlandt, K., Krzyzanowska, M.K, Swami, N., Rodin, G., Le, L.W., Sung, L., & Zimmerman, C. (2014). Referral practices of pediatric oncologists to specialized palliative care. Support Care Cancer, 22, 2315-22. DOI: 10.1007/s00520-014-2203-6.

Journal website: http://www.springer.com/medicine/oncology/journal/520.

Digest commentators: Gaya Narendran and Dr. Fiona Schulte, The University of Calgary

Specialized summer camps have been established as an environment where children faced with chronic illnesses, such as pediatric cancers, may find a place to have fun in a safe way. Currently, few studies have investigated the influence of attending specialized summer camps on children with cancer. Reports indicate that attending camp positively influences camper’s quality of life by affecting factors such as mood, and social interaction skills. The role of specialized summer camp in the long-term psychosocial development of children affected by cancer has not been addressed until recently.

Beckwitt (2014) investigated the potential for long-term influences of attending specialized camp programs for children who had been affected by cancer. Twenty-three Adults Surviving Childhood Cancers (ASCCs) were involved in the study.  ASCCs face ongoing psychosocial challenges into adulthood. During time of treatment, they are often isolated from social interactions and consequently often develop social adjustment problems that have the potential to continue into adult life.

ASCCs were identified as having been diagnosed with cancer at 1 to 18 years of age. The study consisted of a demographic survey and illness narrative interviews. Illness narratives were carried out using in-depth interview techniques in order to gain understanding and insight into how ASCCs view their camp experience. As a result from these interviews, three themes were identified: (1) attending camp provided normalcy, (2) meaningful camp experiences, and (3) access to information. This investigation reports that ASCCs recognized camp as a setting in which they could feel “normal” and relate with other children facing similar challenges. Furthermore, ASCCs’ responses indicated that camp provided a source of long-lasting relationships facilitated by the meaningful experiences felt while attending camp. ASCCs also reported that they were given informational support to learn and discuss potential physical, emotion, and cognitive late-onset effects of their cancer during camp. Together, the results of this investigation indicate that specialized childhood camps play a significant role in ASCCs’ survivorship.

This study provides strong testimonies for the effectiveness and importance of the childhood camp experience from multiple ASCCs. However, due to the small sample size and the similarity of participants, such that most were female and Caucasian, these results cannot readily be generalized. Future research utilizing objective measures, such as psychological assessments and questionnaires, are needed to establish the benefits of attending specialized summer camp programs for ASCCs.

Why I liked this article

This article works to fill a gap in the literature in a way that is easily understood. The included quoted testimonies that were appropriate and supported the conclusions they made. The quotes were also insightful into the emotional and social challenges of ASCCs but also work together with the author’s conclusions to illustrate a strong and complete image of the cancer experience and the role of camp in easing the challenges of this experience.

Article: Beckwitt, A. E. (2014). Childhood Cancer Camps Their Role in Adults Surviving Childhood Cancers Lives. Journal of Pediatric Oncology Nursing, 1043454213515335.

Journal website: http://jpo.sagepub.com/

Author website: http://www.ncu.edu/about-northcentral/our-people/faculty-members/asher-beckwitt

Digest commentators: Lauren C. Capozzi & S. Nicole Culos-Reed

Digest editor: Jennifer Brunet, University of Ottawa

It has been well established that exercise has numerous benefits for cancer survivors, both during and after treatment. In a population where psychosocial concerns like fatigue, pain, anxiety, depression, and decreased physical functioning are a reality for most patients, exercise can positively impact overall quality of life (QOL). But how does this happen? There are few researchers who have examined the underlying mechanisms responsible for improvements in QOL in patients with cancer who exercise. Identifying these mechanisms will aid in developing better targeted interventions, which will likely enhance the impact of exercise interventions on QOL.

Buffart and colleagues were determined to further analyze the factors mediating improvements in QOL during a 12-week group-based exercise program. They hypothesized that the intervention would increase activity levels, as well as perceptions of general self-efficacy and mastery. In turn, this would decrease fatigue and distress, which would then improve QOL. For their study, which was part of a larger multi-site trial, they recruited 209 patients diagnosed with different types of cancer who were on average 48.8 ± 10.9 years of age. A total of 147 patients were included in the exercise intervention group, and 62 were included in the wait list control group. The exercise intervention consisted of two weekly sessions targeting aerobic and strength components.

Interestingly, Buffart and colleagues found that there was no significant direct effect of the group-based exercise intervention on QOL. Rather, the intervention had an indirect positive effect on QOL. Specifically, the intervention positively impacted QOL by increasing physical activity, self-efficacy, and mastery, and subsequently decreasing fatigue and distress. The improvements in fatigue management were partially explained by the indirect effect of increased physical activity and self-efficacy, while the improvements in distress management were partially explained by the indirect effect of increased self-efficacy and mastery. Increased physical activity was directly linked to enhanced QOL. This study not only supports previous findings linking exercise with symptom management and QOL, but also provides insight into the mechanisms linking exercise with improvements in QOL. Accordingly, researchers and health professionals developing exercise intervention should consider approaches and strategies shown to increase perceptions of self-efficacy and mastery as this may decrease fatigue and distress, and in turn improve QOL.

Why I liked this article?

This article is important as it helps identify ways through which exercise can lead to improvements in QOL. This knowledge is also valuable when considering the design of effective exercise interventions as well as sustainable clinic or community-based exercise programs for cancer patients. Further work in this area is needed to identify additional pathways that are perhaps unique to specific cancer groups so we can not only develop targeted interventions, but also developed tailored intervention for patient diagnosed with different types of cancer.

Article: Buffart, L. M., Ros, W. J. G., Chinapaw, M. J. M., Brug, J., Knol, D. L., Korstjens, I., Weert, E van, Mesters, I., Borne, B. van den, Hoekstra-Weebers, J. E. H. M., May, A. M. (2014). Mediators of physical exercise for improvement in cancer survivors’ quality of life. Psycho-oncology, 23: 330-338.

Journal website: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-1611

Author website: http://www.emgo.nl/team/924/laurienbuffart/personal-information/

Digest commentators: Nicole Culos-Reed and Heather Leach, University of Calgary

Digest editor: Jennifer Brunet, University of Ottawa

Many prostate cancer (PC) and breast cancer (BC) survivors are interested in optimizing their health through lifestyle behaviors. The use of health behavior theories can help to understand patterns of nutrition and physical activity following a cancer diagnosis. In this study, predictors from the Commonsense Self-Regulation Model (CSM) and the Transtheoretical Model (TTM) were examined for associations with adherence to physical activity (PA) and healthy diet in PC or BC survivors. PA was measured using the International Physical Activity Questionnaire (IPAQ), assessing PA in the past seven days. Nutrition was assessed using the Past Seven Days Nutrition, assigning a score of 0-6, with higher scores indicating healthier eating guidelines adhered to. Participants were also asked the extent to which their diet and PA behavior had changed since diagnosis, and their preferences for interventions. CSM constructs were measured by the Illness Perception Questionnaire-Revised (IPQR). TTM constructs were represented by a previously developed scale that measured exercise stage of change, which ranges from pre-contemplation (not thinking about exercise), through contemplation, preparation (making small steps towards regular exercise), action (exercising regularly), to maintenance (over 6 months of regular exercise). Self-efficacy was measured using the Exercise and Nutrition Self-Efficacy Scales. Participants in this study were ninety-two men with PC (M age=66.6±7.7 years) and 145 women (M age=56.8±10.5 years) with BC. The median time since diagnosis was 30.0 months for PC and 53.5 months for BC participants. PA guidelines were met by 88% of PC and 85% of BC participants based on self-reported data. PC respondents met on average 2.2 healthy eating guidelines and BC respondents met 2.7. Higher self-efficacy and stage of change from the TTM model were associated with increased PA and greater adherence to nutritional guidelines. Increased PA since diagnosis was associated with higher stage of change and lower illness identity and higher personal control. Healthier eating since diagnosis was associated with longer time since diagnosis, higher stage of change, and higher personal control and higher negative emotional representations. The majority of participants indicated they would be very interested in receiving interventions to assist with improving nutrition or PA, and that they would prefer these interventions at the time of diagnosis or soon after. The associations between a higher TTM stage of change and self-efficacy with adherence were consistent with findings of other studies that have examined PA and healthy eating. No CSM variables were associated with adherence, but some did predict changes in health behaviors. Lower illness identity was associated with increased PA after diagnosis, which suggests that cancer related symptoms may act as a barrier to PA. Higher negative emotions related to cancer was associated with improved post diagnosis diet, suggesting that concerns about cancer may motivate healthy eating behaviors. Associations between higher personal and treatment control beliefs and improved health behaviors since diagnosis suggests that PC and BC survivors are more likely to change health behaviors if they believe that their actions can make a difference in their cancer outcome. The application of theoretical models to explain health behaviors can enhance knowledge of how to provide effective support for the PA and healthy eating needs of PC and BC survivors.

Green HJ, Steinnagel G, Morris C & Laakso EL (2014). Health behaviour models and patient preferences regarding nutrition and physical activity after breast or prostate cancer diagnosis. European Journal of Cancer Care. Advance online publication. doi:10.1111/ecc.12190.

Journal website: http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2354

Author website: http://www.griffith.edu.au/health/school-applied-psychology/staff/dr-heather-green

Li, H.C., Chung, O.K., Ho, K.Y., Chiu, S.Y., & Lopez, V (2013). Effectiveness of an integrated adventure-based training and health education program in promoting regular physical activity among childhood cancer survivors. Psycho-Oncology, 22, 2601-2610.

Journal Website: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-1611

Advances in treatment protocols have resulted in improved rates of survival for childhood cancer patients. Despite enhanced prognosis, treatment regimens are associated with a myriad of adverse side effects. Physical activity has been shown to be a safe and effective strategy to ameliorate and potentially reverse the sequelae of cancer and its treatments in children with cancer. Moreover, it is a beneficial strategy to promote improved psychosocial and physical health. Unfortunately, there is growing concern about low rates of physical activity in childhood cancer survivors. Previous research shows that education alone is not enough to increase physical activity levels; therefore, more research is needed to explore alternative strategies. In this study, Li et al. examined if an integrated adventure-based training and health education program would increase perceptions of self-efficacy, physical activity levels, and quality of life (QOL) in 71 cancer survivors between the ages of 9 and 16 years. They found that participants reported increased perceptions of self-efficacy, physical activity levels, and QOL over the course of the intervention. Additionally, they found that participants who completed the program had greater perceptions of self-efficacy, were more active, and were more willing to participate in physical activity than participants who did not complete the program.

This study provides compelling evidence that an alternative type of physical activity program (e.g., adventure-based training such as rock wall climbing, relay games and three-legged races) can effectively promote positive changes in physical activity behaviour, as well as psychosocial constructs. While these findings are promising, more research is needed to determine if the length and format of the program should be modified based on participants’ personal and/or cancer-related characteristics in order to optimize outcomes. Furthermore, greater research efforts exploring dissemination strategies should be conducted to ensure a greater number of childhood cancer survivors are impacted.

Why I like this article: Currently, data supporting effective means to promote physical activity behaviour, and in turn QOL, for older childhood cancer survivors are lacking. This study sheds light on an exciting alternative type of physical activity that may be more readily adopted and maintained by this age group – adventure-based activities. Accordingly, it offers a novel approach to potentially address the physical inactivity epidemic in childhood cancer survivors.

Digest writer: Amanda Wurz, MSc.

Digest editor: Jennifer Brunet, PhD