Journal of the National Cancer Institute. Monographs最新文献

This commentary demonstrates the value of exercise for individuals living with breast cancer from the patient perspective. Exercise helps patients feel better while they undergo cancer treatment and beyond. Clinicians are urged to consider inclusion of exercise as standard of care during and after cancer treatment.

Exercise is recommended as a part of standard cancer care, based upon its favorable impact on treatment-related side effects and its association with better cancer outcomes. Fully incorporating exercise into oncology practice will require multidisciplinary efforts across oncology and exercise professionals. This article examines current patterns of exercise advice and prescription in oncology settings and highlights the roles of oncology clinicians, physiatrists, physical and occupational therapists, exercise physiologists and fitness trainers, and patient advocates in expanding exercise oncology across the cancer continuum. Future efforts to enhance provider education, expand community-based programs, establish referral pathways, and address policy challenges related to reimbursement will be needed to establish exercise as a universally accessible and effective component of oncology care.

Exercise is increasingly recognized by patients, clinicians, and allied health professionals globally as an important component of cancer care. In this paper, we provide a viewpoint on developments in exercise oncology over the past 4 decades leading up to the creation of the International Society of Exercise Oncology (ISEO). We briefly review research in adult and pediatric cancers from early foundation studies to larger randomized controlled trials published in mainstream oncology journals alongside critical work undertaken in exercise and cancer biological mechanisms. We also discuss potential strengths, weaknesses, opportunities, and threats facing ISEO in becoming a global forum for exercise oncology. Building on the foundational work undertaken over the past 4 decades by researchers, clinicians, and practitioners, ISEO provides an opportunity to support research, leverage collaborations and partnerships, facilitate education and training, increase awareness of exercise oncology, and support translation of research to clinical practice, ultimately improving the quality and quantity of life for people with cancer.

Exercise is safe and beneficial for people diagnosed with cancer. The use of live-remote exercise approaches, where exercise trainers deliver exercise programs via a videoconferencing platform, has increased rapidly, greatly expanding the reach of exercise programs. This method retains key elements of supervised exercise, which provide greater benefits than unsupervised programs. However, challenges in adapting in-person supervised exercise programs to remote delivery exist. This article discusses the key considerations for the effective and safe delivery of live-remote exercise, such as technological requirements, exercise professional skills, safety aspects, exercise programming features, social interactions, costs, and legal and ethical considerations. Considerations relevant for the design and execution of exercise oncology clinical trials and for community practice are described. Remaining knowledge gaps are outlined and point to opportunities to further inform evidence-based practice and practice-based evidence.

Exercise oncology has emerged as a distinctive area of research and clinical practice. To obtain a global overview of this field, we summarize viewpoints from experts across 6 continents on (1) the scope of exercise oncology research and programs, (2) the availability of reimbursement for cancer exercise services, and (3) pathways and initiatives for developing the exercise oncology workforce. From an international perspective, the field of exercise oncology has progressed substantially; however, gains made to date are uneven, with general underdevelopment in Africa, Asia, and South and Central America. In addition, the availability of cancer exercise services continues to fall short of the increasing demand worldwide. With the upcoming formation of the International Society of Exercise Oncology, we suggest leveraging coordinated efforts from the global exercise oncology community to optimize research capacity, enhance workforce development, and expand the delivery of exercise services to advance the field across the world.

The complex requirements of people with cancer can impact the provision of safe, effective, evidence-based exercise prescription. Consequently, a range of essential competencies are required from the exercise oncology workforce. There is a global need for a standardized approach to the development of this workforce. By defining, standardizing, and training the workforce in essential competencies, this will enable various professionals to safely and effectively screen, access, design, and deliver appropriate exercise programs. Therefore, this is also a call for a global collaboration on the development of the exercise oncology workforce with special attention to assisting low- or middle-income countries with their increasing cancer burden and unique challenges, which may require unique context-specific strategies. The building of an appropriate internationally standardized workforce is essential in the provision of physical activity and exercise options as part of standard cancer care.

Exercise oncology is a multidisciplinary field that encompasses research across the translational continuum. Some of the major disciplines contributing to the field include biology, immunology, physiology, psychology, behavioral science, epidemiology, and clinical oncology. Here, we provide a brief overview of the field under the headings of preclinical studies, observational studies, interventional outcome studies, interventional behavioral studies, dissemination and implementation studies, and childhood cancer studies. Preclinical studies have generally demonstrated that exercise can reduce tumor growth, primarily by modulating the tumor microenvironment. Observational studies have generally demonstrated that higher postdiagnosis exercise is associated with lower rates of mortality, however, most studies have not considered the combination and sequencing of exercise with other cancer treatments. Interventional outcome studies have consistently demonstrated strong evidence that aerobic and/or resistance exercise have beneficial effects on fatigue, anxiety, depression, physical functioning, and quality of life in adult patients treated with curative intent. Childhood cancer studies have demonstrated beneficial effects on cardiorespiratory fitness and muscular strength; however, the quality of evidence is often low. Interventional behavioral studies have identified multiple effective exercise behavior change strategies, yet the evidence is limited by a lack of diversity, minimal attention to social determinants, and insufficient knowledge to tailor interventions. Dissemination and implementation studies are occurring globally, yet an evidence base identifying the most cost-effective, equitable, and sustainable strategies is limited. Notwithstanding substantial limitations and remaining research gaps, multidisciplinary exercise oncology research across the translational continuum has provided cancer patients with evidence-based recommendations for improving quality of life and possibly survival.

Exercise oncology is coming of age, with more than 30 000 peer-reviewed citations in the scientific literature and multiple guidelines published by major medical institutions based on strong evidence from randomized controlled trials. There is enthusiasm around the formation of a new international organization that will form a nexus for exercise oncology researchers, clinicians, and practitioners. The contents of this monograph document the progression of exercise oncology research and practice, laying the groundwork for the formation of the International Society of Exercise Oncology. The society will aim to be an organizing body to shepherd the field toward the goal of using exercise as standard of care in the setting of oncology in collaboration with existing medical organizations so that every patient can benefit.

Background: Few studies have tested the effects of evidence-based practices on increasing smoke-free rules in the homes of Black and/or African American women who smoke cigarettes and/or little cigars or cigarillos and live in rural, low-resource communities. This paper presents findings from a randomized controlled trial that tested an intervention to increase the implementation of comprehensive (cigarettes, cigars, electronic cigarettes [e-cigarettes], hookah, IQOS, pipes) and tobacco product-specific smoke-free home rules at 12-month follow-up among this group.

Methods: Participants (n = 184) received motivational counseling delivered by community health workers, carbon monoxide biofeedback, and culturally relevant health education materials at 1, 3, and 6 months (intervention) or education materials only (control). We examined changes in (1) comprehensive and (2) tobacco product-specific smoke-free home rules between baseline and 12-month follow-up by study arm using binary and multinomial logistic regression with a generalized estimating equation approach (using 2-sided statistical significance tests).

Results: Over time, no difference in the implementation of comprehensive smoke-free home rules was observed by study arm. The intervention group had nearly 4 times higher odds of having a complete ban on cigarette smoking and statistically significantly higher odds of having a complete ban on e-cigarette use in the home compared with the control group.

Conclusions: Motivational counseling delivered by a community health worker and culturally relevant health educational materials were effective in increasing cigarette and e-cigarette smoke-free home rules among Black and/or African American women who smoke and reside in rural, low-resource communities. Our approach can inform future interventions that seek to address secondhand smoke exposure among disadvantaged groups (# NCT03476837).