paywalled: Physical Activity, Biomarkers, and Disease Outcomes in Cancer Survivors: A Systematic Review

Physical Activity, Biomarkers, and Disease Outcomes in Cancer Survivors: A Systematic Review:

Background
Cancer survivors often seek information about how lifestyle factors, such as physical activity, may influence their prognosis. We systematically reviewed studies that examined relationships between physical activity and mortality (cancer-specific and all-cause) and/or cancer biomarkers.

Methods
We identified 45 articles published from January 1950 to August 2011 through MEDLINE database searches that were related to physical activity, cancer survival, and biomarkers potentially relevant to cancer survival. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement to guide this review. Study characteristics, mortality outcomes, and biomarker-relevant and subgroup results were abstracted for each article that met the inclusion criteria (ie, research articles that included participants with a cancer diagnosis, mortality outcomes, and an assessment of physical activity).

Results
There was consistent evidence from 27 observational studies that physical activity is associated with reduced all-cause, breast cancer–specific, and colon cancer–specific mortality. There is currently insufficient evidence regarding the association between physical activity and mortality for survivors of other cancers. Randomized controlled trials of exercise that included biomarker endpoints suggest that exercise may result in beneficial changes in the circulating level of insulin, insulin-related pathways, inflammation, and, possibly, immunity; however, the evidence is still preliminary.

Conclusions
Future research directions identified include the need for more observational studies on additional types of cancer with larger sample sizes; the need to examine whether the association between physical activity and mortality varies by tumor, clinical, or risk factor characteristics; and the need for research on the biological mechanisms involved in the association between physical activity and survival after a cancer diagnosis. Future randomized controlled trials of exercise with biomarker and cancer-specific disease endpoints, such as recurrence, new primary cancers, and cancer-specific mortality in cancer survivors, are warranted.

Nutrition and physical activity guidelines for cancer survivors - 2012 - CA: A Cancer Journal for Clinicians

Nutrition and physical activity guidelines for cancer survivors - 2012 - CA: A Cancer Journal for Clinicians

26 APR 2012 - Nutrition and physical activity guidelines for cancer survivors - CA: A Cancer Journal for Clinicians - Wiley Online Library

Nutrition and physical activity guidelines for cancer survivors - CA: A Cancer Journal for Clinicians 

".... After receiving a diagnosis of cancer, survivors soon find there are few clear answers to even the simplest questions, such as: Should I change what I eat? Should I exercise more? Should I gain or lose weight? Should I take dietary supplements? Cancer survivors receive a wide range of advice from many sources about foods they should eat, foods they should avoid, how they should exercise, and what types of supplements they should take, if any. Unfortunately, this advice is often inconsistent and not supported by data...."

Ovarian Cancer

Ovarian cancer is the leading cause of death from gynecologic malignancies in the United States.4 Symptoms tend be nonspecific, making early detection difficult. Consequently, most ovarian cancers are diagnosed at an advanced stage when the prognosis is poor, with an overall 10-year survival rate of 39%.4 The role of lifestyle factors in ovarian cancer prognosis is largely unknown.138, 242 To our knowledge, only 3 studies139, 140, 243 have evaluated the role of dietary factors in ovarian cancer survival. These 3 studies were based on prospective follow-up of the cases participating in case-control studies and evaluated the association between prediagnosis dietary intake and mortality outcomes. One study, conducted in China, focused on the role of green tea and reported that a higher frequency and quantity of green tea intake after diagnosis was associated with better survival.243 The other 2 studies, conducted in Australia140 and the United States,139 suggested that prediagnosis dietary intake may influence the survival experience of patients with ovarian cancer. Both studies tended to support the association of fruit and vegetable consumption with better survival. Dairy food intake was associated with poorer survival in one of the studies,140 while in the other, only milk consumption and not total dairy food consumption was inversely associated with survival.139 Meat consumption was associated with better survival in the Australian study,140 and with lower survival in the study conducted in the United States.139 While these studies controlled for most relevant covariates, they did not include treatment information. In addition, these studies did not evaluate dietary intake after diagnosis. However, they do suggest that dietary intake may influence ovarian cancer survival and warrant further research in this area.

Only one study, also following cases in a case-control study for mortality, has evaluated the role of physical activity in ovarian cancer survival.244 Prediagnosis physical activity was ascertained as hours per week for 3 life periods (childhood, between ages 18-30 years, and in recent years). The study also evaluated the role of changes in physical activity over time. There was not much indication of an association with survival for any of these variables, except for physical activity at aged 18 to 30 years, which seemed to be associated with better survival for women with early stage ovarian cancer and with worse survival for women with an advanced stage of disease at diagnosis.245

The relationship between excess weight and ovarian cancer survival has been evaluated by relatively few studies. Obesity may affect ovarian cancer survival by having a negative impact on optimal surgical and cytotoxic treatment and increasing the likelihood of postoperative complications.246 Overall, the literature evaluating the association between weight/BMI and ovarian cancer survival is limited and inconclusive.76, 242 Cohort studies evaluating the role of prediagnosis obesity obtained at baseline on ovarian cancer mortality have generally found elevated ovarian cancer mortality among obese women.234, 247 Other studies evaluating the role of prediagnosis BMI on ovarian cancer survival by following cases in a case-control study or clinical trial (using baseline data) have offered conflicting results.242 The role of postdiagnosis body size and weight changes on ovarian cancer survival is largely unknown. Only one study has reported on weight changes during chemotherapy and ovarian cancer survival and found that, among patients with advanced ovarian cancer, weight loss during chemotherapy was associated with worse prognosis; however, it is difficult to determine whether this weight loss was involuntary or intentional.248

In summary, while the current evidence is limited and inconclusive, it points to a possible role of dietary factors, physical activity, and body size and weight changes in modulating ovarian cancer survival, and for physical activity in improving the quality of life among ovarian cancer survivors. Further studies are needed before public health recommendations can be made.

Cancerwise: Obesity and Cancer Risk: Our Expert Weighs In

Obesity and Cancer Risk: Our Expert Weighs In: By Jennifer Montgomery, MD Anderson Staff Writer

A new report shows that cancer death rates are still on the decline in the United States, but increasing obesity remains a concern.

The Annual Report to the Nation on the Status of Cancer, released March 28, notes that for more than three decades, too much weight, too little exercise and unhealthy eating habits have been second only to tobacco as preventable causes of disease and death.

Since the 1960s, the report says, tobacco use has declined by one-third, but obesity rates have doubled. According to the report, 2 in 3 adults and 1 in 3 kids are overweight or obese, which places them at risk for not only heart disease and diabetes, but also cancer. After reviewing more than 7,000 studies, the report's researchers have identified six cancers associated with being overweight or obese:

• Esophageal adenocarcinoma
• Colon and rectal cancer
• Kidney cancer
• Pancreatic cancer
• Endometrial cancer
• Breast cancer among postmenopausal women

This review also finds convincing evidence of an association between lack of sufficient physical activity and increased risk of colon cancer. A probable association is cited for post-menopausal breast and endometrial cancers.The report notes that less than half of adults get enough physical activity. Youths get even less. Lorenzo Cohen, Ph.D., professor in the Department of General Oncology and director of MD Anderson's Integrative Medicine Program, shares his reaction to the annual cancer report, as well as suggestions for how people can take action now to reduce obesity and prevent cancer.



The Annual Report to the Nation on the Status of Cancer looks at U.S. cancer numbers from 1975 and 2008. It's a collaboration of researchers from the Centers for Disease Control and Prevention, the North American Association of Central Cancer Registries, the National Cancer Institute and the American Cancer Society.

Additional highlights from the report:

• Death rates from all cancers combined for men, women and children continued to decline in the United States between 2004 and 2008.
• New cancer diagnoses among men fell an average of 0.6% per year over the same period. 
• New cancer diagnoses among women declined 0.5% per year from 1998 through 2006, but rates leveled off from 2006 through 2008.
• For the second consecutive year, mortality rates for lung cancer have decreased among women. Lung cancer death rates in men have been decreasing since the early 1990s.
• Breast cancer incidence rates among women declined from 1999 through 2004 and plateaued from 2004 through 2008.
• Colorectal cancer incidence rates decreased among men and women from 1999 through 2008.
• Incidence rates of some cancers, including pancreas, kidney, thyroid, liver and melanoma, increased from 1999 through 2008.
• Among racial and ethnic groups, the highest cancer incidence rates between 2004 and 2008 were among black men and white women. Cancer death rates from 2004 through 2008 were highest among black men and black women, but these groups showed the largest declines between 1999 and 2008, compared with other racial groups.
• Among children age 19 or younger, cancer incidence rates increased 0.6% per year from 2004 through 2008, while death rates decreased 1.3% per year during the same period.

American Institute for Cancer Research (AICR): 2012 Research Conference on Food, Nutrition, Physical Activity and Cancer

2012 AICR Annual Research Conference
on Food, Nutrition, Physical Activity and Cancer

November 1-2 / Washington, DC

About the Conference:

This conference is a unique forum that brings together researchers and clinicians for a two-day program that is dedicated to increasing knowledge, stimulating research and promoting prevention and treatment of cancer through nutrition, physical activity and weight management.

Who Should Attend:

Basic scientists, clinical investigators, epidemiologists, dietitians, nutritionists, policy makers and other health professionals interested in food, nutrition, physical activity and weight management in relation to cancer.

Letter:: Physical activity for cancer survivors: meta-analysis of randomised controlled trials | BMJ

Blogger's Note:  BMJ is a subscription based journal 

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Rapid Response (Letter):

Physical activity versus exercise in cancer survivors: it is a matter of definition!

7 February 2012

Fong et al.  (Fong DY, Ho JW, Hui BP et al. Physical activity for cancer survivors: meta-analysis of randomised controlled trials. Bmj 2012;344:e70.) systematically evaluated the effects of ‘physical activity’ in adult patients after completion of main treatment related to cancer.(1) Nevertheless, the effects of (increased) physical activity on health indicators were not studied, and changes in daily physical activity levels were not reported.(2) Indeed, the characteristics of the 34 randomized controlled trials included in this meta-analysis show that Fong et al. mostly studied the effects of structured exercise training programs including aerobic and/or resistance exercises.(1) Although physical activity and exercise training are closely related, these are two distinct domains with their own definitions. Physical activity refers to ‘body movement that is produced by the contraction of skeletal muscles and that increases energy expenditure’; while exercise refers to ‘planned, structured, and repetitive movement to improve or maintain one or more components of physical fitness’.(3)
Therefore, we believe that the conclusion of this meta-analysis should be that structured exercise training is associated with clinically important positive effects on physical functions and quality of life in patients who had completed their treatment for cancer.
Whether and to what extent these interventions will also increase daily physical activity levels in cancer survivors remains currently unknown.

Dr. Martijn A. Spruit, scientific advisor
Program Development Center, CIRO+, center of expertise for chronic organ failure
Horn, the Netherlands
Dr. Emiel F.M. Wouters, professor in respiratory medicine
Dept. of Respiratory Medicine, Maastricht University Medical Centre (MUMC+)
Maastricht, the Netherlands

abstract: Feasibility of a lifestyle intervention for ovarian cancer patients receiving adjuvant chemotherapy

OBJECTIVES

This study aimed to assess the feasibility of a lifestyle intervention for promoting physical activity (PA) and diet quality during adjuvant chemotherapy for ovarian cancer.

METHODS:

Patients were enrolled post-operatively and received PA and nutrition counseling, at every chemotherapy visit for six cycles. Quality of life (QoL) was measured with the Functional Assessment of Cancer Therapy (FACT-G), PA with the Leisure Score Index (LSI), dietary intake with 3-day food records, and symptom severity/distress by the Memorial Symptom Assessment Scale (MSAS). Pedometer step count was collected during chemotherapy cycles.

RESULTS:

Recruitment was 73% with 27 patients enrolled. Mean [95% confidence interval] change in minutes of PA from cycle #3 to following cycle #6 was 61min [-3, 120] p=0.063, and from baseline to after cycle #6 was 73min [-10, 15]; p=0.082. Mean change in total fruit and vegetable consumption between baseline and during chemotherapy was 0.56 [-0.09, 0.64]; p=0.090. FACT-G increased from 75.4 at baseline to 77.6 during chemotherapy and 83.9 following chemotherapy (p=0.001 for change from baseline to post-chemotherapy).


Mean total MSAS ( Memorial Symptom Assessment Scale) score was 20.6 at baseline, 26.6 at cycle #3 and decreased to 17.0 following chemotherapy (p=0.01 comparison of cycle #3 and following chemotherapy). Increased moderate to strenuous PA was correlated with higher physical well-being during chemotherapy (r=0.48, p=0.037).

CONCLUSIONS:

Lifestyle counseling during adjuvant chemotherapy for ovarian cancer is feasible and may improve PA and diet quality. Randomized controlled trials examining the effects of lifestyle counseling on quality of life and treatment outcomes in ovarian cancer patients are warranted.

abstract: Recreational physical activity and ovarian cancer

CONCLUSIONS: Our data provide weak evidence in support of beneficial effects of physical activity on ovarian cancer risk and survival, but results should be interpreted cautiously because of the lack of a clear dose response relation with higher levels of exercise and the likely misclassification of self-reported activity.

American Institute for Cancer Research (AICR): AICR Cancer Research Conference Oct 21/22, Washington, DC

Food, Nutrition, Physical Activity and Cancer
October 21 & 22, 2010 | Capital Hilton Hotel, Washington, DC

Who Should Attend

Basic scientists, clinical investigators, epidemiologists, dietitians, nutritionists, policy makers and other health professionals interested in food, nutrition, physical activity and weight management in relation to cancer.

Weight, Physical Activity, Diet, and Prognosis in Breast and Gynecologic Cancers — JCO

Abstract

Diet, physical activity, and weight may affect prognosis among women who are diagnosed with breast or gynecologic cancer. Observational studies show associations between being overweight or obese and weight gain with several measures of reduced prognosis in women with breast cancer and some suggestion of poor prognosis in underweight women. Observational studies have shown an association between higher levels of physical activity and improved breast cancer–specific and all-cause mortality, although a dose-response relationship has not been established. One large randomized controlled trial reported increased disease-free survival after a mean of 5 years in patients with breast cancer randomly assigned to a low-fat diet versus control. However, another trial of similar size found no effect from a high vegetable/fruit, low-fat diet on breast cancer prognosis. The few reported studies suggest that obesity negatively affects endometrial cancer survival, while the limited data are mixed for associations of weight with ovarian cancer prognosis. Insufficient data exist for assessing associations of weight, physical activity, or diet with prognosis in other gynecologic cancers. Associations of particular micronutrient intake and alcohol use with prognosis are not defined for any of these cancers. The effects of dietary weight loss and increase in physical activity on survival or recurrence in breast and gynecologic cancers are not yet established, and randomized controlled trials are needed for definitive data.

Physical activity in women with ovarian cancer and its association with decreased distress and improved quality of life (abstract)

Blogger's Note: yet another study eg. same subject, same conclusions

Weight, Physical Activity, Diet, and Prognosis in Breast and Gynecologic Cancers JCO (abstract)

ABSTRACT

Diet, physical activity, and weight may affect prognosis among women who are diagnosed with breast or gynecologic cancer. Observational studies show associations between being overweight or obese and weight gain with several measures of reduced prognosis in women with breast cancer and some suggestion of poor prognosis in underweight women. Observational studies have shown an association between higher levels of physical activity and improved breast cancer–specific and all-cause mortality, although a dose-response relationship has not been established. One large randomized controlled trial reported increased disease-free survival after a mean of 5 years in patients with breast cancer randomly assigned to a low-fat diet versus control. However, another trial of similar size found no effect from a high vegetable/fruit, low-fat diet on breast cancer prognosis. The few reported studies suggest that obesity negatively affects endometrial cancer survival, while the limited data are mixed for associations of weight with ovarian cancer prognosis. Insufficient data exist for assessing associations of weight, physical activity, or diet with prognosis in other gynecologic cancers. Associations of particular micronutrient intake and alcohol use with prognosis are not defined for any of these cancers. The effects of dietary weight loss and increase in physical activity on survival or recurrence in breast and gynecologic cancers are not yet established, and randomized controlled trials are needed for definitive data.

Abstract: The role of body mass index, physical activity, and diet in colorectal cancer recurrence and survival: a review of the literature.

"In conclusion, only a paucity of data is available about the effect of dietary and other lifestyle factors on colorectal cancer recurrence and survival. Thus far, no clear conclusions can be drawn. Future studies are warranted, particularly on postdiagnosis BMI and diet."

Weight, Physical Activity, Diet, and Prognosis in Breast and Gynecologic Cancers --JCO (abstract)

ABSTRACT
Diet, physical activity, and weight may affect prognosis among women who are diagnosed with breast or gynecologic cancer. Observational studies show associations between being overweight or obese and weight gain with several measures of reduced prognosis in women with breast cancer and some suggestion of poor prognosis in underweight women. Observational studies have shown an association between higher levels of physical activity and improved breast cancer–specific and all-cause mortality, although a dose-response relationship has not been established. One large randomized controlled trial reported increased disease-free survival after a mean of 5 years in patients with breast cancer randomly assigned to a low-fat diet versus control. However, another trial of similar size found no effect from a high vegetable/fruit, low-fat diet on breast cancer prognosis. The few reported studies suggest that obesity negatively affects endometrial cancer survival, while the limited data are mixed for associations of weight with ovarian cancer prognosis. Insufficient data exist for assessing associations of weight, physical activity, or diet with prognosis in other gynecologic cancers. Associations of particular micronutrient intake and alcohol use with prognosis are not defined for any of these cancers. The effects of dietary weight loss and increase in physical activity on survival or recurrence in breast and gynecologic cancers are not yet established, and randomized controlled trials are needed for definitive data.

An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis

Conclusions
Current evidence suggests many health benefits from physical activity during and post cancer treatments. Additional studies are needed in cancer diagnoses other than breast and with a focus on survivors in greatest need of improvements for the health outcomes of interest.