Purpose Cancer survivors are at increased risk for several comorbid conditions, and many seek lifestyle change to reduce dysfunction and improve long-term health. To better understand the impact of cancer on adult survivors' health and health behaviors, a review was conducted to determine (1) prevalent physical health conditions, (2) persistent lifestyle changes, and (3) outcomes of previous lifestyle interventions aimed at improving health within this population. Methods Relevant studies from 1966 and beyond were identified through MEDLINE and PubMed searches. Results Cancer survivors are at increased risk for progressive disease but also for second primaries, osteoporosis, obesity, cardiovascular disease, diabetes, and functional decline. To improve overall health, survivors frequently initiate diet, exercise, and other lifestyle changes after diagnosis. However, those who are male, older, and less educated are less likely to adopt these changes. There also is selective uptake of messages, as evidenced ...

Riding the Crest of the Teachable Moment: Promoting Long-Term Health After the Diagnosis of Cancer

The dose−response relationship between number of cigarettes smoked and risk for lung cancer was established in 1950 by epidemiological studies. Laboratory assays with tobacco tar on mouse skin and smoke inhalation experiments with hamsters provided further evidence for this relationship. In cigarette smoke, among 4800 identified compounds, 69 are carcinogens, and several are tumor promoters or cocarcinogens. The major toxic agents are nicotine, carbon monoxide, hydrogen cyanide, nitrogen oxides, some volatile aldehydes, some alkenes, and some aromatic hydrocarbons. Public health information and education have led to a reduction of cigarette smokers among U.S. adults from 40 to 25%. However, in high school students, smoking increased to 35% and in adults with less than a high school education it remains high at 33.3%. Intervention studies were augmented with attempts of risk reduction by changing the tobacco composition and makeup of cigarettes. This led to cigarettes that, according to the FTC, reduced th...

The less harmful cigarette: a controversial issue. a tribute to Ernst L. Wynder.

Background
People with cancer undergoing active treatment experience numerous disease- and treatment-related adverse outcomes and poorer health-related quality of life (HRQoL). Exercise interventions are hypothesized to alleviate these adverse outcomes. HRQoL and its domains are important measures of cancer survivorship, both during and after the end of active treatment for cancer.

Objectives
To evaluate the effectiveness of exercise on overall HRQoL outcomes and specific HRQoL domains among adults with cancer during active treatment.

Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed MEDLINE, EMBASE, CINAHL, PsycINFO, PEDRO, LILACS, SIGLE, SportDiscus, OTSeeker, Sociological Abstracts from inception to November 2011 with no language or date restrictions. We also searched citations through Web of Science and Scopus, PubMed's related article feature, and several websites. We reviewed reference lists of included trials and other reviews in the field.

Selection criteria
We included all randomized controlled trials (RCTs) and quasi-randomized controlled clinical trials (CCTs) comparing exercise interventions with usual care or other type of non-exercise comparison intervention to maintain or enhance, or both, overall HRQoL or at least one distinct domain of HRQoL. Included trials tested exercise interventions that were initiated when adults with cancer were undergoing active cancer treatment or were scheduled to initiate treatment.

Data collection and analysis
Five paired review authors independently extracted information on characteristics of included trials, data on effects of the intervention, and assessed risk of bias based on predefined criteria. Where possible, we performed meta-analyses for HRQoL and HRQoL domains for the reported difference between baseline values and follow-up values using standardized mean differences (SMDs) and a random-effects model by length of follow-up. We also reported the SMD at follow-up between the exercise and control groups. Because investigators used many different HRQoL and HRQoL domain instruments and often more than one for the same domain, we selected the more commonly used instrument to include in the SMD meta-analyses. We also report the mean difference for each type of instrument separately.

Main results
We included 56 trials with 4826 participants randomized to an exercise (n = 2286) or comparison (n = 1985) group. Cancer diagnoses in trial participants included breast, prostate, gynecologic, hematologic, and other. Thirty-six trials were conducted among participants who were currently undergoing active treatment for their cancer, 10 trials were conducted among participants both during and post active cancer treatment, and the remaining 10 trials were conducted among participants scheduled for active cancer treatment. Mode of exercise intervention differed across trials and included walking by itself or in combination with cycling, resistance training, or strength training; resistance training; strength training; cycling; yoga; or Qigong. HRQoL and its domains were assessed using a wide range of measures.

The results suggest that exercise interventions compared with control interventions have a positive impact on overall HRQoL and certain HRQoL domains. Exercise interventions resulted in improvements in: HRQoL from baseline to 12 weeks' follow-up (SMD 0.33; 95% CI 0.12 to 0.55) or when comparing difference in follow-up scores at 12 weeks (SMD 0.47; 95% CI 0.16 to 0.79); physical functioning from baseline to 12 weeks' follow-up (SMD 0.69; 95% CI 0.16 to 1.22) or 6 months (SMD 0.28; 95% CI 0.00 to 0.55); or when comparing differences in follow-up scores at 12 weeks (SMD 0.28; 95% CI 0.11 to 0.45) or 6 months (SMD 0.29; 95% CI 0.07 to 0.50); role function from baseline to 12 weeks' follow-up (SMD 0.48; 95% CI 0.07 to 0.90) or when comparing differences in follow-up scores at 12 weeks (SMD 0.17; 95% CI 0.00 to 0.34) or 6 months (SMD 0.32; 95% CI 0.03 to 0.61); and, in social functioning at 12 weeks' follow-up (SMD 0.54; 95% CI 0.03 to 1.05) or when comparing differences in follow-up scores at both 12 weeks (SMD 0.16; 95% CI 0.04 to 0.27) and 6 months (SMD 0.24; 95% CI 0.03 to 0.44). Further, exercise interventions resulted in a decrease in fatigue from baseline to 12 weeks' follow-up (SMD -0.38; 95% CI -0.57 to -0.18) or when comparing difference in follow-up scores at follow-up of 12 weeks (SMD -0.73; 95% CI -1.14 to -0.31). Since there is consistency of findings on both types of measures (change scores and difference in follow-up scores) there is greater confidence in the robustness of these findings.

When examining exercise effects by subgroups, exercise interventions had significantly greater reduction in anxiety for survivors with breast cancer than those with other types of cancer. Further, there was greater reduction in depression, fatigue, and sleep disturbances, and improvement in HRQoL, emotional wellbeing (EWB), physical functioning, and role function for cancer survivors diagnosed with cancers other than breast cancer but not for breast cancer. There were also greater improvements in HRQoL and physical functioning, and reduction in anxiety, fatigue, and sleep disturbances when prescribed a moderate or vigorous versus a mild exercise program.

Results of the review need to be interpreted cautiously owing to the risk of bias. All the trials reviewed were at high risk for performance bias. In addition, the majority of trials were at high risk for detection, attrition, and selection bias.

Authors' conclusions
This systematic review indicates that exercise may have beneficial effects at varying follow-up periods on HRQoL and certain HRQoL domains including physical functioning, role function, social functioning, and fatigue. Positive effects of exercise interventions are more pronounced with moderate- or vigorous-intensity versus mild-intensity exercise programs. The positive results must be interpreted cautiously because of the heterogeneity of exercise programs tested and measures used to assess HRQoL and HRQoL domains, and the risk of bias in many trials. Further research is required to investigate how to sustain positive effects of exercise over time and to determine essential attributes of exercise (mode, intensity, frequency, duration, timing) by cancer type and cancer treatment for optimal effects on HRQoL and its domains.

Exercise interventions on health related quality of life for people with cancer during active treatment

There is a steady increase in the number of cancer survivors, that is people diagnosed with cancer (Aziz 2003), worldwide. This is due, in a large part, to the dramatic advances in cancer treatment and management (Aziz 2002; Aziz 2003), growing attention to multidisciplinary post-treatment care (Demark-Wahnefried 2000; Stull 2007), and healthier lifestyles (Demark-Wahnefried 2005; Stull 2007). These factors and trends especially when considered in light of an aging population (Aziz 2008; Stewart 2003), suggest that we can continue to expect increasing numbers of cancer survivors with greater expected length of survival. Ensuring the quality of that survival thus becomes a key priority. The objectives are as follows: To evaluate the effectiveness of exercise on overall HRQoL outcomes and specific HRQoL domains (e.g. physical, psychological, economic, social, and spiritual well-being, and key disease and/or treatment symptoms such as sexual functioning, neuropathy or cognitive changes, and chronic fatigue) among adult post-treatment cancer survivors (i.e. people with a history of cancer who are beyond active treatment, excluding those who are terminally ill and receiving hospice). We will focus on post-treatment cancer survivors so that we can evaluate the effectiveness of exercise on HRQoL without having to adjust for the adverse effects of cancer and/or its treatment on HRQoL. 1. A secondary objective is to examine the effectiveness of exercise on HRQoL outcomes among adult post-treatment cancer survivors stratified by the following: 2. Age at diagnosis (i.e. less than 65 years or greater than or equal to 65 years); 3. Age at trial enrolment (i.e. less than 65 years or greater than or equal to 65 years); 4. Sex; 5. Type of prescribed exercise (i.e. aerobic, anaerobic, combination); 6. Physical condition prior to cancer treatment (i.e. obesity, heart disease, smoking status, asthma); 7. Intensity of exercise (i.e. mild, moderate, vigorous); and Format of exercise (i.e. individual or group, professionally led or not, home or group facility).

Exercise interventions on health related quality of life for cancer survivors

Epidemiology of smoking-induced cardiovascular disease.

OBJECTIVE To examine changes in lifestyle behaviors after a cancer diagnosis and medical and demographic influences on such changes. METHODS Adult cancer survivors (n = 352) completed a survey including demographic, medical, and lifestyle behavior change questions. RESULTS Results showed that since cancer diagnosis, 46% of smokers quit smoking, 47% improved their dietary habits, and 30.1% exercised less. Adult cancer survivors who changed their lifestyle behaviors varied, depending on various demographic and medical variables and physician recommendation. CONCLUSION It appears from our data that cancer diagnosis in adults may have a positive influence on smoking and diet and a negative influence on exercise.

Do adults change their lifestyle behaviors after a cancer diagnosis

This article summarizes principal findings from a conference convened by the American Cancer Society in June 1998 to examine the health risks of cigar smoking. State-of-the-science reports were presented and 120 attendees (representing government and private agencies, academia, health educators, and tobacco control experts) participated in panels and summary development discussions. The following conclusions were reached by consensus: (1) rates of cigar smoking are rising among both adults and adolescents; (2) smoking cigars instead of cigarettes does not reduce the risk of nicotine addiction; (3) as the number of cigars smoked and the amount of smoke inhaled increases, the risk of death related to cigar smoking approaches that of cigarette smoking; (4) cigar smoke contains higher concentrations of toxic and carcinogenic compounds than cigarettes and is a major source of fine-particle and carbon monoxide indoor air pollution; and (5) cigar smoking is known to cause cancers of the lung and upper aerodigestive tract. JAMA. 2000;284:735-740

https://jamanetwork.com/journals/jama/articlepdf/192974/JSC90323.pdf

Health risks associated with cigar smoking.

OBJECTIVE: To examine the cigar smoking perceptions and behaviors of US adults. METHODS: A national sample of 1,012 adults was interviewed by telephone. RESULTS: Current cigar smokers differed from nonsmokers in perceptions of personal risk for cancer and views about cigar smoking as a cancer cause. Both groups showed substantial acceptance of the glamorized image of cigarsmokers. CONCLUSION: Although recognizing smoking as a cancer cause in general, cigar smokers tended to show a self-exempting "optimistic bias" with regard to perceptions of their own risks.

Risk perception and cigar smoking behavior.

The growth of research in behavioral, psychosocial, and policy aspects of cancer is quite evident through examination of the literature. Although it is necessary to recognize the importance of past achievements in these areas, it is equally essential to identify the current interests and future areas that will form a new research agenda. The present study is the first attempt to shed light on these issues by surveying a group of behavioral, psychosocial and policy researchers from 1997 (n=714) and 2002 (n=1102). Questions were posed that dealt with current and future research interests. Results indicate a stable core of research interests in the field, as well as changing trends in interest that may affect the direction of future research. Prevention and detection, psychosocial issues, and quality of life were clearly the most recognized research interests. Emerging areas of research interest seem to be special populations and health care delivery. Examination of these findings may help with research planning, funding allocation, management, beginning researcher education, and practice.

Research interests in the field of behavioral, psychosocial, and policy cancer research.

-Background. In an attempt to address the informational needs of female breast cancer survivors, the American Cancer Society (ACS) develops and distributes written documents. Although this educational effort has been well received, little attention has been given to the suitability of the materials themselves. Methods. A random sample of 812 survivors was derived from callers to the ACS National Cancer Information Center (NCIC) from July to December of 2000. The participants then rated the three most commonly distributed breast cancer information documents on five dimensions 1) presentation, 2) satisfaction, 3) understanding, 4) anxiety, and 5) impact. Results. Participants responded favorably to four of the five rating categories. Conclusions. The evidence suggests that the three materials had positive health outcomes and were well received by the survivors.

Stuart R. Ainsworth

Papers

Do adults change their lifestyle behaviors after a cancer diagnosis

Health risks associated with cigar smoking.

Risk perception and cigar smoking behavior.

Research interests in the field of behavioral, psychosocial, and policy cancer research.

Evaluation of the American Cancer Society's breast cancer-related documents by cancer survivors.