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13 september 2017: Bron: ASCO 2017

Elke kankerpatient zou naast een behandeling tegen kanker een gericht bewegingsprogramma plus psychologische ondersteuning moeten worden voorgeschreven.

Stellen de onderzoekers na een grote reviewstudie. Lichamelijke beweging en sporten kan vermoeidheid gerelateerd aan kanker voorkomen en herstellen. Het effect van gerichte bewegingsoefeningen was zo groot dat de onderzoekers er dus voor pleiten om iedere kankerpatiënt een gericht bewegingsprogramma plus psychologische begeleiding voor te schrijven / adviseren.

Dit blijkt uit een grote reviewstudie van samen 113 gerandomiseerde studies bij totaal meer dan 11.000 patiënten. In deze studie werden vier manieren van aanpak vergeleken: oefeningen / bewegen, oefeningen / bewegen plus psychologische ondersteuning, alleen psychologische ondersteuning en medicijnen / farmaceutische middelen.

Uit de studie kwam heel sterk naar voren dat gerichte bewegingsoefeningen een groot effect hebben de vermindering van aan kanker gerelateerde vermoeidheid: 

Gerichte bewegingsoefeningen (WES, 0.30; 95% CI, 0.25–0.36; P < .001), en
Psychologische ondersteuning (WES, 0.27; 95% CI, 0.21–0.33; P < .001), en
Gerichte bewegingsoefeningen plus psychologische ondersteuning (WES, 0.26; 95% CI, 0.13–0.38; P < .001) verbeterden aan kanker gerelateerde vermoeidheid gedurende en na een behandeling. terwijl een farmaceutische aanpak met medicijnen geen verbetering gaf te zien. (WES, 0.09; 95% CI, 0.00–0.19; P = .05).

Figure 2

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Forest Plot of Weighted Effect Sizes (WESs)

Overall WES across all interventions, exercise interventions, psychological interventions, exercise plus psychological interventions, and pharmaceutical interventions. Different sizes of markers indicate weight.

Een andere studie: Effect of exercise on quality of life (QoL) in 198 older patients with cancer: A URCC NCORP nationwide RCT. uitgevoerd bij oudere mensen, met vooral borstkanker die allemaal chemotherpaie kregen of hadden gehad gaf vergelijkbare resultaten te zien. Waarbgij opvalt dat bewwegen een effect heeft op bepaalde biomarkers, zoals die van ontstekingsmarkers en ook van DNA markers.

Results: Median age was 66.7 ± 2.3 years, 92% were female and 77% had breast cancer. In terms of chemotherapy, 3-week and 2-week regimens were used for 72% and 28%, respectively. EXCAP group had better social (p=0.02), emotional (p=0.04) and physical (p=0.03) well-being post-intervention than the C group. There was also a positive trend for improvement in functional, cognitive and overall well-being (Table 1). In the EXCAP group, improved social well-being was associated with decreases in the pro-inflammatory cytokine, IL-8 (r=0.30, p=0.03).

QoL DomainsEXCAP (mean ± SD)Control (mean ± SD)P-value
FACT-G Overall 85.5 ± 15.6 82.1 ± 17.2 0.46
Social 25.4 ± 4.3 23.7 ± 5.5 0.02
Emotional 20.5 ± 3.0 19.9 ± 3.7 0.04
Physical 20.4 ± 6.3 19.9 ± 5.5 0.03
Functional 19.3 ± 6.0 18.7 ± 6.1 0.49
Fact-Cog Cognition 27.3 ± 5.8 25.5 ± 7.0 0.06

In deze studie: Exercise Recommendations for Cancer-Related Fatigue, Cognitive Impairment, Sleep problems, Depression, Pain, Anxiety, and Physical Dysfunction: A Review wordt beschreven wat de effecten van chemo enz. zijn en wat bepaalde aanpak daaraan kan bijdragen om de bijwerkingen te voorkomen en verminderen

Zie onderstaande grafiek:  

Figure 1

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The 5 A’s of Applied Exercise Oncology

Medscape schreef over de reviewstudie een mooi samenvattend artikel: New Biomarker Data Provide Even More Support for Exercise Against Cancer-Related Fatigue

Zij gebruikten voor dat artikel de volgende referenties. daaronder het abstract van de reviewstudie

References

  1. Mustian KM, Alfano CM, Heckler C, et al. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncol. 2017;3:961-968. doi: 10.1001/jamaoncol.2016.6914.

  2. Mustian KM, Peoples AR, Peppone LJ, et al. Effect of exercise on novel biomarkers of muscle damage and cancer-related fatigue: A nationwide URCC NCORP RCT in 350 patients with cancer. Program and abstracts of the 2017 American Society of Clinical Oncology Annual Meeting; June 2-6, 2017; Chicago, Illinois. Abstract 10020.

  3. Chae JW, Chua PS, Ng T, et al. Mitochondrial DNA content in peripheral blood as a biomarker for cancer-related fatigue in early-stage breast cancer patients: A prospective cohort study. Program and abstracts of the 2017 American Society of Clinical Oncology Annual Meeting; June 2-6, 2017; Chicago, Illinois. Abstract 10018.

  4. Loh KP, Mohile SG, Cole C, et al. Effect of exercise on quality of life (QoL) in 198 older patients with cancer: A URCC NCORP nationwide RCT. Program and abstracts of the 2017 American Society of Clinical Oncology Annual Meeting; June 2-6, 2017; Chicago, Illinois. Abstract 10019.

Hier het abstract van de reviewstudie uit JAMA:

Exercise and psychological interventions are effective for reducing Cancer Related Fatigue - CRF during and after cancer treatment, and they are significantly better than the available pharmaceutical options. Clinicians should prescribe exercise or psychological interventions as first-line treatments for CRF.

JAMA Oncol. Author manuscript; available in PMC 2017 Aug 15.
Published in final edited form as:
PMCID: PMC5557289
NIHMSID: NIHMS892615

Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue A Meta-analysis

Abstract

IMPORTANCE

Cancer-related fatigue (CRF) remains one of the most prevalent and troublesome adverse events experienced by patients with cancer during and after therapy.

OBJECTIVE

To perform a meta-analysis to establish and compare the mean weighted effect sizes (WESs) of the 4 most commonly recommended treatments for CRF—exercise, psychological, combined exercise and psychological, and pharmaceutical—and to identify independent variables associated with treatment effectiveness.

DATA SOURCES

PubMed, PsycINFO, CINAHL, EMBASE, and the Cochrane Library were searched from the inception of each database to May 31, 2016.

STUDY SELECTION

Randomized clinical trials in adults with cancer were selected. Inclusion criteria consisted of CRF severity as an outcome and testing of exercise, psychological, exercise plus psychological, or pharmaceutical interventions.

DATA EXTRACTION AND SYNTHESIS

Studies were independently reviewed by 12 raters in 3 groups using a systematic and blinded process for reconciling disagreement. Effect sizes (Cohen d) were calculated and inversely weighted by SE.

MAIN OUTCOMES AND MEASURES

Severity of CRF was the primary outcome. Study quality was assessed using a modified 12-item version of the Physiotherapy Evidence-Based Database scale (range, 0–12, with 12 indicating best quality).

RESULTS

From 17 033 references, 113 unique studies articles (11525 unique participants; 78% female; mean age, 54 [range, 35–72] years) published from January 1, 1999, through May 31, 2016, had sufficient data. Studies were of good quality (mean Physiotherapy Evidence-Based Database scale score, 8.2; range, 5–12) with no evidence of publication bias. Exercise (WES, 0.30; 95% CI, 0.25–0.36; P < .001), psychological (WES, 0.27; 95% CI, 0.21–0.33; P < .001), and exercise plus psychological interventions (WES, 0.26; 95% CI, 0.13–0.38; P < .001) improved CRF during and after primary treatment, whereas pharmaceutical interventions did not (WES, 0.09; 95% CI, 0.00–0.19; P = .05). Results also suggest that CRF treatment effectiveness was associated with cancer stage, baseline treatment status, experimental treatment format, experimental treatment delivery mode, psychological mode, type of control condition, use of intention-to-treat analysis, and fatigue measures (WES range, −0.91 to 0.99). Results suggest that the effectiveness of behavioral interventions, specifically exercise and psychological interventions, is not attributable to time, attention, and education, and specific intervention modes may be more effective for treating CRF at different points in the cancer treatment trajectory (WES range, 0.09–0.22).

CONCLUSIONS AND RELEVANCE

Exercise and psychological interventions are effective for reducing CRF during and after cancer treatment, and they are significantly better than the available pharmaceutical options. Clinicians should prescribe exercise or psychological interventions as first-line treatments for CRF.

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