Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer.

Multiple organizations around the world have issued evidence-based exercise guidance for patients with cancer and cancer survivors. Recently, the American College of Sports Medicine has updated its exercise guidance for cancer prevention as well as for the prevention and treatment of a variety of cancer health-related outcomes (eg, fatigue, anxiety, depression, function, and quality of life). Despite these guidelines, the majority of people living with and beyond cancer are not regularly physically active. Among the reasons for this is a lack of clarity on the part of those who work in oncology clinical settings of their role in assessing, advising, and referring patients to exercise. The authors propose using the American College of Sports Medicine's Exercise Is Medicine initiative to address this practice gap. The simple proposal is for clinicians to assess, advise, and refer patients to either home-based or community-based exercise or for further evaluation and intervention in outpatient rehabilitation. To do this will require care coordination with appropriate professionals as well as change in the behaviors of clinicians, patients, and those who deliver the rehabilitation and exercise programming. Behavior change is one of many challenges to enacting the proposed practice changes. Other implementation challenges include capacity for triage and referral, the need for a program registry, costs and compensation, and workforce development. In conclusion, there is a call to action for key stakeholders to create the infrastructure and cultural adaptations needed so that all people living with and beyond cancer can be as active as is possible for them.

Uso de estrogênio näo-anticoncepcional e risco de câncer mamário / The use of non anticonceptive estrogens and risk of breast neoplasms

A relaçäo entre o risco de câncer mamário e uso de estrogênios näo-anticoncepcionais foi investigada num estudo hospitalar em 1.610 mulheres com câncer mamário e 1.606 com outras condiçöes. A estimativa do risco relativo global para os estrogênios conjugados, tomados pela primeira vez 18 meses, pelo menos, antes da hospitalizaçäo, em comparaçäo com ausência de uso de quaisquer estrogênios näo-anticoncepcionais foi 0,9 (intervalo de confiança 95% - 0,7 a 1,1). Para outros estrogênios, tomados pelo menos 18 meses antes da hospitalizaçäo, a estimativa foi 0,8 (0,6 a 1,1). Quando levados em conta os fatores conhecidos de câncer mamário, os resultados foram semelhantes. Entre as mulheres pós-menopáusicas, os estrogênios conjugados näo pareceram aumentar o risco de câncer mamário, mesmo quando tomados por muitos anos, no passado distante. Näo houve prova de maior risco devido ao uso de estrogênios conjugados entre os subgrupos de mulheres definidos segundo os vários fatores de risco de câncer mamário. Os resultados deste estudo sugerem que os estrogênios näo anticoncepcionais näo aumentam o risco de câncer mamário