Do older patients with colorectal cancer experience more deterioration in health-related quality of life than younger patients during the first year of palliative chemotherapy? A prospective real-world observational study.

INTRODUCTION: The primary aim was to evaluate changes in health-related quality of life (HRQoL) in a real-life population among younger (< 70 years) and older patients with metastatic colorectal cancer (mCRC) during the first year of palliative chemotherapy. The secondary aims were to assess the impact of chemo-break on HRQoL and to report overall survival (OS). MATERIALS AND METHODS: Patients with newly diagnosed mCRC, ≥ 18 years, and scheduled for first line palliative chemotherapy were included in this multicentre longitudinal observational study. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (0-100) was filled in at baseline and every second month. Changes or differences in QoL scores of >20, 10-20, and 5-10 points were considered to be of large, moderate, and small clinical magnitude, respectively. Comparing means of different QoL scores between groups or over time, a threshold of 5-10 was considered the minimally important difference (MID). Treatments, patient characteristics, and tumour characteristics were prospectively registered. RESULTS: A total of 214 patients were included, and 146 were alive after one year. Four months after start of treatment, large deteriorations in fatigue and physical functioning were reported by 40% and 25% of the patients, respectively. Changes in global QoL, physical functioning, role functioning, fatigue, pain, and nausea/vomiting were not significantly different between the age groups and reached baseline levels after one year. Patients on chemo-break reported significant improvements in several HRQoL domains. Median OS was 17.5 months [95% confidence interval 14.4-20.5] with no difference between younger and older patients. DISCUSSION: Older patients did not experience more deterioration in HRQoL than younger patients during the first year of palliative chemotherapy. Measures to mitigate the deteriorations in fatigue and physical functioning observed during the first months of palliative treatment are warranted. TRIAL REGISTRATION: NCT02395224, March 23, 2015, retrospectively registered.

Diastolic function and cardiovascular risk among patients with severe obesity referred to a lifestyle-program - a pilot study.

Objectives. Severe obesity is associated with a high risk of comorbidities and alterations of cardiac structure and function. The primary aim of the study was to investigate the proportion of diastolic dysfunction (DD) at baseline, and changes in cardiac function from baseline (T1) to 6 months follow-up (T2) among participants with severe obesity attending a lifestyle-intervention. The secondary aim was to explore changes in body mass index (BMI), physical fitness (VO2peak) and cardiovascular risk from T1 to T2 and 12 months follow-up (T3).Design. This was an open single-site prospective observational study. Patients were recruited from an obesity clinic to a lifestyle-intervention consisting of three 3-weeks intermittent stays over 12-months period. Echocardiography was performed at T1 and T2 and BMI, VO2peak and cardiovascular risk measured at T1, T2 and T3.Results. Fifty-six patients were included (mean age 45.1 years; BMI 41.9). Six of 52 patients (12%) had grade 1 DD at T1, while five subjects had DD at T2. E/A ratio (11%, p = .005) and mitral deceleration time (9%, p = .014) were improved at T2. A reduction in BMI (-1.8, p < .001) and improvement in VO2peak (1.6 mL/kg min, p = .026) were assessed at T2 and this improvement persisted at T3. The total cardiovascular risk score was not significantly changed.Conclusion. The patients with severe obesity had low prevalence of DD. For all participants, an improvement in diastolic parameters, and an important initial weight loss was observed.Clinical Trial number: NCT02826122.

Community-Based Multidimensional Cancer Rehabilitation in Norway: A Feasibility Study.

BACKGROUND: Cancer survival is often accompanied by late effects that can be mitigated by tailored rehabilitation. In Norway, this has traditionally been offered as residential programs, whereas community-based cancer rehabilitation programs are lacking. OBJECTIVE: This study aimed to assess the feasibility and acceptability of a newly developed community-based multidimensional cancer rehabilitation program in Norway. METHODS: A feasibility study with a mixed methods explanatory sequential design was implemented. The intervention was a 12-week group-based rehabilitation program comprising 5 components: goal setting, physical exercise, psychoeducation, individual follow-up consultations, and peer support. Feasibility was assessed through recruitment, retention, and intervention delivery. Acceptability was assessed through intervention adherence and participant evaluation. Qualitative data were generated from focus group interviews. Statistical analyses were descriptive, and qualitative data were transcribed and analyzed using framework analyses. RESULTS: Sixty participants started, and 55 completed the 12-week rehabilitation program. The majority were female (80%), and the mean age was 56 years. The largest diagnostic group was breast cancer (42%). Retention was high (92%), as were adherence rates for all intervention components. The exercise component was rated the most beneficial, followed by individual consultations and peer support. Qualitative findings contributed to explaining the high adherence and positive evaluation. CONCLUSION: High retention, strong adherence, and positive evaluation imply that the community-based program was feasible and acceptable to cancer survivors. IMPLICATION FOR PRACTICE: The results will aid intervention refinement and contribute to a future randomized controlled trial to examine its effectiveness. If successful, the rehabilitation program could be implemented in the Norwegian Cancer Pathway "Home."

Exploring use of activity monitors for patients with obesity during weight-loss treatment - a qualitative study.

BACKGROUND: Obesity is a major health concern in western countries. In Norway, patients with obesity can attend weight-loss programmes, which focus on changes in dietary and physical activity habits. Use of self-monitoring is advocated when changing dietary and physical activity habits for adults with obesity. This study aimed to explore the experiences of patients with obesity who used activity monitors while attending a weight-loss programme. METHODS: Patients with body mass index (BMI) > 35 kg/m2 with weight related comorbidities or a BMI > 40 kg/m2 referred to an intermittent weight-loss programme were recruited into this study. They were introduced to one of three different activity monitors, Fitbit Zip™, Mio Fuse™, or Mio Slice™. Semi-structured interviews were performed with patients six months into the weight-loss programme. Thematic analysis was applied when analysing the data. RESULTS: Of the 29 informants (aged 21 to 66 years) interviewed, 59% were female. Their experience with activity monitors was related to their adherence to the weight-loss programme. Two main themes emerged from the informants stories: 1. "Activity monitors visualize proof of effort or failure to change health habits". 2. "Activity monitors act as a positive or negative enforcer when incorporating change". CONCLUSIONS: Using activity monitors either strengthens or undermines patients' attempts to change health habits when attending a weight-loss program. Our findings suggest a need for more individualized weight-loss programmes for patients with obesity.

Long-term work outcomes and the efficacy of multidisciplinary rehabilitation programs on labor force participation in cancer patients - a protocol for a longitudinal prospective cohort study.

Background. Many cancer survivors experience late effects of cancer treatment and therefore struggle to return to work. Norway provides rehabilitation programs to increase labor force participation for cancer survivors after treatment. However, the extent to which such programs affect labor force participation has not been appropriately assessed. This study aims to investigate i) labor force participation, sick leave and disability rates among cancer survivors up to 10 years after being diagnosed with cancer and identify comorbidities contributing to long-term sick leave or disability pensioning; ii) how type of cancer, treatment modalities, employment sectors and financial- and sociodemographic factors may influence labor force participation; iii) how participation in rehabilitation programs among cancer survivor affect the longterm labor force participation, the number of rehospitalizations and incidence of comorbidities. Design and methods. Information from four medical, welfare and occupational registries in Norway will be linked to information from 163,279 cancer cases (15.68 years old) registered in the Norwegian Cancer Registry from 2004 to 2016. The registries provide detailed information on disease characteristics, comorbidities, medical and surgical treatments, occupation, national insurance benefits and demographics over a 10-year period following a diagnosis of cancer. Expected impact of the study for Public Health. The study will provide important information on how treatment, rehabilitation and sociodemographic factors influence labor force participation among cancer survivors. Greater understanding of work-related risk factors and the influence of rehabilitation on work-participation may encourage informed decisions among cancer patients, healthcare and work professionals and service planners.

Exercise and Nutrition Interventions in Patients with Head and Neck Cancer during Curative Treatment: A Systematic Review and Meta-Analysis.

The aim of this meta-analysis was to examine the effects of nutritional and physical exercise interventions and interventions combining these interventions during radiotherapy treatment for patients with head and neck cancer on body composition, objectively measured physical function and nutritional status. Systematic electronic searches were conducted in MEDLINE (PubMed interface), EMBASE (Ovid interface), CINAHL (EBSCO interface) and Cochrane Library (Wiley interface). We identified 13 randomized controlled trials (RCTs) that included 858 patients. For body composition, using only nutrition as intervention, a significant difference between treatment and control group were observed (SMD 0.42 (95CI 0.23-0.62), p < 0.001). Only pilot RCTs investigated combination treatment and no significant difference between the treatment and control groups were found (SMD 0.21 (95CI -0.16-0.58), p = 0.259). For physical function, a significant difference between treatment and control group with a better outcome for the treatment group were observed (SMD 0.78 (95CI 0.51-1.04), p < 0.001). No effects on nutritional status were found. This meta-analysis found significantly positive effects of nutrition and physical exercise interventions alone in favor of the treatment groups. No effects in studies with combined interventions were observed. Future full-scaled RCTs combining nutrition and physical exercise is warranted.

The effects of High- versus Moderate-Intensity Exercise on Fatigue in Sarcoidosis.

BACKGROUND: Fatigue is a common symptom in patients with sarcoidosis. Despite lacking evidence on whether high-intensity interval training (HIIT) will aggravate fatigue, moderate-intensity exercise is often recommended. This study aimed to investigate whether a single session of HIIT would affect fatigue differently from a single session of moderate-intensity continuous training (MICT). METHODS: Forty-one patients with pulmonary sarcoidosis were recruited to a cross-over study. All patients completed one treadmill session of HIIT (85% of peak heart rate (HRpeak)) and one of MICT (70% of HRpeak). Fatigue was assessed with the Visual Analogue Scale 0⁻100 mm, before (T0), after (T1), and 24 hours after (T2) each exercise session. Paired sample t-test was used to compare changes in fatigue from T0 to T1 and from T0 to T2 between HIIT and MICT. RESULTS: No statistically significant difference in fatigue levels was found between HIIT and MICT, either at T1 (3.6 (13.5) and 1.4 (13.5)) or at T2 (8.2 (17.0) and 2.1 (17.1)). CONCLUSIONS: A single session of HIIT did not affect fatigue differently than a single session of MICT. These preliminary findings support the need for further research on the long-term effect of HIIT on fatigue in patients with sarcoidosis.

Changes in fatigue, health-related quality of life and physical activity after a one-week educational program for cancer survivors.

Background: Rehabilitation aims to improve function, but the effects of different programs are not clear. The aims of the present study were to: (1) compare the level of fatigue and health-related quality of life (HRQOL) of cancer survivors admitted to a one-week inpatient educational program (IEP) to the general population (NORMS), (2) examine changes in fatigue, HRQOL and physical activity after the IEP and (3) examine the proportions of survivors for female and male separately with clinically relevant improvement (>10% of maximum scale). Methods: Cancer survivors ≥18 years, diagnosed with breast-, prostate- or gastrointestinal cancer within the last 10 years, about to attend a one-week IEP were invited to an observational study with a pre-post design. The IEP included lectures, group discussions and physical activity. The participants completed a questionnaire on the arrival day (T0) and three months after the stay (T1). Fatigue was assessed by the Fatigue Questionnaire and HRQOL by Short Form-36. Results: Compared to NORMS, both female and male participants had significantly higher mean levels of fatigue and poorer HRQOL at T0 and T1. From T0 to T1, among all participants physical fatigue was reduced from 12.6 (SD 3.9) to 11.8 (SD 3.8; p < .001), mental fatigue from 6.3 (SD 2.2) to 6.0 (SD 2.2; p = .044) and total fatigue from 19.0 (SD 5.3) to 17.8 (SD 5.4; p = .001). Among female participants, 30% experienced clinically relevant improvement in physical fatigue, 28% in total fatigue and 36% in general health. Of male participants, 31% displayed a clinically relevant improvement in role limitations physical. Conclusion: Participants in the IEP reduced their levels of fatigue and improved aspects of HRQOL, more often observed among female participants than among males. Because of the lack of a control group it is not possible to conclude whether the changes were due to the IEP.

Perceived needs for different components in a rehabilitation program among cancer survivors with chronic fatigue compared to survivors without chronic fatigue.

BACKGROUND: Knowledge about the user' needs is important to develop targeted rehabilitation for cancer patients with chronic fatigue (CF). The aims of the study were to examine prevalence of CF in cancer survivors attending an one-week inpatient educational program (IEP) and to identify characteristics of those with CF. Further to examine the perceived needs for different components in a rehabilitation program, need of complex rehabilitation (at least two components) and aspects of health-related quality of life (HRQoL) among survivors with CF versus those without CF. MATERIAL AND METHODS: Cancer survivors ≥18 years, diagnosed with different types of cancer within the last 10 years and attending a one-week IEP were invited to this cross-sectional study. CF was assessed by the Fatigue Questionnaire, perceived needs by asking a question about needs for different components in a rehabilitation program and HRQoL was assessed by The Medical Outcomes Study Short Form 36. RESULTS: Of 564 participants, 45% reported CF. Breast cancer, mixed cancer types (including small groups with different cancer types) and comorbidities increased the risk for having CF. Compared to participants without CF, the participants with CF reported more frequently need for physical training (86% vs. 65%, p < 0.001), physiotherapy (71% vs. 55%, p < 0.001) and nutrition counseling (68% vs. 53%, p = 0.001). Among participants with CF, 75% reported need for three or more components whereas 54% reported need for the same number of components among those without CF (p < 0.001). CONCLUSION: Almost half of the cancer survivors attending the IEP had CF. Physical training, physiotherapy and nutrition counseling were the most frequently reported needs and significantly more often observed in participants with CF than without CF. A higher percentage of those with CF reported need for a complex rehabilitation compared to those without CF. More research is necessary to obtain more knowledge to further make targeted programs to better match cancer survivors' needs.

Are web-based questionnaires accepted in patients attending rehabilitation?

PURPOSE: The aim of the present paper was to study preferences for web based self-administered questionnaires (web SAQs) vs. paper-based self-administered questionnaires (paper SAQs) and to evaluate the feasibility of using web SAQs in patients referred to cardiac, lung, occupational and cancer rehabilitation programs. METHODS: The patients were approached by mail and given the choice to answer the compulsory SAQs either on paper or on a web-based platform. RESULTS: Hundred and twenty seven out of 183 eligible patients (69.3%) were willing to participate and 126 completed the study. Web SAQs were preferred by 77.7%, and these patients were significantly younger, more often cohabiting and tended to have higher level of education than paper SAQ users. Mean number of data missing per patient was less among the web SAQ users than the paper SAQ users (0.55 vs. 2.15, p < 0.001). Costs related to human resources were estimated to be 60% lower with web SAQs compared to paper SAQs. CONCLUSIONS: Web SAQs were well accepted among the patients scheduled for rehabilitation, led to less missing data and considerable cost savings related to human resources. Patients referred to rehabilitation should be offered the choice to complete self-administered questionnaires on internet platforms when internet access is common and available. Implications for Rehabilitation The high acceptability of web-based self-administered questionnaires among rehabilitation patients suggests that internet platforms are suitable tools to collect patient information for rehabilitation units. Web-based modes of patient data collection demonstrate low number of missing data and can therefore improve the quality of data collection from rehabilitation patients. Use of web-based questionnaires considerably reduces administrative costs of data collection in rehabilitation settings compared to traditional pen and paper methods.

Lifestyles of cancer survivors attending an inpatient educational program-a cross-sectional study.

PURPOSE: Cancer survivors have increased risk for adverse health effects, but the risk can be reduced by adopting a healthy lifestyle. Knowledge of lifestyle in terms of physical activity (PA), diet (intake of fruit and vegetables [F&V]) and smoking behaviors of cancer survivors enrolled in an inpatient educational program and identification of subgroups not meeting the lifestyle guidelines are needed to set up more targeted programs. METHODS: We invited 862 cancer survivors, ≥18 years, diagnosed within the last 10 years and about to attend a 1-week educational program, to participate in this cross-sectional study. Sixty-seven percent (n = 576) returned the questionnaire before the start of the program. PA, F&V intake (5-A-Day) and smoking behaviors were self-reported. Logistic regression analyses were used to identify the characteristics of those not meeting the guidelines. RESULTS: Sixty-three percent were women, median age was 60 years (range 28-83), 52 % had high education and median time since diagnosis was 12 months (range 2-119). Fifty-five percent did not meet the PA guidelines, 81 % did not meet the 5-A-Day guidelines and 12 % were current smokers. In multivariate analyses, age ≥60 years and low education were associated with not meeting the PA guidelines, and male gender and low education were associated with not meeting the 5-A-Day guidelines. Living alone was associated with smoking. CONCLUSIONS: The majority of cancer survivors attending an educational program do not meet the public guidelines for PA and diet. Special attention should be given to those who are male, over age 60 years and with low education.

What is covered by "cancer rehabilitation" in PubMed? A review of randomized controlled trials 1990-2011.

OBJECTIVE: This focused review examines randomized controlled studies included by the term "cancer rehabilitation" in PubMed. The research questions concern the type of interventions performed and their methodological quality. DESIGN: Using the Medical Subject Headings (MeSH) terms: neoplasm AND rehabilitation, all articles with randomized controlled studies that included adult cancer patients, written in English, were extracted from PubMed. Papers covering physical exercise, psychiatric/psychological treatment or social support only were excluded as they had been reviewed recently. Abstracts and papers were assessed by 3 pairs of reviewers, and descriptive information was extracted systematically. Methodological quality was rated on a 10-item index scale, and the cut-off for acceptable quality was set at ≥ 8. RESULTS: A total of 132 (19%) of the 683 identified papers met the eligibility criteria and were assessed in detail. The papers were grouped into 5 thematic categories: 44 physical; 15 art and expressive; 47 psycho-educative; 21 emotionally supportive; and 5 others. Good quality of design was observed in 32 studies, 18 of them uni-dimensional and 14 multi-dimensional. CONCLUSION: Published randomized controlled studies on cancer rehabilitation are heterogeneous in terms of content and samples, and are mostly characterized by suboptimal design quality. Future studies should be more specific and well-designed with sufficient statistical strength.

One-year course of fatigue after post-operative radiotherapy in Norwegian breast cancer patients--comparison to general population.

INTRODUCTION: Fatigue after treatment for breast cancer (BC) is common, but poorly understood. We examined the fatigue levels during first year after radiotherapy (RT) according to the extent of RT (local or locoregional), hormonal therapy (HT) and chemotherapy (CT). The impact of comorbidity was also explored. Moreover, we compared fatigue levels in patients with the general population (GenPop) data. MATERIAL AND METHODS: BC patients (n = 250) referred for post-operative RT at St. Olavs Hospital, Trondheim, Norway, were enrolled. Fatigue was measured by the EORTC QLQ-C30-fatigue subscale, ranging from 0 to 100, before RT (baseline), after RT, and at three, six, and 12 months. Clinical and treatment-related factors were recorded at baseline. GenPop data was available from a previous survey (n = 652). Linear mixed models and analysis of covariance were applied. RESULTS: Compliance ranged from 87% to 98%. At baseline, mean value (SD) of fatigue in BC patients was 26.8 (23.4). The level increased during RT (mean change 8.3, 95% CI 5.5-11.1), but declined thereafter and did not differ significantly from pre-treatment levels at subsequent time points. In age-adjusted analyses, locoregional RT accounted for more overall fatigue than local RT (mean difference 6.6, 95% CI 1.2-12.0), but the association was weakened and not statistical significant when adjusting for CT and HT. Similar pattern was seen for CT and HT. The course of fatigue differed significantly by CT (p < 0.001, interaction test). At baseline, fatigue levels were higher in patients with than without CT, but at subsequent time points similar levels were evident, indicating a temporary adverse effect of CT. Comorbidity was significantly associated with increased level of fatigue, independent of other factors (mean difference 8.1, 95% CI 2.2-14.1). BC-patients were not significantly more fatigued than GenPop, except for immediately after ending RT, and then only among those without comorbidity (mean 35.9 vs. 25.8, p < 0.001). CONCLUSION: Comorbidity seems to be a more important determinant for fatigue levels than the cancer treatment.

Feasibility and changes in symptoms and functioning following inpatient cancer rehabilitation.

AIM: The aim was to assess feasibility of a 3 + 1 week inpatient rehabilitation program for cancer survivors, to explore characteristics of the attending participants and examine changes in work status, symptoms and functioning, level of fatigue, exercise and physical performance following rehabilitation. METHODS: This was an open intervention study involving cancer survivors having completed primary cancer treatment. The multidisiplinary program consisted of physical training, patient education and group sessions. Participant were assessed at primary stay (T0), at follow-up stay 8-12 weeks later (T1), and six months after T1 (T2). Symptoms and functioning were assessed by the European Organization for Research and Treatment Core Quality-of-Life Questionnaire, physical fatigue by Fatigue Questionnaire, physical exercise by The Nord- Trøndelag Health Study Physical Activity Questionnaire and physical performance by aerobic capacity (VO(2max)), 30 second Sit-to-stand (STS) and Maximum Step Length (MSL). Linear mixed models were used in analyses. RESULTS: One hundred and thirty-four of 163 included participants (82%) completed both rehabilitation stays and returned questionaires at T2. The majority of completers were females (81%), breast cancer survivors (60%), highly educated and with mean age of 52.8 years (SD of 8.1). Participants had higher level of symptoms and fatigue and lower functioning at admission compared to a Norwegian reference population. However, they reported higher physical exercise level and 47% reported improved work status from T0 to T2. Symptoms and functioning, fatigue, physical exercise and physical performance improved significantly from T0 to T1 and were maintained at T2. CONCLUSIONS: The rehabilitation program was feasible and symptoms and functioning normalized following rehabilitation. The program mainly recruited well-educated breast cancer survivors, reporting relative high level of physical exercise. More focus should be put on recruiting and selecting those who need comprehensive inpatient rehabilitation and also compare the effects of inpatient with outpatient rehabilitation programs.

Physical exercise for cancer patients with advanced disease: a randomized controlled trial.

BACKGROUND: Physical exercise can improve cancer patients' functioning and reduce their symptom levels. A randomized, controlled trial was launched to test the hypothesis that physical exercise reduces fatigue and improves physical performance in cancer patients with advanced and incurable disease. METHODS: Cancer patients (n = 231) with a life expectancy ≤2 years were randomized to a physical exercise group (PEG, n = 121) or a control usual care group (UCG, n = 110). The PEG exercised under supervision 60 minutes twice a week for 8 weeks. Assessments were performed before and after the intervention. The primary outcome was physical fatigue (PF) measured by the Fatigue Questionnaire. Physical performance was a secondary outcome measured by the Shuttle Walk Test (SWT) and hand grip strength (HGS) test. Analyses were performed after multiple imputations for missing data. The trial is registered with ClinicalTrials.gov (identifier, NCT00397774). FINDINGS: Thirty-six percent of the PEG were lost to follow-up compared with 23% of the UCG, primarily as a result of disease progression. Seventy-eight PEG and 85 UCG patients completed the intervention. Analyses showed no significant between-group effects in PF. However, clinically and statistically significant between-group effects were found for the SWT and HGS test. INTERPRETATION: Fatigue was not reduced but physical performance (SWT and HGS test) was significantly improved after 8 weeks of physical exercise. Physical exercise might therefore be a suitable approach for maintaining physical capacity in cancer patients with incurable and advanced disease.

Development of a computer-administered mobility questionnaire.

PURPOSE: Mobility is an important aspect of physical functioning, but feasible and validated self-report assessment instruments for palliative patients are lacking. This study is a part of the European Palliative Research Network research programme, aiming to develop an internationally endorsed assessment tool for symptoms and functioning in palliative cancer care. The specific aim of the present study is to assess psychometric properties of a mobility item bank, with regards to uni-dimensionality, functional coverage, redundant items and gaps in the scale. METHODS: A cross-sectional study with 604 responses from palliative cancer and 186 from chronic pain patients (mean age 59 ± 14 years, 55% female) was performed. A tablet computer with a touch- sensitive screen was used for data collection. An item pool of 21 mobility items, ranging from sitting without support to running were presented in random order, each scored on a four-category scale rating the difficulty in performing the activity. Psychometric properties were assessed by exploratory factor analysis, internal consistency and item response theory. RESULTS: The mobility scale can be regarded as uni-dimensional and has good internal consistency (Cronbach's alpha = 0.97). Items had a wide functional coverage from low to high functioning. Two items were with poor psychometric properties and two redundant items were removed. There were no obvious gaps in the scale. CONCLUSIONS: The psychometric properties of the scale are good and the next step is to make a pre-programmed version of the scale to be used in a pan-European study.

Computer-based assessment of symptoms and mobility in palliative care: feasibility and challenges.

The aims of the study were to explore the ability of cancer patients who are primarily receiving palliative care to use a touchscreen computer for assessment of symptoms and mobility and to investigate which factors predicted the need for assistance during the assessment. Before the main data collection, a pilot study was conducted to explore the preferences of these patients toward using such a computerized assessment tool. Patients were recruited from nine different inpatient and outpatient palliative care and general cancer clinics in Norway. The patients responded to 60 items on symptoms and mobility directly on the computer. In the pilot study (n=20), 11 patients (55.0%) preferred computerized assessment over paper and pencil, whereas five (25.0%) had no preference. In the main data collection, 370 patients (52.7% men with mean age 62 years and mean Karnofsky Performance Status score of 70) completed the assessment. Eighty-six patients (23.2%) required assistance. Patients requiring assistance were significantly older, had worse performance status, and poorer cognitive function than those not requiring assistance. Predictors for requiring assistance were age (P<0.001) and performance status (P<0.001). Because higher age and worse performance status resulted in more need of assistance, assessment tools should be short and user-friendly to ensure good compliance in frail patients.

Physical activity in Hodgkin's lymphoma survivors with and without chronic fatigue compared with the general population - a cross-sectional study.

BACKGROUND: Hodgkin's lymphoma survivors (HLSs) commonly report chronic fatigue, defined as high levels of fatigue for 6 months or more. Underlying mechanisms are poorly understood. Based upon knowledge from other populations, lifestyle parameters may be related to this increased and persistent fatigue. The primary objective of the present study was to assess self-reported levels of physical activity, smoking habits and sleep patterns in HLSs with and without chronic fatigue. The secondary objective was to compare these results with data from age and gender adjusted data from the general population (Gen-Pop). METHODS: The Fatigue Questionnaire (FQ) and questions about daily smoking, sleep patterns and level of physical activity were completed by 476 HLSs treated at Rikshospitalet-Radiumhospitalet Trust (RR). The Gen-Pop data was derived from 56.999 inhabitants in a Norwegian county responding to a mail survey. Fischer's exact test, chi square test and t-tests were used to compare groups. P-values < .05 were considered statistically significant. A logistic regression analysis was performed in comparing the Gen-Pop with the HLSs. RESULTS: Level of physical activity, smoking habits and sleep patterns did not differ significantly between HLSs with and without chronic fatigue. The multivariate logistic regression analysis adjusting for different covariates, showed significantly more physically active men among HLSs compared with the Gen-Pop (OR = 1.50, CI 1.04 - 2.17), p = .031. No significant difference was found among females (OR = 1.20, CI = 0.83 - 1.74), p = .33. CONCLUSION: Lifestyle parameters did not seem to be related to increased and persistent fatigue among HLSs. The results may indicate that the experience of Hodgkin's lymphoma increases the level of physical activity among male HLSs.

The effect of a physical exercise program in palliative care: A phase II study.

The purpose of this pilot study was to assess the effects of a physical exercise program on physical performance and quality of life (QOL) in a population with incurable cancer and a short life expectancy. Thirty-four patients participated in a 50-minute group exercise program twice a week for 6 weeks. Physical performance was measured by three tests: "6-minute walk test," "timed repeated sit to stand," and "functional reach." Fatigue was measured by the Fatigue Questionnaire. QOL was assessed by the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire. The outcome variables were assessed before and after the intervention. The walk length increased and the "timed repeated sit to stand" was reduced (P < 0.05). Emotional functioning improved and physical fatigue was reduced (P < 0.05). Physical exercise seems to be a feasible way to improve well-being among patients with incurable cancer. Future randomized trials are needed to confirm the results.

Are palliative cancer patients willing and able to participate in a physical exercise program?

OBJECTIVE: The primary aim of the present article was to identify palliative care patient populations who are willing to participate in and able to complete a group exercise/physical training program designed specifically for the individual patient. METHOD: We conducted a prospective phase II intervention study examining the willingness and ability of palliative care cancer patients to participate in a group exercise physical training program. Patients who were diagnosed with incurable cancer and had a life expectancy of less than 1 year at two outpatient clinics were invited to participate in an exercise program in the hospitals. The groups met twice a week over a 6-week period. RESULTS: One hundred one consecutive patients were asked for inclusion. Sixty-three patients agreed to participate. Sixteen (25%) of the 63 patients dropped out after consent was given, but before the program started due to medical problems, social reasons, or death. Thus, 47 patients started the exercise program. Thirteen patients withdrew during the program due to sudden death, medical problems, or social reasons. The most frequent reasons for withdrawal were increased pain or other symptoms. Thirty-four patients completed the exercise program. SIGNIFICANCE OF RESULTS: A high proportion of incurable cancer patients were willing to participate (63%) in a structured exercise program. The attrition rate was high, but despite being severely ill, 54% of the patients completed the exercise period. This shows that a physical exercise program tailored to the individual patient is feasible in this population.