Randomized trial of exercise on depressive symptomatology and brain derived neurotrophic factor (BDNF) in ovarian cancer survivors: The Women's Activity and Lifestyle Study in Connecticut (WALC).

OBJECTIVES: Depression is one of the most prevalent mental disorders, and rates are higher among cancer survivors than the general population, and higher in ovarian cancer patients compared to cohorts of other cancer survivors. Physical activity has been associated with lower depressive symptoms in cancer survivors, yet no trial has examined this association in women with ovarian cancer. We examined the effect of exercise on depression symptomatology and serum brain derived neurotrophin factor (BDNF) which has been associated with depression, in women with ovarian cancer. METHODS: We conducted a 6-month home-based randomized trial of exercise vs. attention-control (AC) in 144 ovarian cancer survivors. Depressive symptomatology was measured via the Center for Epidemiologic Studies Depression Scale (CES-D). Serum total and free BDNF was measured at baseline and 6-months. Student's t-statistic and mixed-model repeated measures analysis was used to evaluate six-month change between arms in CES-D scores and BDNF. RESULTS: Women were 57.3 ±â€¯8.6 (mean ±â€¯SD) years old, 1.7 ±â€¯1.0 years post-diagnosis with a baseline CES-D score of 11.79 ±â€¯10.21. The majority (55%) were diagnosed with stage III/IV ovarian cancer. CES-D scores decreased in the exercise arm by 2.7 points (95% CI: -4.4, -0.9) or a 21% decrease compared to a 0.3 point decrease (-2.2, 1.5) (3% decrease) in the AC arm (P = 0.05). There was no difference in change in total or free BDNF between the exercise and AC arms. CONCLUSIONS: Ovarian cancer survivors are able to exercise at recommended levels, and exercise was associated with a significant reduction in depressive symptomatology.

Randomized Trial of Exercise on Quality of Life in Women With Ovarian Cancer: Women's Activity and Lifestyle Study in Connecticut (WALC).

Background: Ovarian cancer survivors experience a wide range of treatment side effects that can negatively affect health-related quality of life (HRQOL). Physical activity has been shown to improve HRQOL and cancer-related fatigue (CRF) for other cancer survivors; however, no large randomized controlled trial (RCT) has been conducted for ovarian cancer. Methods: This study examined the impact of a six-month RCT of exercise vs attention control on change in HRQOL (Short Form Health Survey-36) and CRF (Functional Assessment of Cancer Therapy-Fatigue Scale) in ovarian cancer survivors. Women (n = 144) were randomly assigned to study arms between May 1, 2010, and March 20, 2014. All statistical tests were two-sided. Results: A total of 74 women were randomly assigned to exercise and 70 to attention control. A total of 113 (78.5%) of the participants completed the six-month assessment. Adherence to the exercise intervention was excellent (166.0±66.1 minutes/week in the exercise arm). At six months, women in the exercise arm had improved physical HRQOL (SF-36 Physical Component Summary Score) compared with the control arm, 1.8 (SD = 1.1) vs -2.0 (SD = 1.2) , respectively (group difference = 3.7, SD = 1.2, 95% confidence interval [CI] = 0.7 to 6.8, P = .02). No group differences were seen for change in mental HRQOL. There was a statistically significant improvement in the fatigue score (Functional Assessment of Cancer Therapy-Fatigue) for exercisers (4.0, SD = 1.1, 95% CI = 1.8 to 6.2, P < .001) but not for controls (1.2, SD = 1.2, 95% CI = -1.1 to 3.5, P = .31), with a between-group difference of 2.8 (SD = 1.5, 95% CI = -0.2 to 5.7, P = .06). Conclusions: We found a six-month home-based, telephone-delivered exercise intervention of primarily brisk walking to be associated with improved physical HRQOL in women with ovarian cancer. Given that higher HRQOL and exercise have both been associated with overall survival in women diagnosed with ovarian cancer, oncologists and primary care providers should recommend and refer women diagnosed with ovarian cancer to clinic- or community-based exercise programs.

Health-related quality of life in ovarian cancer survivors: Results from the American Cancer Society's Study of Cancer Survivors - I.

OBJECTIVE: There are limited data on outcomes and predictors of health-related quality of life (HRQOL) of ovarian cancer survivors. Therefore, we examined the trajectory and predictors of HRQOL one- and two-years post-diagnosis in this population. METHODS: 365 ovarian cancer survivors, a subset of participants in the longitudinal American Cancer Society's Study of Cancer Survivors-I, completed questionnaires at one-year post-diagnosis on sociodemographics, clinical factors, and HRQOL (SF-36). 284 women had HRQOL data at two-years post-diagnosis. In this secondary data analysis, we examined HRQOL at both time points, changes in HRQOL and predictors of HRQOL with univariate and multivariate linear regression. RESULTS: Mean mental and physical HRQOL scores one-year post-diagnosis were 49.37 (SD±11.59) and 45.96 (SD±10.89), respectively. Older age, lower income, higher disease stage, more comorbidities and greater symptom burden were associated with poorer physical functioning one year post-diagnosis. Younger age, higher stage, having an existing mental health issue, greater symptom burden, and not receiving chemotherapy were associated with poorer mental functioning. Disease recurrence between one- and two-years post-diagnosis and greater symptom burden were predictors of declining physical functioning from one- to two-years post-diagnosis. Mental functioning did not change significantly between assessments. CONCLUSIONS: Overall mental and physical functioning of these ovarian cancer survivors was similar to the general population. However, lower HRQOL was associated with a number of variables, including disease recurrence, treatment status, symptom burden, age, and number of comorbidities. These findings can help health care providers identify survivors who may benefit from relevant interventions.

Self-management for adult patients with cancer: an integrative review.

BACKGROUND: Individuals with cancer are surviving long term, categorizing cancer as a chronic condition, and with it, numerous healthcare challenges. Symptoms, in particular, can be burdensome and occur from prediagnosis through many years after treatment. Symptom severity is inversely associated with functional status and quality of life. OBJECTIVE: Management of these millions of survivors of cancer in a stressed healthcare system necessitates effective self-care strategies. The purpose of this integrative review is to evaluate intervention studies led by nurse principal investigators for self-care management in patients with cancer. METHODS: PubMed, CINAHL (Cumulative Index to Nursing and Allied health Literature), and the Cochrane Database were searched from January 2000 through August 2012. Search terms included "symptom management and cancer," "self-management and cancer," and "self-care and cancer." All articles for consideration included intervention studies with a nurse as the primary principal investigator. RESULTS: Forty-six articles were included yielding 3 intervention areas of educational and/or counseling sessions, exercise, and complementary and alternative therapies. Outcomes were predominately symptom focused and often included functional status and quality of life. Few studies had objective measures. Overarching themes were mitigation, but not prevention or elimination of symptoms, and improved quality of life related to functional status. No one intervention was superior to another for any given outcome. CONCLUSIONS: Current interventions that direct patients in self-care management of symptoms and associated challenges with cancer/survivorship are helpful, but incomplete. No one intervention can be recommended over another. IMPLICATIONS FOR PRACTICE: Guiding patients with cancer in self-care management is important for overall functional status and quality of life. Further investigation and tailored interventions are warranted.