The association of an exercise and rehabilitation clinical workflow algorithm on sedentary behavior and performance status from time of breast cancer diagnosis and throughout care

Breast Cancer Research and Treatment · 2026-04-17

Chemotherapy Timing and Outcomes in Early Breast Cancer

SSRN Electronic Journal · 2026-01-01

Dietary Patterns Associated With Weight Loss Among Patients With Colorectal Cancer During the First 6 Months After Diagnosis: A Cross-Sectional Analysis From the ColoCare Study

Journal of the Academy of Nutrition and Dietetics · 2026-03-31

Healthcare Systems-Based Exercise Oncology Programs: Emphasizing and Speaking the Language of the Clinic and Patient

Translational Journal of the American College of Sports Medicine · 2025-03-18 · 1 citations

ABSTRACT Introduction Exercise oncology services are evidence based and aim to reduce symptom burden and potentially improve outcomes in adults living with and beyond cancer. Healthcare system-based exercise oncology programs include exercise prior to, during, and after treatment, but the implementation and maintenance of these programs are not well documented. We aimed to describe five healthcare system-based exercise oncology programs in the United States, including service information and barriers to and facilitators of program success. Methods This was a qualitative case study of five healthcare-based exercise oncology programs in the United States informed by the Exploration, Preparation, Implementation, Sustainment framework. We conducted semistructured online interviews with the founders and other key representatives of each program assessing program structure, adoption, and integration into the healthcare system. Data were evaluated using qualitative descriptive methodology. Results In each healthcare-based exercise oncology program, trained exercise professionals delivered in-person, virtual, or hybrid exercise programs to adults with cancer. Buy-in from healthcare system leadership, clinicians, and administration was key to success. All programs were designed to meet the needs of the individual healthcare systems. Institutionalization of the programs into existing healthcare systems facilitated sustainment. Length and exercise prescription for each program varied, but individually tailored exercise programs with physical or functional assessments (often pre/post) were reported by most programs. Funding was a common barrier. Conclusions Institutional priorities and buy-in from both leadership and clinicians were used to establish and maintain five healthcare-based exercise oncology programs from across the United States. These programs followed evidence-based recommendations provided by exercise professionals within the healthcare system to serve patients from the healthcare system’s catchment area. Healthcare systems exploring the creation of exercise oncology programs should consider institutional structures, provider priorities, resources (e.g., staff, finances), leadership buy-in, and financial support.

A prospective trial of a structured exercise program to lessen fatigue in patients with advanced prostate cancer (aPC) undergoing androgen deprivation therapy (ADT).

Journal of Clinical Oncology · 2025-02-10 · 1 citations

120 Background: Cancer-related fatigue, one of the most significant issues affecting quality of life (QOL), is reported by up to 75% of men with advanced prostate cancer (aPC) on ADT. Exercise may serve as a tool to improve fatigue in cancer patients. We examined the effect of a structured exercise program on fatigue in men with aPC. Methods: This prospective trial enrolled participants with aPC treated with an ADT-based regimen on a 12 week exercise program at a single institution. Patients with at least 4/10 tiredness, self-reported sedentary lifestyle (<90 min/week exercise), no evidence of disease progression, and no chemotherapy within 3 months were eligible. Participants underwent peak aerobic capacity, muscular strength and endurance testing before and after 12 weeks of structured, guided exercise through the institution’s hospital-based exercise oncology program called Personal Optimism With Exercise Recovery (POWER). Participants completed symptom questionnaires including the 7-item PROMIS fatigue at baseline and after 6 and 12 weeks. Participants had 45-60 min supervised sessions weekly, either in person or virtually, and were instructed to work up to 150 min of moderate activity and 2 resistance training sessions weekly. The primary endpoint was change in fatigue; a 4 point reduction in T score is a clinically important difference. The key secondary endpoint was change in relative peak aerobic capacity (ml/kg/min). Mean and 95% Gaussian confidence intervals are reported. Results: 119 participants with aPC, 92% of whom had metastatic disease, enrolled between 2018 and 2022. Nine withdrew from the study and 10 were lost to follow-up. Data were incomplete for 28 participants primarily due to inadequate follow-up during COVID. Of the 119 enrolled participants, 96% were white, 83% were married, 52% had at least a college degree, and 25% were currently employed. Mean age was 70.3 years and mean BMI was 30.5 kg/m 2 . 29 participants (24%) were receiving treatment with ADT alone, and the rest were receiving a combination of ADT and targeted therapy. The primary endpoint was evaluable in 72 participants. There was a clinically significant reduction in fatigue of 5.1 points (95%CI 3.6-6.7) between baseline (56.7 [95%CI 55.1-58.0]) and 12 weeks (51.4 [95%CI 49.8-53.1]). Of those who completed both aerobic fitness assessments (n=76), there was a 3.1 ml/kg/min (95%CI 2.1-4.0) improvement in relative peak aerobic capacity from a mean 27.5 [95%CI 25.8-29.2] at baseline to a mean 30.6 [95%CI 28.8-32.3] at 12 weeks. Conclusions: Completion of a 12 week supervised exercise regimen led to a clinically significant improvement in fatigue and peak aerobic exercise capacity. These findings support routinely recommending exercise for and examining symptom management in patients with metastatic cancer to improve QOL. Clinical trial information: NCT03421782 .

Exercise and diet studies among patients living with multiple myeloma: current evidence and considerations of patient preferences

Frontiers in Hematology · 2025-03-21

Background: Multiple myeloma (MM) is the second most common blood cancer after leukemia in adults. Despite advancements in treatment that have extended survival, MM remains incurable and the cancer and its treatment result in adverse acute, long-term and latent side-effects, necessitating a focus on strategies to attenuate these side-effects and improve quality of life. This narrative review highlights MM patient preferences for exercise and/or diet interventions relative to complete and ongoing interventions to identify gaps and needs for future lifestyle interventions in MM patients aimed at improving MM survivorship care. Methods: This updated review was completed using a comprehensive search that was conducted using PubMed and ClinicalTrials.gov databases using keywords related to MM, exercise, physical activity, diet, nutrition and patient preferences. Studies involving adults diagnosed with MM were included. Results: Among published studies, there are five exercise interventions and four diet and nutrition observational studies. The importance of individualized exercise interventions tailored to MM patients' needs was emphasized. Supervised exercise interventions showed higher adherence and engagement compared to unsupervised interventions. Observational diet/nutrition studies demonstrated that decreased gut microbiome diversity post-transplant is linked to poorer outcomes. Additionally, nutritional status and dietary patterns, such as high-carbohydrate and plant-based diets, can significantly impact clinical outcomes in MM patients, including sustained minimal residual disease negativity. Current clinical trials are primarily focused on feasibility and adherence, with a limited emphasis on long-term outcomes. In ClinicalTrials.gov, there are six ongoing exercise interventions, with an additional seven that are completed with no published results, one suspended trial and one active but not recruiting. Additionally, there are two combined diet and exercise interventions that are currently recruiting, with one active but no longer recruiting. Among diet and nutrition ongoing trials, there are currently two actively recruiting, two completed with no primary paper published and one study that was withdrawn. Discussion: These findings underscore the need for more comprehensive, long-term and adequately powered studies on the impact of exercise and diet interventions in MM patients. Patient education and empowerment within these trials are crucial for enhancing engagement and adherence to these interventions.

Feasibility and acceptability of the Comprehensive Oncology Rehabilitation and Exercise (CORE) clinical workflow algorithm in patients with newly diagnosed stage I–III breast cancer who undergo surgery as first‐line treatment

Cancer · 2025-04-28 · 2 citations

BACKGROUND: This pilot, mixed-methods, randomized controlled trial determined the feasibility and acceptability of the Comprehensive Oncology Rehabilitation and Exercise (CORE) clinical workflow algorithm. CORE was designed to connect patients with newly diagnosed breast cancer to exercise and rehabilitation services from the time of diagnosis throughout cancer care. METHODS: In total, 72 patients with newly diagnosed, stage I-III breast cancer who required surgery as first-line treatment were randomized 2:1 to CORE or standard of care. CORE included a triaging tool of two questionnaires regarding self-reported exercise (the Godin Leisure Time physical activity questionnaire) and functional status (the Patient-Reported Outcomes Measurement Information System physical function questionnaire), which were administered at the check-in desk for routine breast surgical oncology clinic visits at the initial surgical consultation, postoperatively, and 24 weeks after surgery. Responses to questionnaires in the triaging tool triaged participants to one of three pathways within the algorithm: exercise service, rehabilitation service, or exercise self-management (not a service). Service pathways required referral by clinic staff. Feasibility was determined based on completing the triaging tool (≥66%) and referral completion (≥50%) at the initial surgical consultation visit. Acceptability was determined by four study participant focus groups and one clinic team focus group (≥50% positive response). RESULTS: Ninety-three percent of participants in CORE (n = 40) completed the triaging tool. Among those triaged to a service pathway (n = 29), 62% completed their referral. Focus group feedback was primarily positive. CONCLUSIONS: The CORE clinical workflow algorithm is feasible and acceptable among women who have newly diagnosed stage I-III breast cancer with plans for surgery as first-line treatment. CORE was also acceptable among clinic staff. CLINICAL TRIALS REGISTRATION: NCT04594473.

The Association Between Body Composition, Overall Survival, Treatment Decisions, and Patient‐Reported Outcomes in Metastatic Non‐Small‐Cell Lung Cancer

Cancer Medicine · 2025-01-01 · 1 citations

INTRODUCTION: The purpose of this study was to evaluate the association between body composition, overall survival, odds of receiving treatment, and patient-reported outcomes (PROs) in individuals living with metastatic non-small-cell lung cancer (mNSCLC). METHODS: This retrospective analysis was conducted in newly diagnosed patients with mNSCLC who had computed-tomography (CT) scans and completed PRO questionnaires close to metastatic diagnosis date. Cox proportional hazard models and logistic regression evaluated overall survival and odds of receiving treatment, respectively. Hazard ratios (HR) and odds ratios (OR) were evaluated as the interquartile range for body composition compartments. Multiple linear regression evaluated the association between PROs and body composition. Models were adjusted for gender, age at diagnosis, smoking history, and mutation status. The survival model also included adjustment for tumor histology. RESULTS: Our sample (n = 69) included men (52%) and women (48%), with a median age of 67.4-years, history of smoking (67%), wild-type genotype (75.4%), and a tumor histology of adenocarcinoma (68%). Greater skeletal muscle area was associated with higher physical function scores. Larger intermuscular adipose tissue area was associated with higher mortality risk (HR 2.03, 95% CI 1.32, 3.11), lower odds of receiving treatment (OR 0.76, 95% CI 0.61, 0.93), and higher fatigue. Larger subcutaneous adipose tissue area was associated with lower mortality risk (HR 0.42, 95% CI 0.22, 0.82) and higher odds of receiving treatment (OR 1.03, 95% CI 1.01, 1.06). Larger total adipose tissue area was linked with improved survival (HR 0.59, 95% CI 0.36, 0.96). CONCLUSION: Findings support an association between different body composition compartments at mNSCLC diagnosis and survival, decisions to treat, and PROs. This work supports the use of data collected in routine CT scans and PROs to inform treatment decisions and supportive care options.

Association between physical activity, performance scores, and clinical trial enrollment in cancer survivors

BMC Cancer · 2025-08-26 · 1 citations

BACKGROUND: To investigate the association between patient-reported habitual physical activity (PA) and physician-assessed physical performance scores, specifically the Eastern Cooperative Oncology Group (ECOG) score, and experimental therapeutic clinical trial enrollment in adult cancer survivors. METHODS: This was a secondary data analysis of patient-reported and clinical cancer data from the Total Cancer Care (TCC) cohort at the Huntsman Cancer Institute between 2016 and 2022. Patients completed a modified Godin questionnaire to assess average weekly PA (MET/hrs-week) for the previous 12 months. A demographics questionnaire collected information on sex, race, ethnicity, education level, and income status. ECOG performance scores were retrieved from the medical record and classified as either "Good" (ECOG of 0 or 1) or "Poor" (ECOG of 2, 3 or 4) physical function. Binary logistic regressions were used to assess the relationship between PA levels (total PA, moderate-vigorous PA, and light PA) and ECOG ratings, and PA levels and clinical trial enrollment (yes/no). Models were adjusted for demographics and cancer characteristics. RESULTS: Patients who completed the TCC questionnaire packet (n = 603) were primarily female (51%), non-Hispanic (95%), white (95%) with an average age of 61.9 ± 15.5 years. The top three cancer types represented were Head and Neck (30%), Thyroid (24%), and Lung (24%); all cancer stages were represented. Higher PA levels were linked with increased odds of having a good ECOG rating in unadjusted models (OR 1.01, 95% CI 1.00 to 1.02), but not in adjusted models (OR 1.01, 95% CI 0.99 to 1.03). Higher levels of light PA were linked with greater odds of having good ECOG rating in unadjusted and adjusted models (OR 1.05, 95% CI 1.00 to 1.11; OR 1.072, 95% CI 1.01 to 1.13; respectively). Statistically significant associations were not observed between moderate-vigorous PA and ECOG rating, and PA and clinical trial enrollment. CONCLUSIONS: Patient-reported light PA may serve utility in physician decision making of ECOG rating. More work is needed identifying patient centered subjective and objective tools to complement physician-assessed ECOG scores considering the implications of ECOG in cancer treatment decisions and eligibility for clinical trials.

Short-term 24h dietary recalls from observational studies cannot support claims on mortality

Diabetes & Metabolic Syndrome Clinical Research & Reviews · 2025-10-01 · 1 citations