Exercise and cancer treatment symptoms in 408 newly diagnosed older cancer patients
Introduction
Aging is associated with declines in physical[1], [2], [3], [4] and psychological[3], [4] function and cancer treatments can further exacerbate these functional decrements. Younger cancer patients often experience a transient decline in function, whereas older cancer patients may never fully recover.5 These decrements in physiological and psychological function can ultimately lead to reduced quality of life.[6], [7]
Older adults are at much greater risk of developing cancer than those who are younger. In the United States, approximately 60% of new cancer diagnoses occur in those over 65 years of age. By 2030, 70% of cancer patients will be elderly.8 Compared to older adults without a history of cancer, older cancer survivors suffer from a greater incidence of frailty and more limitations in activities of daily living,9 lower self-rated health,9 reduced quality of life,10 and a greater prevalence of geriatric syndromes such as dementia, depression, falls, incontinence, and osteoporosis.9 The severity of cancer-related fatigue, another problem facing many cancer patients during and following treatment, is related to the cancer and its treatment as well as age-related factors.11
Regular physical activity reduces the risk of developing many chronic conditions, such as coronary artery disease, hypertension, osteoporosis, type II diabetes, obesity, and chronic obstructive pulmonary disease, while playing a role in the management of anxiety, depression, dementia, and pain.12 The American College of Sports Medicine (ACSM) recommends that older adults, even those with chronic medical conditions, participate in regular aerobic exercise training (150–300 min per week) and resistance exercise training (at least 2 days a week).12 Evidence also supports the use of exercise for side-effect and symptom management in cancer survivors.[13], [14], [15] Among elders, especially those who are frail, physical activity intervention programs have resulted in improved muscular mass and strength,16 improved aerobic capacity,17 fall reduction,[18], [19], [20] improved perceived health status,21 and improved physical functioning.22
Exercise is a promising behavioral intervention with the potential to mitigate multiple symptoms and improve physical functioning in older cancer patients.[23], [24], [25], [26], [27] However, it is important to investigate the proportion of older cancer patients who participate in exercise during and following treatment and to investigate the possible associations between exercise and symptom severity in older cancer patients. The purpose of this paper is to describe the proportion of older cancer patients both during and following treatment who report using exercise and to describe the associations between exercise and symptom severity during these time frames.
Section snippets
Study Sample
Participants were newly-diagnosed cancer patients who were scheduled to receive chemo- or radiation-therapy. Patients who participated in this investigation met the following criteria: a) had a diagnosis of breast, gynecological, lung, hematologic, gastrointestinal, genitourinary tract, or head and neck cancer, b) had not received chemotherapy or radiation therapy in the past, c) had an estimated life expectancy of 10 months or more, d) were 65 years of age or older, and e) were able to read and
Sample Characteristics
A total of 408 patients 65 to 92 years of age provided evaluable information. Of those, 361 were between the ages of 65 and 79 and 47 were 80 years of age or older. The mean age of patients in this study was 73 years. Males comprised just over half of the sample. A majority of patients were white and married, had a Karnofsky performance status of 90 or greater and had undergone surgery for their cancer prior to chemotherapy and/or radiation therapy. The largest proportion of cancer diagnoses were
Discussion
The number of adults over 65 years of age is increasing more rapidly than any other age group, with those over 80 growing the fastest and expected to account for 20% of people over 65 by the year 2050.31 Cancer is a disease that disproportionally affects those over the age of 65.32 To our knowledge, this is one of the few studies to focus on symptom severity, self-rated health and exercise participation in older cancer patients undergoing chemotherapy and/or radiation therapy and one of the few
Author Contribution
Concept and Design:
Lisa Sprod
Karen Mustian
Data Collection:
Lisa Sprod
Gary Morrow
Raymond Lord
Howard Gross
Analysis and Interpretation of Data:
Lisa Sprod
Michelle Janelsins
Luke Peppone
Wendy Demark-Wahnefried
Supriya Mohile
Manuscript writing and approval:
Michelle Janelsins
Luke Peppone
Wendy Demark-Wahnefried
Supriya Mohile
Lisa Sprod
Gary Morrow
Raymond Lord
Howard Gross
Disclosure
None of the authors have anything to disclose.
References (48)
- et al.
Decline of physical and cognitive conditions in the elderly measured through the functional reach test and the mini-mental state examination
Arch Gerontol Geriatr
(May-Jun. 2010) - et al.
Effects of exercise programs on falls and mobility in frail and pre-frail older adults: a multicenter randomized controlled trial
Arch Phys Med Rehabil
(Jul. 2006) - et al.
Exercise issues in older cancer survivors
Crit Rev Oncol Hematol
(2004) - et al.
Fatigue in older cancer patients: etiology, assessment, and treatment
Semin Oncol
(2008) Loss of skeletal muscle mass in aging: examining the relationship of starvation, sarcopenia and cachexia
Clin Nutr
(2007)- et al.
Treatment strategies for sarcopenia and frailty
Med Clin North Am
(2011) - et al.
Decline in skeletal muscle mitochondrial function with aging in humans
Proc Natl Acad Sci U S A
(Apr. 12 2005) - et al.
The effect of aging on functional decline among older Japanese living in a community: a 5-year longitudinal data analysis
Aging Clin Exp Res
(Jun. 2004) - et al.
Trajectories of physical function decline and psychological functioning: the Quebec longitudinal study on nutrition and successful aging (NuAge)
J Gerontol B Psychol Sci Soc Sci
(Jul. 2011) - et al.
Difficulties in physical functioning reported by middle-aged and elderly women with breast cancer: a case–control comparison
J Gerontol
(1990)
Physical exercise and quality of life following cancer diagnosis: a literature review
Ann Behav Med
Quality of life for long-term survivors of cancer: influencing variables
Cancer Nurs
Epidemiology of cancer and aging
J Oncol Manag
Association of a cancer diagnosis with vulnerability and frailty in older Medicare beneficiaries
J Natl Cancer Inst
Health-related quality of life of cancer and noncancer patients in Medicare managed care
Cancer
The effects of cancer-related pain and fatigue on functioning of older adult, long-term cancer survivors
Cancer Nurs
American College of Sports Medicine position stand. Exercise and physical activity for older adults
Med Sci Sports Exerc
Review of exercise intervention studies in cancer patients
J Clin Oncol
Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials
J Clin Oncol
Exercise interventions for cancer patients: systematic review of controlled trials
Cancer Causes Control
Effects of a physical and nutritional intervention program for frail elderly people over age 75. A randomized controlled pilot treatment trial
Aging Clin Exp Res
Effects of exercise training on frailty in community-dwelling older adults: results of a randomized, controlled trial
J Am Geriatr Soc
Preventing falls in physically active community-dwelling older people: a comparison of two intervention techniques
Gerontology
Reduction in fear of falling through intense tai chi exercise training in older, transitionally frail adults
J Am Geriatr Soc
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2016, Seminars in Oncology NursingCitation Excerpt :Increasing evidence demonstrates that weight-bearing aerobic and resistance exercise may benefit bone metabolism78 and maintain bone mineral density,79 and the two combined could offer a valuable intervention for moderating bone loss among cancer patients.80 Exercise improves a wide array of psychological and physical symptoms, including muscle atrophy and weakness, fatigue, obesity, immune function, insomnia, anxiety, cognitive decline, and impaired quality of life, among others.4,5,79,81-102 In addition, epidemiological data also suggest that increased physical activity via regular exercise reduces the risk of cancer recurrence and cancer mortality.103-105