Transcript What works for cancer survivors?

Cancer Survivors and Physical Activity Programs
(CPCRN – December 13, 2010)
Survivorship Workgroup Co-chairs:
Betsy Risendal, University of Colorado Cancer Center
Marcia Ory, Texas A&M Health Science Center
Call to Action:
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Number of cancer survivors increasing to now over 13 million
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Cancer survivors are at greater risk for developing second
malignancies, cardiovascular disease, diabetes, osteoporosis, and
functional decline
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65% of cancer survivors are over age 65 and more likely to
experience co-morbidities, which can also benefit from increased
physical activity
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More people are living longer with cancer
Cancer Survivors and Physical Activity
Programs: What Now, and Why Now?
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Institute of Medicine (IOM) delivers a nationwide report of the
numerous health issues of cancer survivors and the potential
benefits of lifestyle modifications (Lost in Translation, 2005)
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The American Cancer Society reissued its guide for Informed
Choices on Nutrition and Physical Activity During and After
Cancer Treatment (2006)
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Recent systematic and meta-analyses suggest that physical
activity improves survival
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American College of Sports Medicine passed guidelines to
promote physical activity in this group (highlight of the Biennial
Cancer Survivorship Meeting in June, 2010)
Physical Activity Programs for Cancer
Survivors are Moving Ahead…..
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Certifications for fitness trainers working with
cancer survivors are available from ACSM
and others
YMCA, LAF promoting programs at the
national and local level
Over 600 programs identified from our
Internet search in the 10 CPCRN states)
However, physical activity interventions
available on RTIPS do not target cancer
survivors (adaptation!)
Cancer Survivors and Health Behavior:
What do we know that might affect
adaptation?
Preferred Channels for Delivery: “As with intervention timing, there are
relatively few studies that have explored patient preferences regarding
intervention delivery channel and even fewer that have compared the
relative efficacy of different methods.”
Intervention Components: “Most health promotion interventions among
cancer survivors have reported favorable findings, although more
research is needed to determine optimal approaches, not only with
regard to delivery channel, but also to timing, pairing, of behavioral
components, and so forth.”
Demark-Wahnefried, W. and Jones, LW. Hematol Oncol Clin N Am 22
(2008) 319–342
Cancer Survivors and Health Behavior:
What do we know that might affect
adaptation?
What works for cancer survivors? “There is much scope for offering
interventions based on theories found to be useful in promoting behavior
change in non-cancer populations.”
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Interventions based on the Transtheoretical Model have been found to be effective in
improving fitness, smoking cessation, and reducing pain and fatigue.
Studies with Motivational Interviewing interventions have produced mixed,
inconclusive results in this population.
Interventions based on Social Cognitive Theory constructs have been effective in
increasing walking, daily fruit and vegetable intake, and reducing body mass.
Identification of Core Intervention Components: …”it is possible to identify both
the theories that have been applied in the development of specific
interventions and their potential utility to intervention efficacy in cancer
survivors.”
Pinto, B. and Floyd A. Seminars in Oncology Nursing, Vol 24, No 3 (August), 2008:
pp 153-163
Translation/Dissemination of Physical
Activity Programs in Cancer Survivors
Translating Physical Activity Interventions for Breast Cancer Survivors into
Practice: An Evaluation of Randomized Controlled Trials. White et al., 2009
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This review was designed to provide a quantitative estimate of the reporting of both
internal and external validity in recent studies of physical activity in breast cancer
survivors, using the RE-AIM framework.
“….no studies reported methods to identify the target delivery agent, delivery agent,
inclusion/exclusion criteria, adoption rate, or representativeness of study settings to
the broader population of clinical settings that would ultimately deliver such an
intervention.”
“ The reporting of implementation indicators of physical activity interventions at the
organizational level is lacking in both the general literature and the physical activity
and breast cancer literature.”
White S.M., McAuley, E., Estabrooks P., Courneya, K. Ann. Behav. Med. (2009) 37:10–
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Why a Scoping Study: Purpose and
Definitions
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Methodology* originating in the social sciences to produce a review that
is more useful to policy makers, practitioners and service users than
systematic reviews or meta-analyses (utility)
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Addresses effectiveness piece (“how”)
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Unlike systematic reviews, includes wide range of study designs to
document the extent, nature and range of activity and gaps
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Includes grey literature, such as unpublished progress reports or
evaluation plans (electronic databases, internet, research registries)
*Best practices for conducting this type of review: Arksey, H. and O'Malley, L. (2005)
Scoping studies: towards a methodological framework, International Journal of Social
Research Methodology, 8, 1, 19-32.
Goal and Significance of Scoping Study
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Perform a scoping study to summarize and
synthesize the implementation literature (i.e.
published and grey literature) of health
promotion programs for cancer survivors.
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The results of this scoping study can be used
as a guide for public health professionals,
funders, and practitioners when planning and
implementing programs in this population.
Research questions that this scoping study
will answer:
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What current physical activity interventions
have been implemented and/or designed in
cancer survivor populations?
How have evidence-based physical activity
programs been adapted for this population?
What are the components and results of
these studies?
How have these interventions been
translated for use on a large scale or for the
cancer survivor population?
Scoping Study Rubric for Published
Literature
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Title, Citation
Description of intervention
Study Design
Dose/Intensity/Duration
Population/Cancer Type
Setting
Program/sample size and demographics
Results/Outcomes
What else could we ask to discern adaptation?
Scoping Study: Steps as defined by best
practices
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Stage 1. Identifying the research question
Stage 2 Identifying relevant studies*
Stage 3 Study selection
Stage 4 Charting the data
Stage 5 Collating, summarizing and reporting
the results.
Progress to Date
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Criteria for inclusion:
Databases used - MEDLINE, PubMed, Internet “Google” search for
“grey literature”
Inclusion Criteria: Since the goal of this study is to describe and inform
program implementation strategies, the study or report must include a
description of the components of the intervention used and (if
applicable) the population studied.
Exclusion Criteria: Literature and reports prior to 1980 will be excluded.
Key Words:
“cancer survivor evidence based exercise” 36 results on 8/22/2010
“cancer survivor exercise” 494 results on 8/18/2010
“cancer survivor exercise health promotion” 46 results on 8/23/2010
“cancer survivor exercise translation” 3 results on 8/23/2010
“cancer survivor exercise implementation” 5 results on 8/23/2010
UPDATE: So far in our review, 69 OF THESE MEET INCLUSION
CRITERIA
Translation and Dissemination Framework
of Relevance to Survivorship Workgroup
Activities: CFIR (Damschroder)
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Consolidated Framework: intervention characteristics, outer
setting, inner setting, characteristics of the individuals involved,
and the process of implementation
Will this serve as a general framework for this activity?
It is unlikely that the articles we review will have detail on the
various constructs by provides a general guide
We can indicate what we do find n the literature
We can design future efforts to obtain more detailed information
Scoping Study Stages, Collaboration and
Action Steps
Stages*:
1-Identifying the research question
2-Identifying relevant studies
3-Study selection
4-Charting the data
5-Collating, summarizing and reporting the results
CPCRN Involvement:
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The survivorship workgroup has helped frame the research question.
We have heard from some people who are interested in participating
and invite others to get in touch with us if they are interested.
Action Plan:
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More details will be discussed on a survivorship workgroup call in January.
*Arksey, H. and O'Malley, L. (2005) Scoping studies: towards a methodological framework, International
Journal of Social Research Methodology, 8, 1, 19-32.
Review of Survey Activities
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Colorado has 17 surveys completed -50%
response rate.
Colorado started key informant interviews
Utilizing the results from the Colorado key
word search, Texas is identifying potential
survey sites and obtaining IRB approvals—
this will be co-sponsored by Cancer Alliance
of Texas
2 additional CPCRN sites have expressed
interest