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Open Access 01-06-2009 | Original Article

Long-term effects on cancer survivors’ quality of life of physical training versus physical training combined with cognitive-behavioral therapy: results from a randomized trial

Authors: Anne M. May, Irene Korstjens, Ellen van Weert, Bart van den Borne, Josette E. H. M. Hoekstra-Weebers, Cees P. van der Schans, Ilse Mesters, Jan Passchier, Diederick E. Grobbee, Wynand J. G. Ros

Published in: Supportive Care in Cancer | Issue 6/2009

Abstract

Background

We compared the effect of a 12-week group-based multidisciplinary self-management rehabilitation program, combining physical training (twice weekly) and cognitive-behavioral therapy (once weekly) with the effect of 12-week group-based physical training (twice weekly) on cancer survivors’ quality of life over a 1-year period.

Materials and methods

One hundred forty-seven survivors [48.8 ± 10.9 years (mean ± SD), all cancer types, medical treatment ≥3 months ago] were randomly assigned to either physical training (PT, n = 71) or to physical training plus cognitive-behavioral therapy (PT + CBT, n = 76). Quality of life and physical activity levels were measured before and immediately after the intervention and at 3- and 9-month post-intervention using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 questionnaire and the Physical Activity Scale for the Elderly, respectively.

Results

Multilevel linear mixed-effects models revealed no differential pattern in change of quality of life and physical activity between PT and PT + CBT. In both PT and PT + CBT, quality of life and physical activity were significantly and clinically relevantly improved immediately following the intervention and also at 3- and 9-month post-intervention compared to pre-intervention (p < 0.001).

Conclusion

Self-management physical training had substantial and durable positive effects on cancer survivors’ quality of life. Participants maintained physical activity levels once the program was completed. Combining physical training with our cognitive-behavioral intervention did not add to these beneficial effects of physical training neither in the short-term nor in the long-term. Physical training should be implemented within the framework of standard care for cancer survivors.

Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376 doi:10.1093/jnci/85.5.365 PubMedCrossRef

Antoni MH, Lechner SC, Kazi A, Wimberly SR, Sifre T, Urcuyo KR et al (2006) How stress management improves quality of life after treatment for breast cancer. J Consult Clin Psychol 74:1143–1152PubMedCrossRef

Apolone G, Filiberti A, Cifani S, Ruggiata R, Mosconi P (1998) Evaluation of the EORTC QLQ-C30 questionnaire: a comparison with SF-36 Health Survey in a cohort of Italian long-survival cancer patients. Ann Oncol 9:549–557 doi:10.1023/A:1008264412398 PubMedCrossRef

Berglund G, Bolund C, Gustafsson UL, Sjoden PO (1994) One-year follow-up of the ‘Starting Again’ group rehabilitation programme for cancer patients. Eur J Cancer 30A:1744–1751 doi:10.1016/0959-8049(94)00330-8 PubMedCrossRef

Bjordal K, Mastekaasa A, Kaasa S (1995) Self-reported satisfaction with life and physical health in long-term cancer survivors and a matched control group. Eur J Cancer B Oral Oncol 31B:340–345 doi:10.1016/0964-1955(95)00039-9 PubMedCrossRef

Borg GA (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14:377–381PubMed

Courneya KS, Friedenreich CM, Sela RA, Quinney HA, Rhodes RE, Handman M (2003) The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: Physical fitness and quality of life outcomes. Psychooncology 12:357–374 doi:10.1002/pon.658 PubMedCrossRef

Courneya KS, Mackey JR, Bell GJ, Jones LW, Field CJ, Fairey AS (2003) Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. J Clin Oncol 21:1660–1668 doi:10.1200/JCO.2003.04.093 PubMedCrossRef

Creer TL (2002) Self-management of chronic illness. Handbook of self regulation. Academic, San Diego, CA, US

10.

D’Zurilla TJ, Nezu AM (2007) Problem-solving therapy: a positive approach to clinical intervention, 3rd edn. Springer, New York

11.

Daley AJ, Crank H, Saxton JM, Mutrie N, Coleman R, Roalfe A (2007) Randomized trial of exercise therapy in women treated for breast cancer. J Clin Oncol 25:1713–1721 doi:10.1200/JCO.2006.09.5083 PubMedCrossRef

12.

Graves KD (2003) Social cognitive theory and cancer patients’ quality of life: a meta-analysis of psychosocial intervention components. Health Psychol 22:210–219 doi:10.1037/0278-6133.22.2.210 PubMedCrossRef

13.

Helgeson VS, Cohen S, Schulz R, Yasko J (2001) Long-term effects of educational and peer discussion group interventions on adjustment to breast cancer. Health Psychol 20:387–392 doi:10.1037/0278-6133.20.5.387 PubMedCrossRef

14.

Karvinen KH, Courneya KS, North S, Venner P (2007) Associations between exercise and quality of life in bladder cancer survivors: a population-based study. Cancer Epidemiol Biomarkers Prev 16:984–990 doi:10.1158/1055-9965.EPI-06-0680 PubMedCrossRef

15.

Karvonen J, Vuorimaa T (1988) Heart rate and exercise intensity during sports activities. Practical application. Sports Med 5:303–311 doi:10.2165/00007256-198805050-00002 PubMedCrossRef

16.

Korstjens I, May AM, van Weert E, Mesters I, Tan F, Ros WJG et al (2008) Quality of life after cancer rehabilitation: a randomized controlled trial comparing physical training with a multidisciplinary physical and cognitive-behavioral training. Psychosom Med 70:422–429 doi:10.1097/PSY.0b013e31816e038f PubMedCrossRef

17.

Korstjens I, May AM, van Weert E, Mesters I, van den Borne B (2006) Quality of life after multidisciplinary cancer rehabilitation, combining physical training and psycho-education. Psychooncology 15:S293

18.

May AM, van Weert E, Korstjens I, Hoekstra-Weebers JE, Van Der Schans CP, Zonderland ML et al (2008) Improved physical fitness of cancer survivors: A randomised controlled trial comparing physical training with physical and cognitive-behavioural training. Acta Oncol 47:825–834 doi:10.1080/02841860701666063 PubMedCrossRef

19.

McLachlan SA, Devins GM, Goodwin PJ (1998) Validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) as a measure of psychosocial function in breast cancer patients. Eur J Cancer 34:510–517 doi:10.1016/S0959-8049(97)10076-4 PubMedCrossRef

20.

McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS (2006) Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. Can Med Assoc J 175:34–41 doi:10.1503/cmaj.051073 CrossRef

21.

Michael YL, Kawachi I, Berkman LF, Holmes MD, Colditz GA (2000) The persistent impact of breast carcinoma on functional health status: prospective evidence from the Nurses’ Health Study. Cancer 89:2176–2186 doi:10.1002/1097-0142(20001201)89:11<2176::AID-CNCR5>3.0.CO;2-6 PubMedCrossRef

22.

Milne HM, Wallman KE, Gordon S, Courneya KS (2008) Effects of a combined aerobic and resistance exercise program in breast cancer survivors: a randomized controlled trial. Breast Cancer Res Treat 108:279–288 doi:10.1007/s10549-007-9602-z PubMedCrossRef

23.

Nezu AM (2004) Problem-solving and behavioor therapy revisited. Behav Ther 35:1–33 doi:10.1016/S0005-7894(04)80002-9 CrossRef

24.

Nezu AM, Nezu CM, Houts PS, Friedman SH, Faddis S (1998) Helping cancer patients cope: a problem-solving approach. American Psychological Association, Washington, DC, USACrossRef

25.

Nezu AM, Nezu CM, Felgoise SH, McClure KS, Houts PS (2003) Project Genesis: assessing the efficacy of problem-solving therapy for distressed adult cancer patients. J Consult Clin Psychol 71:1036–1048 doi:10.1037/0022-006X.71.6.1036 PubMedCrossRef

26.

Osborn RL, Demoncada AC, Feuerstein M (2006) Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med 36:13–34 doi:10.2190/EUFN-RV1K-Y3TR-FK0L PubMedCrossRef

27.

Osoba D, Rodrigues G, Myles J, Zee B, Pater J (1998) Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 16:139–144PubMed

28.

Pennebaker JW, Beall SK (1986) Confronting a traumatic event: toward an understanding of inhibition and disease. J Abnorm Psychol 95:274–281 doi:10.1037/0021-843X.95.3.274 PubMedCrossRef

29.

Scheier MF, Helgeson VS, Schulz R, Colvin S, Berga S, Bridges MW et al (2005) Interventions to enhance physical and psychological functioning among younger women who are ending nonhormonal adjuvant treatment for early-stage breast cancer. J Clin Oncol 23:4298–4311 doi:10.1200/JCO.2005.05.362 PubMedCrossRef

30.

Schmitz KH, Holtzman J, Courneya KS, Masse LC, Duval S, Kane R (2005) Controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 14:1588–1595 doi:10.1158/1055-9965.EPI-04-0703 PubMedCrossRef

31.

Schuit AJ, Schouten EG, Westerterp KR, Saris WH (1997) Validity of the Physical Activity Scale for the Elderly (PASE): according to energy expenditure assessed by the doubly labeled water method. J Clin Epidemiol 50:541–546 doi:10.1016/S0895-4356(97)00010-3 PubMedCrossRef

32.

Stull VB, Snyder DC, Demark-Wahnefried W (2007) Lifestyle interventions in cancer survivors: designing programs that meet the needs of this vulnerable and growing population. J Nutr 137:243S–248SPubMed

33.

Sweeney C, Schmitz KH, Lazovich D, Virning BA, Wallace RB, Folsom AR (2006) Functional limitations in elderly female cancer survivors. J Natl Cancer Inst 98:521–529PubMedCrossRef

34.

van den Hout JH, Vlaeyen JW, Heuts PH, Zijlema JH, Wijnen JA (2003) Secondary prevention of work-related disability in nonspecific low back pain: does problem-solving therapy help? A randomized clinical trial. Clin J Pain 19:87–96 doi:10.1097/00002508-200303000-00003 PubMedCrossRef

35.

van Weert E, Hoekstra-Weebers JE, May AM, Korstjens I, Ros WJ, Van Der Schans CP (2008) The development of an evidence-based physical self-management rehabilitation programme for cancer survivors. Patient Educ Couns 71:169–190 doi:10.1016/j.pec.2007.11.027 PubMedCrossRef

Title: Long-term effects on cancer survivors’ quality of life of physical training versus physical training combined with cognitive-behavioral therapy: results from a randomized trial
Authors: Anne M. May
Irene Korstjens
Ellen van Weert
Bart van den Borne
Josette E. H. M. Hoekstra-Weebers
Cees P. van der Schans
Ilse Mesters
Jan Passchier
Diederick E. Grobbee
Wynand J. G. Ros
Publication date: 01-06-2009
Publisher: Springer-Verlag
Published in: Supportive Care in Cancer / Issue 6/2009
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-008-0519-9

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