Lauren Bates-Fraser

Objective: Physical activity (PA) is a safe, effective non‐pharmacological method for reducing many adverse symptoms among cancer survivors. However, evidence supporting the benefits of digital PA interventions on cognitive function, anxiety, and depression among survivors is inconsistent, with very few examining the fear of cancer recurrence (FCR). This trial with a cohort study aimed to examine the impact of a one‐year digital PA intervention on changes in cognitive and mental health outcomes among cancer survivors. Methods: 415 participants were randomized 2:1 to an interactive PA website or flexibility control website. Anxiety, depression, FCR, and perceived cognitive function measured at baseline and at three‐, six‐, and 12‐month follow‐ups were analyzed using linear mixed models adjusted for age. Two post‐hoc analyses were performed: (1) stratified by compliance with website protocol and (2) excluding participants at baseline with low anxiety, depression, or FCR, or high cognitive functioning. Results: 94% of participants included in this analysis were women ( n = 368) with a mean age of 62 years (SD = 8.5). In intent‐to‐treat models, the intervention was not effective in improving depression, anxiety, cognitive function, or FCR; however, among participants with high baseline FCR, engaging with the PA website intervention led to a significant reduction in FCR throughout the trial duration (compliant: 19.2 [16.8–21.6] at month 12 compared to 23.8 [21.3–26.2] at baseline). Conclusions: Overall, the intervention showed no meaningful effects on depression, anxiety, or perceived cognitive function. Post‐hoc findings suggested reduced FCR among compliant survivors with elevated baseline FCR, warranting prospective validation. Trial registration: This trial was registered on ClinicalTrials.gov (NCT05356988)

Background: Cancer survivors experience symptoms that can often be managed with moderate-to-vigorous physical activity. Most studies are short, small, and in-person, limiting scalability. This study evaluated a 12-month digital moderate-to-vigorous physical activity intervention and its impact on long-term physical health outcomes in a large sample of cancer survivors. Methods: This 2-arm trial was embedded within the Cancer Prevention Study-3 prospective cohort study and included survivors with cancers associated with physical inactivity. Eligible participants were randomly assigned to a digital moderate-to-vigorous physical activity intervention or control group and completed 4 assessments (including surveys and accelerometry) across the 12-month intervention. Primary outcomes were total steps, step cadence (peak 1 minute and 30 minutes), 30-second sit-to-stand, self-reported mobility, walking pace, and pain. The primary analysis followed an intention-to-treat approach, with subgroup analyses by website engagement and among those with poor outcomes at baseline. Results: In total, 415 were randomly assigned (intervention: n = 286; control participants: n = 129), and 391 were included in the analysis. The intervention did not statistically significantly affect total steps, mobility, walk pace, or pain. However, website-adherent participants showed higher peak cadence (adherent: 125 steps per minute vs nonadherent or control participants: 121-122 steps per minute) and clinically meaningful improvement in sit-to-stand performance (average increase: 13-16, P < .001). Conclusions: In intention-to-treat analyses, there were no statistically significant changes in most physical health outcomes. Among participants who adhered to the website protocol, the intervention was associated with improvements in cadence and 30-second sit-to-stand performance. Implications: Our findings support the potential of scalable digital interventions to promote moderate-to-vigorous physical activity, with benefits more apparent among engaged users.

PURPOSE: Transportation affects access to quality medical care and health equity, especially for vulnerable populations. Little is known about patients'(PTs) experiences, particularly Black Americans with cancers like multiple myeloma (MM), regarding transportation access, despite its impact on clinical outcomes and survival. METHODS: Using the National Institute on Minority Health and Health Disparities research framework, we conducted a qualitative study from November 2021 to April 2022. Twenty-one PT-informal caregiver (CG) dyads (42 participants) from the Lineberger Comprehensive Cancer Center participated in semistructured interviews. These interviews allowed participants to discuss their experiences with MM-related health issues. We used ATLAS.ti v9 for project management and data analysis using the Sort and Sift, Think and Shift approach by ResearchTalk Inc. All participants completed a sociodemographic survey. RESULTS: The average age of participants was 68 ± 10.13 years, with half identifying as Black and 53% as female. Three themes emerged related to health care access and transportation: (1) individual factors, including attitudes toward transportation; (2) interpersonal factors, such as reliance on CGs, family, or friends; and (3) organizational factors, such as high parking costs and structural barriers limiting access. Participants primarily recommended solutions aimed at addressing financial challenges and improving accessibility. CONCLUSION: Older adults with MM and their CGs face complex transportation challenges when accessing cancer care, including high travel-related expenses, limited parking options with accessibility concerns, and long travel times. Addressing these issues requires multilevel interventions, such as including transportation coverage in health insurance and improving infrastructure, especially in underserved areas. Community solutions like volunteer driver programs and expanded telehealth can also help. Further research is needed to refine these solutions and assess their impact on health equity.

Background: Evidence for potential mortality benefits of leisure-time moderate-to-vigorous intensity physical activity (MVPA) for survivors of cancer types beyond breast and colorectal is limited. The aim of this study was to evaluate relationships between postdiagnosis MVPA and all-cause mortality in participants with a history of 11 cancer types. Methods: Data were pooled from 6 United States–based cohort studies. Cohort-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of MVPA assessed ≥1 year after a cancer diagnosis and all-cause mortality were calculated using multivariable Cox proportional hazards models and then pooled using random effects meta-analysis. Models were adjusted for age, sex, race/ethnicity, smoking status, alcohol use, and cancer treatment and stage. The sample included 90 844 cancer survivors (mean [standard deviation] age at diagnosis = 67 [10] years, 55% women), among whom 45 477 died during 10.9 [7.0] years of follow-up. Results: Compared with no MVPA, engaging in recommended amounts of MVPA (7.5 to <15 MET-hr/wk) was related to better overall survival in participants with a history of 1 of 10 cancer types: oral (HR = 0.44, 95% CI = 0.27 to 0.73), endometrial (0.50, 95% CI = 0.34 to 0.76), lung (0.51, 95% CI = 0.38 to 0.68), rectal (0.51, 95% CI = 0.36 to 0.71), respiratory (0.51, 95% CI = 0.29 to 0.72), bladder (0.53, 95% CI = 0.40 to 0.72), kidney (0.53, 95% CI = 0.37 to 0.77), prostate (0.60,95% CI = 0.49 to 0.74), colon (0.61, 95% CI = 0.50 to 0.76), and breast (0.67, 95% CI = 0.55 to 0.81). Eight of the 10 observed inverse associations remained similar when excluding participants who died within 2 years of follow-up. Conclusion: Engaging in leisure-time MVPA after a cancer diagnosis appears to improve survival for people with a history of several cancer types, including bladder, breast, colon, endometrial, kidney, lung, oral, prostate, rectal, and respiratory cancer.

Purpose: Sedentary behavior (SB) contributes to the heightened risk of cardiovascular disease (CVD) in endometrial cancer survivors (ECS). This feasibility study aimed to evaluate key outcomes to assess the practicality of SB reduction interventions for ECS. Secondary aims included SB domain assessment and preliminary efficacy testing of the relationship between SB and arterial stiffness. Methods: Forty stage-1 ECS (BMI ≥ 25.0 kg/m², aged 50-80, P < .001]. ECS exhibited a PWV of 9.04 ± 1.80 m/s, 13.4% higher than normative values, with occupational SB significantly associated with PWV. Conclusions: This study highlights high SB and PWV levels in ECS, indicating the need for interventions, particularly for occupational SB. The high retention and consent rates suggest ECS are willing to engage in behavior change, pointing to future research focusing on strategies to reduce SB and improve cardiovascular health.

Purpose Prolonged sitting acutely increases arterial stiffness, with interruption strategies only providing limited success in offsetting these rises. Acute aerobic exercise is a potent stimulus to decrease arterial stiffness. However, limited information exists on the effectiveness of acute exercise to maintain arterial stiffness when performed prior to prolonged sitting, particularly within physically active individuals. Methods Using a randomized crossover design, 22 young, active individuals (50% female) performed two conditions 30 min of walking at 55–65% of heart rate reserve (EX) and 30 min of standing (STAND) followed by 2.5-h of sitting. Brachial-femoral (bfPWV) and femoral-ankle pulse wave velocity (faPWV) were assessed at Baseline, post-exercise and pre-sitting (Pre), and post-sitting (Post) as estimates of central and peripheral arterial stiffness, respectively. Results For bfPWV, no interaction, condition, or time effects were observed. For faPWV, an interaction was present (p < 0.001); compared to Baseline, there was a 6.1% decrease for EX (− 0.4 m/s, p < 0.001) and a 4.6% increase for STAND (0.3 m/s, p = 0.016) for STAND such that there was an 11.3% difference between conditions at Pre (0.7 m/s, p < 0.001). From Pre to Post, EX then increased by 11.7% (0.9 m/s p < 0.001) while STAND remained unchanged, resulting in no difference between conditions (0.1 m/s, p = 0.569). Conclusions While aerobic exercise resulted in a significant decrease in faPWV prior to sitting, the prior exercise bout did not confer a protective effect against the deleterious effects of uninterrupted sitting. Future work should investigate the combined effect of prior exercise and sitting interruption strategies on markers of arterial stiffness.

Background: Multiple myeloma (MM) is an incurable debilitating blood cancer associated with the lowest health related quality of life (HRQoL) of all cancers. With nearly 88% of adults aged ≥55 years at diagnosis, age‐associated physical losses, comorbidities, and social factors contribute to worsening HRQoL. This qualitative study assessed dyadic (patient–informal caregiver) perspectives on the factors contributing to HRQoL in MM survivors. Methods: We recruited 21 dyads from the UNC‐Chapel Hill Lineberger Comprehensive Cancer between 11/2021 and 04/2022. Participants completed a single dyadic semistructured interview capturing broad perspectives on MM. We used ATLAS. ti v 9 for project management and to facilitate data analysis using the Sort and Sift, Think and Shift approach (ResearchTalk, Inc.). This iterative approach allowed the exploration and identification of themes within and across transcripts. Results: The mean age at enrollment was 71 years (median: 71, range: 57–90) for patients and 68 years (median 67, range: 37–88) for caregivers. All dyads were racially concordant (11 Black/AA and 10 White). However, we aggregated the findings due to no consistent racial differences. Six themes related to (1) physical burden, (2) treatment challenges, (3) losses of independence, (4) caregiver burden, (5) patient and caregiver perseverance, and (6) adjustment to a new normal were identified. Dyads also experienced MM together, resulting in patients and caregivers experiencing changes in their ability to engage in physical and social activities, which further contributed to poor HRQoL. Patients' increased need for social support led to shifts in the caregiver roles, resulting in caregivers feeling burdened by their responsibilities. All dyads acknowledged the need for perseverance and adaptability to a new normal with MM. Conclusion: The functional, psychosocial, and HRQoL of older patients with MM and their caregivers remain impacted ≥6 months after a new diagnosis highlighting clinical and research opportunities to focus on preserving or improving the health of dyads living with MM.

Background: Breast (BCa) and prostate (PCa) cancer are two of the most common but survivable cancers. One important component of survivorship that is impacted by treatment long term is diminished quality of life (QoL). Supervised exercise improves QoL and subsequent outcomes but is not accessible for all survivors. Additionally, many factors influence QoL including physical activity (PA), cardiorespiratory fitness (CRF), physical function, and fatigue. However, the COVID-19 pandemic has highlighted the need to increase access to exercise beyond supervised exercise facilities. Home-based exercise may provide a feasible alternative for cancer survivors especially for those living in rural communities. Objectives: The primary aim is to investigate the effects of home-based exercise training (Pre-training vs. Post-training) on QoL in BCa/PCa. A secondary aim is to investigate PA, CRF, physical function, and fatigue and potential moderators (age, cancer-type, intervention duration and type). Home-based exercise trials (randomized crossover or quasi-experimental design) with adults (aged 18 years and over) breast or prostate cancer survivors (not currently undergoing chemotherapy or radiation treatment) were eligible for inclusion. Data sources: Electronic databases were searched (inception-December 2022) for studies which included adult BCa or PCa survivors (not currently on chemotherapy/radiation), at least measured QoL, and undergoing unsupervised, home-based exercise training. Appraisal and synthesis methods: Initially, 819 studies were identified, from which 17 studies (20 effects) involving 692 participants were extracted. Effect sizes were calculated as standardized mean differences (SMD). Data were pooled using a 3-level model with restricted maximum likelihood estimation. Pooled SMD was used to assess the magnitude of effect, where <0.2, 0.2, 0.5, and 0.8 was defined as trivial, small, moderate, and large respectively. Results: Home-based exercise resulted in small improvements in QoL (SMD = 0.30, 95% CI 0.01, 0.60, p = 0.042), PA (SMD = 0.49, 95% CI 0.26, 0.75, p<0.001) and CRF (SMD = 0.45, 95% CI -0.01, 0.91, p = 0.056). Physical function (SMD = 0.00, 95% CI -0.21, 0.21, p = 1.000) and fatigue (SMD = -0.61, 95%CI -1.53, 0.32, p = 0.198) did not change. Conclusions: Home-based exercise results in small improves QoL in BCa/PCa survivors, independent of cancer type, intervention duration and type, or age. Home-based exercise also improves PA and CRF enhancing survivorship. Therefore, home-based exercise is an efficacious alternative option to improve QoL for BCa and PCa survivors especially for those who live in rural communities or lack access to exercise facilities.