A randomized trial of exercise and quality of life in colorectal cancer survivors. Activities of Daily Living and Quality of Life of Elderly Patients After Elective Surgery for Gastric and Colorectal Cancers Determinants of exercise during colorectal cancer treatment: an application of the theory of planned behavior. Physical activity and survival after colorectal cancer diagnosis. Prospective Evaluation of Health-Related Quality of Life in a Homogeneous Mediterranean Group of Colorectal Cancer Patients Prospective relationships of physical activity with quality of life among colorectal cancer survivors. Effect of Darbepoetin Alfa on Physical Function in Patients Undergoing Surgery for Colorectal Cancer The effects of exercise on pain, fatigue, insomnia, and health perceptions in patients with operable advanced stage rectal cancer prior to surgery: a pilot trial Postoperative Physical Training following Colorectal Surgery: A Randomised, Placebo-Controlled Study Results of postoperative treatment of colorectal cancer by radiotherapy, chemotherapy and immunotherapy. Effect of physical activity and body size on survival after diagnosis with colorectal cancer Surgical resection of primary tumour improves aerobic performance in colorectal cancer. Design of the Physical exercise during Adjuvant Chemotherapy Effectiveness Study (PACES):A randomized controlled trial to evaluate effectiveness and cost-effectiveness of physical exercise in improving physical fitness and reducing fatigue Final results of randomized trials by the National Surgical Adjuvant Study of Colorectal Cancer (NSAS-CC) Chemotherapy as an Adjuvant to Surgery for Colorectal Cancer Quality of Life following Colorectal Cancer Surgery: The Role of Alexithymia Quality of life after adjuvant intra‐arterial chemotherapy and radiotherapy versus surgery alone in resectable pancreatic and periampullary cancer
We conducted a r and omized controlled trial to determine the effects of a home-based exercise intervention on change in quality of life ( QOL ) in recently resected colorectal cancer survivors , most of whom were receiving adjuvant therapy . Participants were r and omly assigned in a 2:1 ratio to either an  exercise ( n = 69 ) or control ( n = 33 ) group . The exercise group was asked to perform moderate intensity exercise 3 - 5 times per week for 20 - 30 min each time . The primary outcome was change in QOL as measured by the Functional Assessment of Cancer Therapy-Colorectal ( FACT-C ) scale . Adherence in the exercise group was good ( 75.8 % ) but contamination in the control group was problematic ( 51.6 % ) . Intention-to-treat analysis revealed no significant differences between groups for change in the FACT-C ( mean difference , -1.3 ; 95 % CI , -7.8 to 5.1 ; P = 0.679 ) . In an ' on-treatment ' ancillary analysis , we compared participants who decreased versus increased their cardiovascular fitness over the course of the intervention . This analysis revealed significant differences in favour of the increased fitness group for the FACT-C ( mean difference , 6.5 ; 95 % CI , 0.4 - 12.6 ; P = 0.038 ) . These data suggest that increased cardiovascular fitness is associated with improvements in QOL in colorectal cancer survivors but better controlled trials are needed Objective : To establish reliable st and ards for surgical application to elderly patients 75 years old or older with gastric or colorectal cancer with special reference to the postoperative recovery of activities of daily living ( ADL ) and quality of life ( QOL ) . Summary Background Data : ADL and QOL are important outcomes of surgery for the elderly . However , there has been only limited evidence on the natural course of recovery of functional independence . Methods : Two hundred twenty-three patients 75 years old or older with gastric or colorectal cancer were prospect ively examined .  Physical conditions , ADL , and QOL  were evaluated preoperatively and at the first , third , and sixth postoperative month . Results : The mortality and morbidity rates were 0.4 % and 28 % , respectively . Twenty-four percent of patients showed a decrease in ADL at 1 month postoperatively , but most patients recovered from this transient reduction , with only 3 % showing a decline at the sixth postoperative month ( 6POM ) . ADL of these patients was likely to decrease after discharge from the hospital . QOL of the patients showed a recovery to an extent equal to or better than their average preoperative scores . Conclusions : Of the patients 75 years old or older who underwent elective surgery for gastric or colorectal cancer , only a few showed a protracted decline in ADL and most exhibited better QOL after surgery . This indicates that surgical treatment should be considered , whenever needed , for elderly patients 75 years old or older with gastric or colorectal cancer . Estimation of Physical Ability and Surgical Stress is useful for predicting postoperative declines in ADL and protracted disability ; this could aid in establishing a directed rehabilitation program for preventing protracted disability in elderly patients PURPOSE / OBJECTIVES To examine determinants of exercise during colorectal cancer treatment using the theory of planned behavior . DESIGN A retrospective survey . SETTING Cancer Registry of Alberta , Canada . SAMPLE R and omly selected survivors of colorectal cancer ( N = 110 ) diagnosed between 1992 and 1995 who had undergone adjuvant therapy . Participants ' ages ranged from 26 to 77 years ( mean = 61 years ; SD = 11 ) , 63 % were male , and 85 % were disease stage II or III . METHODS Initial open-ended elicitation question naire to determine salient beliefs , a mailed main question naire , a postcard reminder one week later , and a second question naire three weeks later . Exercise  was assessed by the Godin Leisure Time Exercise Question naire . MAIN RESEARCH VARIABLES Exercise during cancer treatment , intention , perceived behavioral control , attitude , subjective norm , and salient beliefs . FINDINGS Exercise during cancer treatment was determined by intention and perceived behavioral control . Intention was determined solely by attitude . Salient beliefs about exercise were different for patients with cancer as compared to a healthy population . CONCLUSIONS The theory of planned behavior may be a viable framework on which to base interventions to promote exercise in patients with colorectal cancer . IMPLICATION S FOR NURSING PRACTICE Oncology nurses need to have an underst and ing of motivational factors related to exercise during cancer treatment to be able to assist patients with cancer to initiate and maintain exercise PURPOSE Physically active individuals have a lower risk of developing colorectal cancer but the influence of exercise on cancer survival is unknown . PATIENTS AND METHODS By a prospect i ve , observational study of 573 women with stage I to III colorectal cancer , we studied colorectal cancer-specific and overall mortality according to predefined physical activity categories before and after diagnosis and by change in activity after diagnosis . To minimize bias by occult recurrences , we excluded women who died within 6 months of their postdiagnosis physical activity assessment . RESULTS Increasing levels of exercise after diagnosis of nonmetastatic colorectal cancer reduced cancer-specific mortality ( P for trend = .008 ) and overall mortality ( P for trend = .003 ) . Compared with women who engaged in less than 3 metabolic equivalent task [ MET ] -hours per week of physical activity , those engaging in at least 18 MET-hours per week had an adjusted hazard ratio for colorectal cancer-specific mortality of 0.39 ( 95 % CI , 0.18 to 0.82 ) and an adjusted hazard ratio for overall mortality of 0.43 ( 95 % CI , 0.25 to 0.74 ) . These results remained unchanged even after excluding women who died within 12 and 24 months of activity assessment . Prediagnosis physical activity was not predictive of mortality . Women who increased their activity ( when comparing prediagnosis to postdiagnosis values ) had a hazard ratio of 0.48 ( 95 % CI , 0.24 to 0.97 ) for colorectal cancer deaths and a hazard ratio of 0.51 ( 95 % CI , 0.30 to 0.85 ) for any-cause death , compared with those with no change in activity . CONCLUSION Recreational physical activity after the diagnosis of stages I to III colorectal cancer may reduce the risk of colorectal cancer-specific and overall mortality This study was design ed to prospect ively evaluate health-related quality of life in a homogeneous Mediterranean group of colorectal cancer patients . Ninety-five colorectal cancer patients were preoperatively assessed and followed-up with by skilled investigators using the Short Form-36 Health Survey question naire .  Overall , patients showed deterioration in all domains , except for pain , when baseline values were compared with 3 and 6 months postoperatively ( P = 0.0001 ) . A significant improvement of all Short Form-36 Health Survey question naire domains was noted between 6 and 12 months ( P = 0.0001 ) . Scores for general health , pain , emotional well-being , and role limitations due to emotional problems at 1 year were shown better than preoperative ( P < 0.001 ) . Improved scores in role limitations due to physical health and emotional problems were found at baseline and at 1 year , when laparoscopic were compared with open resections ( P < 0.05 ) . Patients that received chemotherapy proved to be more vulnerable regarding their energy , social functioning , and role limitations at 3 months ( P < 0.05 ) , whereas older patients had diminished physical functioning at 3 and 6 and 12 months ( P < 0.05 ) postoperatively . Greek colorectal cancer patients remain fragile up to 6 months after surgery , with significant improvements at 1 year , whereas certain aspects of health-related quality of life at 1 year may be even better than before PURPOSE Physical activity can enhance quality of life for cancer survivors . However , few longitudinal studies have examined whether physical activity has a sustained effect on improvements in quality of life . The present study aims to examine the relationships between physical activity and quality of life over 2 years after a colorectal cancer diagnosis . PATIENTS AND METHODS Data were collected within the Colorectal Cancer and Quality of Life Study , in which 1,966 people diagnosed with colorectal cancer were recruited through the Queensl and Cancer Registry . Participants completed telephone interviews at approximately 6 , 12 , and 24 months after diagnosis . Generalized linear mixed models were used to estimate the overall , interindividual , and intraindividual level independent effects of participation in physical activity on quality of life . RESULTS There was an overall independent association between  physical activity and quality of life . At a given time point , participants achieving at least 150 minutes of physical activity per week had an 18 % higher quality of life score than those who reported no physical activity . Significant associations were also present at the interindividual level ( differences between participants ) and intraindividual level ( within participant changes ) . CONCLUSION These findings suggest that the positive association between  physical activity and quality of life is consistent over time . Encouraging colorectal cancer survivors to be physically active may be a helpful strategy for enhancing quality of life Objective : To study whether perioperative treatment with darbepoetin alfa ( DA ) improves physical performance following colorectal cancer surgery . Methods : Patients admitted for planned colorectal cancer surgery were r and omized to receive either weekly placebo or DA 300 or 150 µg depending on the hemoglobin ( Hb ) concentration . Patients were assessed 10 days before , as well as 7 and 30 days after surgery for work capacity , postural sway , muscle strength , fatigue and quality of life ( QoL ) . The primary outcome measure were the changes in patients ’ physical performance from preoperative to postoperative day 7 . Results : Of 221 included patients , 151 were evaluable . Baseline characteristics were similar in the 2 groups . Patients receiving DA had a significantly better working capacity on day 7 ( p = 0.03 ) and day 30 ( p = 0.03 ) compared with the placebo group . There were no statistically significant differences between the 2 groups on days 7 or 30 for fatigue , postural sway and QoL.  DA treatment significantly ( p < 0.01 ) reduced the decrease in Hb concentrations on day 7 and result ed in an earlier return ( p < 0.01 ) to the preoperative Hb concentration compared to placebo treatment . Conclusion : Perioperative DA  treatment improved postoperative work capacity and Hb concentrations , but had no effect on postoperative fatigue , postural sway , QoL and muscle strength Background Promoting quality of life ( QoL ) is a key priority in cancer care . We investigated the hypothesis that , in comparison to usual care , exercise post-neoadjuvant chemoradiation therapy/prior to surgical resection will reduce pain , fatigue , and insomnia , and will improve physical and mental health perceptions in patients with locally advanced stage rectal cancer . Methods In this non-r and omized controlled pilot trial , patients in the supervised exercise group ( EG ; Mage = 64 years ; 64 % male ) and in the control group ( CG ; Mage = 72 years ; 69 % male ) completed the European Organization for Research and Treatment of Cancer core Quality of Life question naire and the R AND 36-Item Health Survey three times : pre-neoadjuvant chemoradiation therapy ( Time 1 ; nEC = 24 ; nCG = 11 ) , post-neoadjuvant chemoradiation therapy/pre-exercise intervention ( Time 2 ; nEC = 23 ; nCG = 10 ) , and post-exercise intervention ( Time 3 ; nEC = 22 ; nCG = 10 ) . The 6-week exercise intervention was delivered in hospital and comprised of interval aerobic training . Patients trained in pairs three times per week for 30 to 40 min . Data were analyzed by Mann – Whitney tests and by Wilcoxon matched-pairs signed-rank tests . Results No significant between-group differences in changes were found for any of the outcomes . In both groups , fatigue levels decreased and physical health perceptions increased from pre- to post-exercise intervention . Pain levels also decreased from pre- to post-exercise intervention , albeit not significantly . Conclusions The findings from this study can be used to guide a more definitive trial as they provide preliminary evidence regarding the potential effects of pre-operative exercise on self-reported pain , fatigue , insomnia , and health perceptions in patients with locally advanced rectal cancer . Trial registration : This study has been registered with clinical trials.gov ( NCT01325909 ; March 29 , 2011 ) Background and Aims : Major surgery is often followed by fatigue and reduced physical function . We wished to study if postoperative physical training reduced fatigue and improved physical function . Material and Methods : R and omised , placebo-controlled , single-blinded study . Participants were unselected patients ≥ 60 years undergoing elective colorectal surgery without disseminated cancer or inflammatory bowel disease . Group A trained muscular strength and work capacity . Group B performed relaxation exercises and received hot wrappings and massage . Main outcome measures were : fatigue ( visual analogue scale ) , muscular strength , walking speed , physical performance test , and physical function questions ( SF-36 ) . Results : Preoperatively the two groups were similar except that A was more fatigued than B. By postoperative day seven fatigue had increased compared to preoperatively , more in B than A , but by day 30 and 90 there were no significant differences between groups . All indices of physical function decreased postoperative day seven and were at the preoperative level day 90 with no significant differences between groups in change in function . Day seven the change in knee extension strength tended to be lower in B than A but by day 30 changes were similar in both groups . Conclusion : Postoperative training did not improve physical function , but reduced fatigue in hospital Adjuvant therapy was given to patients with colorectal cancer stage Duke 's B2 and C. The 53 patients were r and omized and stratified after surgery . One arm received radiotherapy and chemotherapy and the other radiotherapy , chemotherapy , and MER . The survival and disease-free interval up to 2 years were longer and better in the radiochemo-MER arm . It is too early to conclude whether this combination increases the cure rate or delays the appearance of metastases . The time interval between the cytotoxic therapy  and the immunotherapy and the dose of the immunotherapeutic agent is very important for the success of the combination therapy . Further follow-up is necessary and more patients need to be entered into the trial Background : Physical inactivity and obesity increase the risk of  colorectal cancer  but little is known about whether they influence prognosis after diagnosis . Methods : Incident cases of colorectal cancer were identified among participants of the Melbourne Collaborative Cohort Study , a prospect i ve cohort study of 41 528 Australians recruited from 1990 to 1994 . Participants diagnosed with their first colorectal cancer between recruitment and 1 August 2002 were eligible . At the time of study entry , body measurements were taken and participants were interviewed about their physical activity . Information on tumour site and stage , treatments given , recurrences , and deaths were obtained from systematic review of the medical records . Results : A total of 526 cases of colorectal cancer were identified . Median follow up among survivors was 5.5 years , and 208 deaths had occurred , including 181 from colorectal cancer . After adjusting for age , sex , and tumour stage , exercisers had an improved disease specific survival ( hazard ratio 0.73 ( 95 % confidence interval ( CI ) 0.54–1.00 ) ) . The benefit of exercise was largely confined to stage II – III tumours ( hazard ratio 0.49 ( 95 % CI 0.30–0.79 ) ) . Increasing per cent body fat result ed in an increase in disease specific deaths ( hazard ratio 1.33 per 10 kg ( 95 % CI 1.04–1.71 ) ) . Similarly , increasing waist circumference reduced disease specific survival ( hazard ratio 1.20 per 10 cm ( 95 % CI 1.05–1.37 ) ) . Conclusions : Increased central adiposity and a lack of regular physical activity prior to the diagnosis of colorectal cancer is associated with poorer overall and disease specific survival BACKGROUND Colorectal cancer is the third most common cancer in the UK , with patients suffering declines in muscle mass and aerobic function . We hypothesised that tumour removal in non-metastatic colorectal cancer would lead to a restoration of lean muscle mass and increases in objective and subjective measures of aerobic performance . METHODS We recruited two groups : patients with colorectal cancer ( n = 30 , 65.3 ( 51 - 77 ) y , body mass index 27.67 ( 4.83 ) kg m(-2 ) ) and matched controls ( n = 30 , 64.6 ( 42 - 77 ) y , BMI 27.14 ( 3.51 ) kg m(-2 ) ) . Controls underwent a single study while colorectal cancer patients were studied before and 10 months after tumour resection . Aerobic performance was assessed via cardiopulmonary exercise testing and activity question naires . Lean muscle mass was measured via dual-energy X-ray absorptiometry . RESULTS Lean muscle mass was not different between groups ( control : 47.82 ( 8.23 ) ; pre-resection : 52.41 ( 10.59 ) ; post-resection : 52.38 ( 10.52 ) , kg ) . Anaerobic threshold was lower in pre-operative patients compared to controls ( 14.40 ( 3.23 ) vs. 19.67 ( 5.81 ) ml kg(-1 ) min(-1 ) , p < 0.0001 ) , increasing significantly post-resection ( 17.00 ( 3.56 ) ml kg(-1 ) min(-1)p < 0.0001 ) . Self reported maximal physical activity was lower after resection compared to preoperatively ( pre-resection 6.0 ( 6.5 - 5 IQR ) , post-resection 3.75 ( 4 - 3 IQR ) , p < 0.0001 ) . CONCLUSION In colorectal cancer , anaerobic threshold is reached more rapidly than in matched controls , returning toward normal with tumour resection . Self-reported measures of activity do not mirror this objective change , cardiopulmonary exercise testing may therefore allow for a more accurate evaluation of pre and postoperative performance capability . The variance between objective and subjective measures of exercise capacity may be important in determining return to normal activities Background Cancer chemotherapy is frequently associated with a decline in general physical condition , exercise tolerance , and muscle strength and with an increase in fatigue . While accumulating evidence suggests that physical activity and exercise interventions during chemotherapy treatment may contribute to maintaining cardiorespiratory fitness and strength , the results of studies conducted to date have not been consistent . Additional research is needed to determine the optimal intensity of exercise training programs in general and in particular the relative effectiveness of supervised , outpatient ( hospital- or physical therapy practice -based ) versus home-based programs . Methods This multicenter , prospect i ve , r and omized trial will evaluate the effectiveness of a low to moderate intensity , home-based , self-management physical activity program , and a high intensity , structured , supervised exercise program , in maintaining or enhancing physical fitness ( cardiorespiratory fitness and muscle strength ) , in minimizing fatigue and in enhancing the health-related quality of life ( HRQoL ) .  Patients receiving adjuvant chemotherapy for breast or colon cancer ( n = 360 ) are being recruited from twelve hospitals in the Netherl and s , and r and omly allocated to one of the two treatment groups or to a  ' usual care ' control group .  Performance-based and self-reported outcomes are assessed at baseline , at the end of chemotherapy and at six month follow-up . Discussion This large , multicenter , r and omized clinical trial will provide additional empirical evidence regarding the effectiveness of physical exercise during adjuvant chemotherapy in enhancing physical fitness , minimizing fatigue , and maintaining or enhancing patients ' quality of life . If demonstrated to be effective , exercise intervention programs will be a welcome addition to the st and ard program of care offered to patients with cancer receiving chemotherapy . Trial registration This study is registered at the Netherl and s Trial Register ( NTR 2159 Objective In the latter 1990s , adjuvant chemotherapy for completely resected Stage III colorectal cancer remained controversial in Japan . We conducted two independent r and omized controlled trials in patients with Stage III colon and rectal cancer . Methods Patients were r and omly assigned to receive surgery alone or surgery followed by treatment with UFT ( 400 mg/m2/day ) , given for five consecutive days per week for 1 year . The primary endpoint was relapse-free survival ( RFS ) , and the secondary endpoint was overall survival ( OS ) . Results A total of 334 patients with colon cancer and 276 with rectal cancer were enrolled . The patients ’ characteristics were similar between the UFT group and the Surgery-alone group . There was no significant difference in RFS or OS in colon cancer . In rectal cancer , however , RFS and OS were significantly better in the UFT group than in the Surgery-alone group . The only grade 4 toxicity in the UFT group was diarrhea , occurring in one patient with colon cancer and one patient with rectal cancer . Conclusions Postoperative adjuvant chemotherapy with UFT is successfully tolerated and improves RFS and OS in patients with Stage III rectal cancer . In colon cancer , the expected benefits were not obtained ( hazard ratio = 0.89 ) A combined intraoperative and postoperative adjuvant program of 5 minus Fluorouracil ( 5 FU ) for patients undergoing " curative " resection for adenocarcinoma of the colon and rectum was initiated as a r and omized clinical trial in January 1968 . Patients at the Medical College of Virginia and the University of Virginia were r and omly assigned to an intraluminal 5 FU or intraluminal control ( Saline ) group and were so treated at the time of surgical resection if findings at operation indicated that all gross neoplastic disease could be resected . Patients with operative findings denoting incurability were eliminated from the study after surgical exploration . Those patients receiving intraluminal 5 FU ( 30mg/kg ) received intravenous 5 FU ( 10mg/kg ) on each of the two first postoperative days and 5 subsequent postoperative courses of oral 5FU ( 90 mg/kg in each 18 day course ) over a one year period . By December 31 , 1973 ( 6 years ) 156 patients undergoing " curative " resection were entered into the study . SU therapy with the control or " No Treat " group reveal no significant benefit from this intensive adjuvant course of 5 FU thus far . Continued assessment of these patient groups and their subgroups will be required to develop confidence in these findings but the data thus far suggest no potential benefit from this particular adjuvant program Background : Alexithymia refers to a set of cognitive and emotional deficits . Its effect on surgical outcome has been demonstrated but no studies have been published on colorectal cancer patients . Study Design : A series of 60 consecutive colorectal cancer patients were enrolled in a 3-year prospect i ve study on quality of life by using the SF-36 test and Toronto Alexithymia Scale question naires . Patients were investigated pre- and postoperatively ( before discharge and then 1 and 3 months thereafter ) . The control group consisted of patients undergoing laparoscopic cholecystectomy for cholelithiasis .  These two groups were divided into two subsets : high-level alexithymia ( HA ) and low-level alexithymia ( LA ) . The prevalence of HA was 34 % in colorectal patients and 35 % in cholelithiasis patients . Results : During the postoperative period , in the colorectal group the SF-36 score was significantly higher in HA than in LA subsets . This result was confirmed in the cholelithiasis group . During follow-up , a progressive reduction of the SF-36 score was observed in both HA population s. Discussion : Results emerging from this investigation demonstrate that surgery significantly improves the quality of life in HA patients . These findings suggest that alexithymia might be advantageous in evaluating the adaptation after surgery in the short follow-up period Adjuvant therapies for pancreatic and periampullary cancer reportedly achieve only a marginal survival benefit . In this r and omized controlled trial , 120 patients with resected pancreatic or periampullary cancer received either adjuvant celiac axis infusion chemotherapy combined with radiotherapy ( CAI/RT ) or no adjuvant treatment . The objective of the study was to compare the quality of life ( QoL ) in patients who received CAI/RT after pancreatoduodenectomy with the QoL in patients who did not receive adjuvant treatment
Endurance training alone was found to increase both lower extremity strength and endurance capacity .
Colorectal cancer surgery results in considerable postoperative morbidity , mortality and reduced quality of life .
As many patients will undergo additional (neo)adjuvant therapy , it is imperative that each individual optimize their physical function .
To eluci date the potential of exercise in patient optimization , we investigated the evidence for an exercise program before and after surgical treatment in colorectal cancer patients .