Lin K-Y1,2, Edbrooke L3,4, Granger C3,5, Denehy L3,4, Frawley H1,2
1Monash University, Physiotherapy, Frankston, Australia, 2Cabrini Institute, Centre for Allied Health Research and Education, Malvern, Australia, 3The University of Melbourne, Physiotherapy, Parkville, Australia, 4Peter MacCallum Cancer Centre, Cancer Allied Health Service, Melbourne, Australia, 5The Royal Melbourne Hospital, Physiotherapy, Parkville, Australia
Background: Exercise interventions may have beneficial effects on physical activity levels and body mass index in patients with gynaecological cancer, however few studies have examined the change in physical activity levels before and after gynaecological cancer treatment. A better understanding of the natural history of physical activity levels during and following gynaecological cancer treatment will establish the time at which physical activity levels are lowest in order to target exercise interventions in this population accordingly.
Purpose: To conduct a systematic review to evaluate the impact of gynaecological cancer treatments on physical activity levels and to summarise the pattern of changes in physical activity levels over time among patients with gynaecological cancer.
Methods: A comprehensive literature search was performed via MEDLINE (1946-2018), CINAHL (1982-2018), EMBASE (1947-2018), Ovid Emcare (1947-2018), PsycINFO (1806-2018) and the Cochrane Library (1991-2018). Studies were eligible for inclusion if they assessed changes in physical activity levels during and after gynaecological cancer treatment. The methodological quality of the eligible studies was assessed by two independent reviewers using the Joanna Briggs Institute Critical Appraisal Tools.
Results: In total, six studies (three cohort studies and three cross-sectional studies) comprising 1607 participants were included. All studies used patient-reported physical activity measures. Two of the three cohort studies measured patient-recalled physical activity levels before diagnosis (baseline). The length of follow-up varied across all studies. The majority of participants were treated surgically +/- adjuvant therapy. Physical activity levels decreased at six months following surgery when compared with pre-treatment levels. Approximately 91% of participants did not meet physical activity guidelines two years following diagnosis, and 58% reported being less physically active three years after diagnosis, compared with pre-diagnosis levels.
Conclusion(s): Despite the paucity of evidence and limitations in the current body of literature, this review demonstrated that compared to pre-diagnosis, levels of physical activity remain low in gynaecological cancer survivors up to three years after diagnosis. Where possible future studies should utilise both performance-based measures (such as accelerometers) and patient-reported measures of physical activity. Further research is needed to better characterise the pattern of change of physical activity levels across the cancer continuum and identify changes in physical activity patterns associated with different cancer treatments and gynaecological tumour streams in order to target interventions accordingly.
Implications: At the time of gynaecological cancer diagnosis, healthcare professionals should emphasise the need for ongoing regular exercise across the lifespan, as sedentary behaviour is significantly related to both all-cause and cardiovascular mortality. The important role of physiotherapists in exercise prescription and physical activity promotion (the core skills of physiotherapists) may benefit patients with gynaecological cancer by identifying the times of low physical activity across the disease trajectory and providing appropriate interventions tailored to the characteristics, capabilities, needs and preferences of individual patients.
Keywords: Gynaecological cancer, Physical activity, Systematic review
Funding acknowledgements: This study was unfunded.
Purpose: To conduct a systematic review to evaluate the impact of gynaecological cancer treatments on physical activity levels and to summarise the pattern of changes in physical activity levels over time among patients with gynaecological cancer.
Methods: A comprehensive literature search was performed via MEDLINE (1946-2018), CINAHL (1982-2018), EMBASE (1947-2018), Ovid Emcare (1947-2018), PsycINFO (1806-2018) and the Cochrane Library (1991-2018). Studies were eligible for inclusion if they assessed changes in physical activity levels during and after gynaecological cancer treatment. The methodological quality of the eligible studies was assessed by two independent reviewers using the Joanna Briggs Institute Critical Appraisal Tools.
Results: In total, six studies (three cohort studies and three cross-sectional studies) comprising 1607 participants were included. All studies used patient-reported physical activity measures. Two of the three cohort studies measured patient-recalled physical activity levels before diagnosis (baseline). The length of follow-up varied across all studies. The majority of participants were treated surgically +/- adjuvant therapy. Physical activity levels decreased at six months following surgery when compared with pre-treatment levels. Approximately 91% of participants did not meet physical activity guidelines two years following diagnosis, and 58% reported being less physically active three years after diagnosis, compared with pre-diagnosis levels.
Conclusion(s): Despite the paucity of evidence and limitations in the current body of literature, this review demonstrated that compared to pre-diagnosis, levels of physical activity remain low in gynaecological cancer survivors up to three years after diagnosis. Where possible future studies should utilise both performance-based measures (such as accelerometers) and patient-reported measures of physical activity. Further research is needed to better characterise the pattern of change of physical activity levels across the cancer continuum and identify changes in physical activity patterns associated with different cancer treatments and gynaecological tumour streams in order to target interventions accordingly.
Implications: At the time of gynaecological cancer diagnosis, healthcare professionals should emphasise the need for ongoing regular exercise across the lifespan, as sedentary behaviour is significantly related to both all-cause and cardiovascular mortality. The important role of physiotherapists in exercise prescription and physical activity promotion (the core skills of physiotherapists) may benefit patients with gynaecological cancer by identifying the times of low physical activity across the disease trajectory and providing appropriate interventions tailored to the characteristics, capabilities, needs and preferences of individual patients.
Keywords: Gynaecological cancer, Physical activity, Systematic review
Funding acknowledgements: This study was unfunded.
Topic: Oncology, HIV & palliative care
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: Ethics approval was not required for this study as it was based on published studies.
All authors, affiliations and abstracts have been published as submitted.
