Effect of exercise on cortisol dysregulation in ovarian cancer survivors

运动对卵巢癌幸存者皮质醇失调的影响

• 批准号: 8452053
• 负责人: Brenda Cartmel
• 金额: $ 7.82万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-02 至 2015-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8452053
• 关键词: Affect; Attention; Cancer Patient; Cancer Survivor; Control Groups; Diagnosis; Disease; Distant Metastasis; Enrollment; Epidemiologic Studies; Exercise; Fatigue; Funding; Health Educators; Home environment; Human Resources; Hydrocortisone; Intervention; Malignant neoplasm of ovary; Mental Depression; Outcome; Patients; Pattern; Prognostic Marker; Public Health Schools; Quality of life; Randomized; Regional Cancer; Research; Role; Staging; Survivors; Symptoms; Testing; Time Study; United States National Institutes of Health; Walking; Woman; Yoga; base; cost effective; efficacy testing; functional disability; improved; malignant breast neoplasm; outcome forecast; randomized trial; response; screening

DESCRIPTION (provided by applicant): There is no effective screening test for ovarian cancer and the symptoms are non-specific resulting in the majority (85%) of women with ovarian cancer being diagnosed with late stage (regional or distant cancer) disease. Women diagnosed with ovarian cancer at a late stage have a relatively poor prognosis (5-year survival: 72% for regional cancer, 27% for distant cancer), with the disease and resulting treatment negatively impacting quality of life (QOL). Ovarian cancer survivors diagnosed with late stage disease have frequently been found to have perturbed diurnal cortisol patterns. Normally, cortisol levels decline over the course of the day, that is levels are highest upon waking and lowest in the evening; people who have a perturbed diurnal pattern show a less than expected decline in cortisol level over the course of the day (i.e. a flatter slope). Perturbed cortisol profiles have been associated with fatigue, vegetative depression and greater functional disability in ovarian cancer survivors and poorer survival in later stage breast cancer survivors. Recently a small randomized study in Stage II-IV breast cancer survivors has shown that yoga beneficially affects both cortisol patterns and fatigue. A large ongoing randomized trial at the Yale School of Public Health, which is testing the efficacy of a home-based 6-month exercise intervention to improve QOL and reduce fatigue in ovarian cancer survivors, gives us a unique cost effective opportunity to explore whether exercise effects cortisol patterns. At enrollment women are relatively inactive, and those randomized to the exercise group increase their exercise to150 minutes per week (primarily walking) during the 6-month intervention. All women in the study are contacted once a week by an exercise trainer (exercise group) or a health educator (control group). The two groups receive equal contact time from study personnel, an essential component to effectively explore the effect of exercise, as attention itself can affect some aspects of QOL. In the proposed study we plan to i) explore whether a 6-month home-based exercise intervention will alter the diurnal cortisol patterns in ovarian cancer survivors compared to similar survivors n the control group and ii) explore the association between diurnal cortisol patterns and QOL, depression and fatigue in ovarian cancer survivors. Since perturbed cortisol patterns have been associated with poorer survival in breast cancer survivors, exploring how exercise affects cortisol could provide important information on the mechanisms through which exercise may impact prognosis for cancer survivors. The impact of cortisol on survival among ovarian cancer survivors has not been studied. If we find that exercise beneficially alters diurnal cortisol patterns in ovarian cancer survivors, this would warrant further research to investigate the effect of exercise on survival in women diagnosed with ovarian cancer; a group of understudied cancer survivors.

描述(申请人提供)：目前尚无有效的卵巢癌筛查试验，症状无特异性，导致大多数(85%)卵巢癌妇女被诊断为晚期(区域或远处癌症)疾病。晚期卵巢癌患者的预后相对较差(5年生存率：区域癌72%，远处癌27%)，这种疾病和由此导致的治疗对生活质量(QOL)产生了负面影响。被诊断为晚期疾病的卵巢癌幸存者经常被发现扰乱了白天的皮质醇模式。正常情况下，皮质醇水平会随着一天的进程而下降，也就是说，醒着的时候皮质醇水平最高，晚上最低；昼夜规律受到干扰的人，一天中皮质醇水平的降幅比预期的要小(即坡度平坦)。受扰的皮质醇图谱与卵巢癌幸存者的疲劳、植物性抑郁和更大的功能障碍以及晚期乳腺癌幸存者更差的生存有关。最近，一项针对II-IV期乳腺癌幸存者的小型随机研究表明，瑜伽对皮质醇模式和疲劳感都有好处。耶鲁大学公共卫生学院正在进行的一项大型随机试验正在测试为期6个月的家庭运动干预的有效性，以改善卵巢癌幸存者的生活质量和减少疲劳，这为我们提供了一个独特的具有成本效益的机会，来探索运动是否影响皮质醇模式。在登记时，女性相对不活跃，那些被随机分到运动组的女性在6个月的干预期间将她们的运动量增加到每周150分钟(主要是步行)。运动训练师(运动组)或健康教育者(控制组)每周联系研究中的所有女性一次。这两组人从研究人员那里得到了同等的接触时间，这是有效探索运动效果的重要组成部分，因为注意力本身会影响生活质量的某些方面。在这项拟议的研究中，我们计划：1)探索为期6个月的家庭运动干预是否会改变卵巢癌幸存者与对照组中类似幸存者的皮质醇昼夜模式；2)探索卵巢癌幸存者的昼夜皮质醇模式与生活质量、抑郁和疲劳的关系。由于紊乱的皮质醇模式与乳腺癌幸存者较差的存活率有关，探索运动如何影响皮质醇可以提供关于运动可能影响癌症幸存者预后的机制的重要信息。皮质醇对卵巢癌幸存者存活率的影响尚未被研究。如果我们发现锻炼有益地改变了卵巢癌幸存者的昼夜皮质醇模式，这将值得进一步研究以调查其影响。 运动对诊断为卵巢癌的女性存活率的影响；一群研究不足的癌症幸存者。