EXERCISE AND QUALITY OF LIFE IN WOMEN WITH BREAST CANCER

乳腺癌在美国是一个重要的健康问题，也是美国女性最常见的癌症诊断。据估计，1997年将发生181600起事件和44190起死亡事件。老年妇女的BC发病率为每100,000人中有300人，大约是年轻妇女发病率的五倍。对于大多数在癌症中幸存下来的女性来说，一个重要的问题是成功地调整和恢复日常活动和生活质量。这些挑战在老年女性中最大，她们可能随着年龄的增长经历了身体状况的解除和社会支持的减少。癌症和主要恶性肿瘤是与功能状态密切相关的常见疾病，与糖尿病和骨质疏松症的活动天数相当。这种下降的一个关键途径似乎是身体不活动和情绪不集中的时期，远离癌症或其治疗。建议的干预研究是一项对照临床试验(2X2析因设计)，将测试和比较普通康复医学中改善患者结局的两种模式的有效性：患者教育和支持计划，以及增加社区日常活动的培训。这项研究将招募212名50岁及以上的女性，她们最近被诊断为公元前0-2期，并对她们进行了18个月的跟踪调查。主要的结果指标是6分钟步行(身体健康)和FACT-BC(综合HRQL)。在第一阶段，受试者将被随机分成三个月的增强型常规护理(关于现有支持服务的患者信息、患者时事通讯和每月一次的跟踪电话联系)或全面的心理教育计划。在第二阶段，受试者将被重新随机分配到锻炼或通常的护理条件下，并跟踪15个月。这项研究的主要目的是确定：1)与加强日常护理(UC+)相比，适度运动计划是否显著改善患有BC的老年妇女的身体功能和HRQL；以及2)与UC+相比，心理教育计划是否显著改善患有BC的老年妇女的身体功能和HRQL。

Breast cancer (BC) is an important health concern in the United States and is the most common cancer diagnosis among American women. An estimated 181,600 incident cases and 44,190 deaths due to BC are projected to occur in 1997. The incidence of BC in older women is 300 per 100,000, of approximately five times the incidence in younger women. For the increasing majority of women who survive their cancer, an important issue is successful readjustment and resumption of daily activities and quality of life. These challenges are greatest among older women who likely have experienced physical deconditioning and reductions in social supports with aging. Cancer and major malignancies are among the incident illnesses strongly associated with functional status and are associated with restricted activity days comparable in number to diabetes and osteoporosis. A key pathway for this decline appears to be periods of physical inactivity and emotional distr5ess from cancer or its treatment. The proposed intervention study is a controlled clinical trial (2X2 factorial design) which will test and compare the efficacy of two modalities in general rehabilitative medicine to enhance patient outcomes: patient education and support programs, and training to increase daily activity in the community. The study will enroll 212 women, 50 years of age and older, recently diagnosed with stage 0-2 BC and follow them for 18 months. The primary outcome measures are the 6-minutes walk (physical fitness) and the FACT-BC (comprehensive HRQL). In phase I, subjects will be randomized to 3 months of either enhanced usual care (patient information about existing support services, a patient newsletter and a monthly follow-up telephone contact) or a comprehensive psychoeducational program. In phase II, subjects will be re-randomized to exercise or to the usual care condition, and followed for 15 months. The primary aims of the study are to determine if: 1) A moderate exercise program, as compared to enhanced usual care (UC+), significantly improves the physical functioning and HRQL in older women with BC; and 2) A psychoeducational program, as compared to UC+, significantly improves physical functioning and HRQL in older women with BC.