Abstract PS1-02-10: Knowledge and adherence to exercise recommendations among oncologic patients

6501 Background: Clinically annotated specimens from cancer clinical trial participants offer an opportunity for discovery and validation of pharmacogenomic findings. This observational study assessed patient (pt) and institutional factors that may contribute to participation in pharmacogenomic components of prospective cancer clinical trials. No trial in the study used pharmacogenomic results to guide therapy, but germline DNA was collected from consenting pts for future study of potential heritable variations associated with clinical outcome. Methods: Pt demographic data (age, sex, diagnosis, self-reported race) and institutional characteristics (CALGB/CTSU site, diversity, accrual rate) were evaluated for 8546 pts enrolled in 7 CALGB phase III trials with a pharmacogenomic component. Participation was defined as pt consent specific to this component documented in the CALGB database. Results: Most pts (81%) enrolled on the clinical trials consented to participate in the pharmacogenomic component. In a multivariable analysis, site (CALGB vs CTSU), self-reported race (non-white vs white) and institutional diversity (% minority cancer pts on national trials) were significantly associated with participation. Pts from CALGB sites were more likely to participate than pts at CTSU sites (OR 2.09, CI 1.60-2.73, p<0.0001). Non-white pts were less likely to participate than white pts (OR 0.48, CI 0.41-0.56, p<0.0001). A significant interaction between site and race was observed (OR 0.41, CI 0.37-0.47, p<0.0001). As institutional diversity increased, likelihood of participation in the pharmacogenomic component decreased for both white (p=0.0001) and non-white pts (p=0.054). Conclusions: Pharmacogenomic studies are achievable in the context of multicenter cancer clinical trials, but optimization of pt and institution participation is needed. Institutional factorsappear to be more important than pt demographics. To promote equitable pt benefit, prospective studies should be conducted to understand barriers and incentives to participation in pharmacogenomic research at the patient, clinician and institutional levels.

E08 - A pilot study of simultaneous care in oncologic patients

Background: Some breast cancer patients (pts) refused treatment despite their providers’ recommendations. Treatment refusals can be detrimental to these pts’ short- and long-term health outcomes. Limited research has investigated the national trends in treatment refusals and their impacts on the survival of breast cancer pts. Methods: We analyzed data collected from breast cancer pts in the 2004-2020 National Cancer Database (NCDB). Four treatment modalities were assessed: chemotherapy (CT), hormone therapy (HT), radiotherapy (RT), and surgery. The CT cohort included stage I-IV pts. The HT cohort included stage I-IV, hormone receptor-positive pts. The RT or surgery cohort was limited to only stage I-III pts. Refusal status was categorized as “yes/no,” and its correlates were assessed using multivariable logistic regression. Estimated rates of overall survival (OS) were calculated using the Kaplan-Meier method. The association between refusal status and OS was examined using log-rank tests, followed by multivariable Cox regression models. Results: In the CT cohort, 9.6% of 1,296,488 pts who were offered the treatment refused. In the RT cohort, 6.1% of 1,635,916 pts refused. In the HT cohort, 5.0% of 1,893,339 pts refused. In the surgery cohort, only 0.6% of 2,590,963 pts refused. Significant increasing trends in treatment refusals from 2004-2020 across the four treatment modalities were observed (all p-trends < .001). We found significant differences in age, race, AJCC stage group, molecular subtype, tumor grade, and care access indicators (e.g., insurance, median household income, facility type, and rural/urban area) by refusal status. Black pts were more likely than White pts to refuse surgery (adjusted odds ratio [AOR] 2.01, 95% CI: 1.89-2.14). Asian or Pacific Islander pts were also more likely to refuse surgery (AOR 1.29, 95% CI: 1.15-1.44) and CT (AOR 1.21, 95% CI: 1.16-1.27). Uninsured pts were more likely than privately insured pts to refuse surgery (AOR 4.83, 95% CI: 4.22-5.51), RT (AOR 1.97, 95% CI: 1.83-2.12), CT (AOR 1.61, 95% CI: 1.51-1.72), and HT (AOR 1.61, 95% CI: 1.49-1.73). Compared with pts who did not refuse treatment, those who refused had lower rates of 5-year OS in the cohorts of HT (81.4% vs. 88.4%), CT (74.9% vs. 84.4%), RT (74.4% vs. 90.8%), and surgery (42.0% vs. 88.1%). When stratified by stage, similar patterns of 5-year OS rates were observed across all cohorts. After adjusting for sociodemographic and clinicopathologic factors, pts who refused surgeries had a higher mortality risk than those who did not (aHR 2.91, 95% CI: 2.82-3.01). Pts who refused RT had a higher risk of dying than those who did not (aHR 1.97, 95% CI: 1.93-2.01). Pts who refused CT had a greater risk of dying than those who did not (aHR 1.86, 95% CI: 1.83-1.90). Pts who refused HT had a greater risk of death than those who did not (aHR 1.56, 95% CI: 1.53-1.59). Black pts had higher mortality risk than their White counterparts across all cohorts (HT: aHR 1.15, 95% CI: 1.13-1.17; CT: aHR 1.14, 95% CI: 1.12-1.16; RT: aHR 1.11, 95% CI: 1.1.09-1.14; surgery: aHR 1.10, 95% CI: 1.08-1.11). Conclusions: In this sample of breast cancer pts, the rate of treatment refusal was highest for CT and lowest for surgery, and there were significantly increased trends in refusals over time. Age, race, stage, molecular subtype, tumor grade, and care access measures were independently associated with treatment refusals, suggesting that differential refusals not only are affected by biological factors but also may reflect disparities in socioeconomic status. Furthermore, pts who refused treatment experienced worse OS, regardless of treatment modality. These findings suggest that stressing the importance of recommended treatment and interventions tailored for this patient population may be needed to improve their survival outcomes. Citation Format: Jincong Freeman, James Li, Susan Fisher, Katharine Yao, Sean David, Dezheng Huo. Prevalence of Refusal of Recommended Cancer Treatments and Survival Differences in Breast Cancer Patients: Analysis of the National Cancer Database [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS18-02.

IntroductionRemaining physically active is important to patients undertaking dialysis, however, clinical recommendations regarding exercise type, timing, intensity, and safety precautions vary. The purpose of this scoping review was to analyse and summarise recommendations for physical activity and exercise for people undertaking dialysis and identify areas that require further research or clarification.Materials and methodsA scoping review of literature from five bibliographic databases (Medline, Scopus, Web of Science, CINAHL, and SPORTDiscus) was conducted. Eligible articles included consensus guidelines, position statements, reviews, or clinical practice guidelines that included specific physical activity and exercise recommendations for people undertaking dialysis. Key search terms included "kidney disease" OR "kidney failure" OR "chronic kidney disease" OR "end stage kidney disease" AND guideline* OR consensus OR "position statement" OR prescription OR statement AND exercise OR "physical activity". Hand searching for relevant articles in all first twenty quartile 1 journals listed on SCImago under ‘medicine—nephrology’ and ‘physical therapy, sports therapy and rehabilitation’ using the terms ‘exercise and dialysis’ was undertaken. Finally, home pages of key societies and professional organisations in the field of sports medicine and nephrology were searched.ResultsThe systematic search strategy identified 19 articles met the inclusion criteria. Two were specific to pediatric dialysis and three to peritoneal dialysis. Whilst many publications provided recommendations on aerobic exercise, progressive resistance training and flexibility, few provided explicit guidance. Recommendations for the intensity, duration and frequency of aerobic and resistance training varied. Discrepancies or gaps in guidance about precautions, contraindications, termination criteria, progression, and access site precautions were also apparent.ConclusionFuture guidelines should include specific guidance regarding physical activity, safety precautions, and timing and intensity of exercise for individuals who undertake dialysis. Collaborative multidisciplinary guideline development and appropriate exercise counselling may lead to increased participation in physical activity and exercise and facilitate better patient outcomes.

Pregnancy and Exercise Guidelines

Objective: To identify patterns of physical activity (PA) participation, exercise preference, and barriers of stage 2–3 prostate cancer survivors across cancer trajectories based on selected demographic and medical variables. Design: The current study is a descriptive cross-sectional study which included data from a total of 111 prostate cancer survivors, at Shinchon Severance Hospital, Seoul, Korea. The survey includes PA levels before and after prostate cancer diagnosis, exercise barriers, and preferences. Results: Moderate- to vigorous-intensity PA levels were significantly lower after cancer diagnosis (vigorous PA:41.9 ± 123.1 min/week vs. 4.6 ± 29.8 min/week, p < 0.001; moderate PA: 159.9 ± 240.0 min/week vs. 56.8 ± 129.7 min/week, p < .001) compared to their PA level before cancer diagnosis. Perceived exercise barriers were distinctly different according to participants’ age and time since surgery. The two most prevalent exercise barriers among prostate cancer survivors <65 years were lack of time (28.6%) and poor health (26.5%), whereas the exercise barriers for prostate cancer survivors aged ≥65 years were lack of exercise facilities (21.4%) and lack of exercise information (17.9%). Furthermore, within 6 months after surgery, prostate cancer survivors perceived poor health (29.5%) and pain at the surgery site (29.5%) to be the two most prevalent exercise barriers. 6 months after surgery, prostate cancer survivors perceived lack of time (21.3%) and poor health (14.8%) to be the two most prevalent exercise barriers. Walking, pelvic floor and Kegel exercises were three most preferred exercises among prostate cancer survivors in our study, which uniquely differ according to time since surgery. Conclusion: This study showed significant reduction in PA levels among prostate cancer survivors and their perceived exercise barriers were distinct according to their age and time since surgery. Therefore, PA and exercise recommendation should be specific to their personal characteristics such as age and time since surgery.

Diabetes is a major public health problem that affects certain ethnicities disproportionately. Physical activity (PA) (exercise) is a key component necessary for the prevention and treatment of type 2 diabetes. Adults with and without diabetes may face challenges that interfere with following exercise recommendations. This article reviews the relationships among PA, race/ethnicity, behaviors, and health outcomes of adults with prediabetes and type 2 diabetes. The authors review recent cross-sectional and intervention studies and assess their relevance to clinical practice. This is a focused review of the literature from January 2010 to September 2012 on the relationship among PA, type 2 diabetes, and race/ ethnicity with respect to the following components: (1) PA and the likelihood of persons with prediabetes developing diabetes; (2) PA and improvements in health outcomes of persons with prediabetes; (3) PA and improvements in health outcomes of persons with type 2 diabetes; and (4) enablers of and barriers to PA for persons with type 2 diabetes. The initiation of effective PA programs designed to reduce the incidence of type 2 diabetes or improve diabetes outcomes rely on a critical interpretation of current research findings.

which unique insights can be gained from the investigations of the physiology of the growing child? Are there pragmatic outcomes to research in children's exercise science that bear specific utility to this age group or to their future life? What importance do exercise responses in youth bear to our

Fit to Deliver was written by three health or fitness professionals—a physician, a physiotherapist, and an exercise physiologist—who set out to produce a “benchmark health and fitness resource for pregnant and postpartum women.” Their goal was to create a programme that could be used by any woman, regardless of her fitness level. The authors state that this book relies on the latest scientific research as well as on the practical knowledge of health and fitness professionals who work with women throughout their pregnancies. This book was first published in 2000, and this second edition catches the eye with its attractive cover and many illustrations and photographs. More detailed information is offered in this edition, including a section of selected references and resources that was lacking from the first edition. However, I was often left wondering if statements made in the book were factual or merely based on clinical or practical knowledge, as there is little use of reference citations. The index at the back of the book is an asset. The authors encourage reading the first two chapters of this easy-to-read book before beginning the actual programme so that the reader is aware of safety concerns and fitness guidelines. The book aims to guide the reader through a fitness programme from start to finish. It would be best to read it in its entirety in order to benefit from all that it has to offer. Fit to Deliver attempts to tailor the exercises presented for each trimester of pregnancy and for beginning, intermediate, and advanced fitness levels. The authors frequently remind readers that the exercises “are not exhaustive and you may add others based on your experience or on the advice of your healthcare or fitness professional.” I liked the vast number of photographs depicting many of the exercises, including position variations. The “tips from the team” that are highlighted in boxes found on select pages are also beneficial and attention getting. One chapter is designated solely for the “core,” with many photographs and descriptions of the abdominal and pelvic floor muscles and exercise variations. Included in this section is information on postural changes, the body mechanics of lifting, and getting down to and up from the floor. Even if the reader read no further than this chapter, she would definitely learn some important information and exercise suggestions. Subsequent chapters provide information about how and why to train, introducing program participants to a number of approaches for warm-up, stretching, strengthening, and balance exercises. Although I liked the variety of photographs in this chapter, I found the section on strength or resistance training somewhat confusing. In the sample workout section, I had difficulty locating the trimester and fitness level at a quick glance. For some, this may be a bit daunting—another reason to read the book in its entirety first. At the end of the book are chapters and appendices on relaxation, postpartum exercise guidelines, nutrition, and preconception exercise guidelines. These provide some extra information or guideline considerations for those interested in these topics. Fit to Deliver is intended for all healthy pregnant or postpartum women and includes fitness guidelines and suggestions at beginner, intermediate, and advanced fitness levels. The book may be useful for physiotherapists who work with pregnant women and especially for health care professionals who are uncertain as to what type of information or guidelines to provide for their pregnant or postpartum clients. For some women, the exercise recommendations in this book may be too advanced. Those who already have sound knowledge of fitness training will benefit most from this informative book.

Although trends in health behaviour generally develop positively, problems of overweight have increased in adults and lack of exercise remains common according to a national annual survey in Finland [1]. In 2009, only 12% of males and 11% of females performed exercise as recommended. The current recommendations state that adults should engage in 2 hours and 30 minutes a week moderate-intensity, or 1 hour and 15 minutes a week vigorous-intensity aerobic physical exercise. The exercise should also include muscle-strengthening activities at least twice a week. The amount of exercise performed decreases with age and those aged below 25 years complied with the exercise recommendations most often and those aged over 54 years least often [1]. As a consequence, obesity is increasing and in 2009 58% of men and 42% of women aged from 15 to 64 were overweight (body mass index BMI ≥ 25). Excessive weight causes elevated cardiovascular risk, orthopaedic problems, and psychosocial consequences. Cardiovascular risk is associated with psychological distress [2], which may further challenge efforts to modify the risk through increased exercise. These facts show a compelling need for more effective lifestyle management and promotion of exercise in communities and in primary care. Physical activity prescriptions (PAP) programmes are widely recommended in primary care. The problem is, however, often that many participants do not complete these programmes [3]. It is difficult to achieve and maintain changes in modifiable lifestyle factors, and this is also true of patients who have already experienced cardiovascular disease [4]. So how should we tackle the physical inactivity problem in primary care? More attention should be paid to the exercise habits of children. The inactivity epidemic and obesity are constantly growing also in the youth. It is estimated that 25% of young people perform very little physical activity. A passive lifestyle has effects at all socioeconomic levels. In Finland, a statute from 2009 becomes obligatory in 2011 and guarantees more resources for child and youth preventive health services. Better resources allow new targets, and the physical activity of young people and families needs more attention. Cooperation with schools is fruitful: school-based multi-component action is effective in increasing physical activity and reducing weight [5]. Middle-aged men have become a target for health promotion and counselling in Finland, and also because it is believed that their lifestyle habits transfer to the next generation. Most often the health promotion consists of a health examination session by a public health nurse; however, multi-level approaches might be more successful. Currently, strategies that include cooperation with physical education services and with the target of increasing physical activity are being tested. Exercise specialists may counsel the men in a health centre. Experiments with group exercise interventions are also being carried out. Primary care has a unique opportunity to enhance physical activity in the community. General practitioners (GPs) are experienced in cardiovascular preventive consultations. Patients report cognitive and emotional effects and healthy lifestyle changes after these consultations [6]. Brief advice by motivated GPs is effective in increasing physical activity in inactive adults [7]. Still more holistic approaches are possible. We need to design interventions where efficacy is maximized by using synergistic strategies: knowledge management, social marketing, and partnerships with other professionals in communities. Close cooperation of the health care and sport sectors is essential. Physical activity should be fun, moderate, and cumulative. With the aid of the school system, public sports facilities, and physical education professionals in communities, low-threshold opportunities for physical activity can be offered to all.

Physical exercise recommendations become particularly effective when embedded into medical rehabilitation. However, little is known about long-term behaviour maintenance and its effect on sickness absence and subjective employability. The current longitudinal observational study investigated self-reported physical exercise, sickness absence and subjective employability over a period of 8 years. A total of 601 (T0) outpatients (mean age 45.14 years; standard deviation 10.73 years, age range 18-65 years) with different orthopaedic disorders were recruited during their 3-week medical rehabilitation in Germany. Of these, 61.7% (n = 371) were female. Follow-ups were carried out at 6 months (T1, n = 495), 12 months (T2, n = 340), 3 years (T3, n = 296) and 8 years (T4, n = 142) after baseline. Patient characteristics, exercise status, social-cognitive variables, sickness absence and subjective employability were obtained via self-report questionnaires. SPSS hierarchical regression models were used for data analysis, controlling for baseline measures and sociodemographic variables. Physical exercise status 6 months after rehabilitation treatment (T1) predicted sickness absence at 12 months (T2). Inactive people were 3.28 times more likely to be on sick leave at T2. In addition, physical exercise at T1 predicted subjective employability 12 months (T2) and 3 years (T3) later. Those who met the recommendations to be physically active for at least 40 min a week were more likely to feel able to work. Exercise appears to play an important role in reducing sickness absence and subjective employability and should be promoted within and after rehabilitation treatment.

The AI paradox in exercise recommendation INTRODUCTIONRegular physical activity is a cornerstone for maintaining and promoting physical and mental health and for preventing and managing numerous non-communicable diseases (e.g., cardiovascular disease, type 2 diabetes, certain cancers, and mental health disorders), a consensus widely advocated by the global health community [1, 2].Personalized exercise prescription, defined as a guidance plan tailored to an individual's health status, fitness level, preferences, goals, and life context, is considered a key strategy to maximize benefits, enhance adherence, and ensure safety [3].However, despite its undisputed value, access to high-quality, personalized exercise guidance from qualified professionals (e.g., physicians, physical therapists, certified personal trainers) remains challenging for the public, particularly for those in resource-limited settings or facing economic constraints [4].In recent years, the rapid advancement of artificial intelligence technologies, epitomized by Large Language Models (LLMs) (e.g., those based on the seminal Transformer architecture [5]) for which GPT is a notable example, has presented an unprecedented

1818MO Can thromboprophylaxis build a link for cancer patients undergoing surgical and/or chemotherapy treatment? Intermediate results from the MeTHOS study

1640P Impact of COVID-19 vaccination campaign on psychological status in cancer patients (pts)

Sedentary lifestyle is one of the major risk factors for cardiovascular disease (CVD). In India, a large percentage of the people are physically inactive with fewer than 10% engaging in recreational physical activity. Physical activity has many beneficial effects on the risk factors for CVD. Apart from improving fitness level, it decreases myocardial oxygen demand and improves myocardial perfusion. There is an inverse association between physical activity and all-cause mortality. In primary prevention, physical inactivity is associated with a two-fold increase in the risk for coronary events. In secondary prevention, data confirm the existence of an inverse dose–response relationship between cardiovascular fitness and the all-cause mortality in large populations of cardiovascular patients. Guidelines from the American authorities as well as the European Society of Cardiology provide specific recommendations for exercise depending on the clinical setting (primary or secondary prevention of CVD) and the patient-specific factors (the patient's physical activity level and the perceived CVD risk). The present review summarizes the clinical evidence regarding the role of exercise in CVD prevention and the exercise recommendations from the leading Cardiac societies.