Effectiveness of psychosocial interventions in improving the quality of life for adult patients with cancer in low- and middle-income countries (LMICs): a systematic review and meta-analysis

Introduction Psychosocial care improves the quality of life (QoL) for cancer patients and their families. A growing body of randomized controlled trials (RCTs) and quasi experimental studies have been published and systematic reviews have been done on psychosocial interventions in cancer care in the recent past, in the low-and-middle income countries (LMICs). However, a quantitative assessment of the effectiveness of psychosocial interventions in cancer care for adults living with cancer in LMICs is missing. This study aimed at synthesizing the available evidence on the effectiveness of psychosocial care interventions towards the improvement of the quality of life of adult patients with cancer in LMICs. Methods We registered the protocol of this study with PROSPERO (ID: CRD4202342156) before conducting this systematic review and meta-analysis of original studies on psychosocial care interventions in cancer care for adults with cancer in LMICs. Studies published between 1st January 2002 and 31st December 2023 in any LMIC, were searched from various electronic databases which included Ovid MEDLINE (PubMed), Web of Science, EmBASE, APA PsycINFO, and Google Scholar. We followed the standard guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) standards. Results Twenty-six RCTs and quasi experimental studies (with 3,878 participants, 1,955 in study arm and 1,923 in control arm) were included in this systematic review and meta-analysis. Sixty-nine percent (n=18) of the included studies were RCTs. The study sizes ranged between 24 and 2140 participants. Most of the included studies (46%) were published between 2016 and 2019. Of the five WHO regions, the Eastern Mediterranean region had the highest number (62%, 18) of the included studies and Africa region has only three studies (1 from Ethiopia and 2 from Nigeria) in this meta-analysis. The biggest number of psychosocial care interventions utilised by the included studies belonged to the Cognitive Behavioural therapy (CBT) (38%, n=10 studies) followed by Mindfulness-based therapy (MBT) with 31% (n=8) with Family systems therapy trailing with 4% (n=1). From the subgroup analyses of the means and standard deviations of domains of quality of life in the pooled primary studies, the respective standardized mean differences (SMD) indicated that the psychosocial care intervention had a significant positive effect on the physical (0.972: p= 0.002), social (0.884: p=0.005) and psychological (0.590: p= 0.03) domains of quality of life of adult patients with cancer. However, the negative SMD for depression (-1.612: p=0.007) and anxiety (-3.313: p= <0.001) domains indicates that the psychosocial care interventions in the primary studies for these domains did not improve the quality of life of study participants. The CBT-related psychosocial care interventions significantly improved in the QoL of adult patients with cancer compared to the interventions that belonged to other models. Conclusion On the overall, psychosocial care interventions effectively improved most domains of the QoL of adult patients with cancer. Future research is needed for those interventions whose findings had negative effect on some domains of the QoL of patients with cancer.

Objective: The objective of the study was to determine the demographic factors affecting Quality Of Life (QOL) of hemodialysis (HD) patients.Methods: This observational study was conducted at Shalamar Hospital, Lahore. Patients of End Stage Renal Disease (ESRD) and on maintenance HD for more than three months were included during the period March to June 2012. Patient of ESRD not on dialysis and Acute Renal Failure were excluded. One hundred and twenty five patients who fulfilled the criteria were included. Demographic data containing age, sex, residence, socio economic status, education, mode of traveling for dialysis, total time consumed in dialysis were collected by the investigators. QOL index was measured using 26 items, WHO QOL BREF.Results: There were 89(71.2%) male and 36(28.8%) female patients. Environmental domain score was highest (p=0.000) than all other domains in HD Patients. In overall analysis age, marital status and total time consumed in getting HD effect QOL significantly (p=<0.05). In domain wise analysis, male has better QOL in social relationship domain than female. Age has negative relationship with physical health and psychological health domain. QOL of unmarried and literate patients is significantly better (p=<0.05) in physical health domain. Employed patients have better QOL in physical, psychological and social relationship domain (p=<0.05) than unemployed patients. Patients of residence of rural areas have better QOL in physical and environment domain. Financial status of HD patients affect QOL in social domain. Distance covered to reach hospital effect QOL in psychological domain (p=<0.05). Patients traveling in private transport have better QOL in environmental domain (p=<0.05). Total time consumed in getting HD effect social relation in QOL (p=<0.05). According to linear regression model, marital status is positive predictor and unemployment is negative predictor of QOL in physical health domain. Age is negative predictor of QOL in psychological domain, monthly income is positive predictor of QOL in domain. Unemployment is positive predictor of QOL in social relation domain. Monthly income and place of residence is positive predictor of QOL in environment domain.Conclusion: Gender, age, marital status, unemployment, residence of rural area, economical status, distance covered to reach hospital, mode of transport, total time consumed in getting HD, effect QOL in HD patient. Education level is a positive factor for improving QOL of HD patients.

Introduction: the nutritional status of cancer patients should be screened regularly due to their high risk of malnutrition, which impairs patient quality of life (QoL). Therefore, an assessment of nutritional status is strongly necessary. Recently, the Global Leadership Initiative on Malnutrition (GLIM) criteria for assessing the severity of malnutrition were published (2019). Objectives: the primary aim of this study was the assessment of nutritional status and QoL in advanced cancer patients. A secondary aim was to investigate the impact of malnutrition severity on QoL in these patients. Methods: this study included 33 advanced cancer patients (head/neck, esophageal, gastric) from the Nutritional Counselling Centre Copernicus in Gdansk, and the Department of Surgical Oncology, Medical University of Gdansk, Poland. The assessment of nutritional status was conducted with the 2019 GLIM criteria and the Subjective Global Assessment (SGA) method. QoL was assessed using the World Health Organization Quality of Life-BREF questionnaire (WHOQOL-BREF). Results: according to the SGA method, most of the patients were malnourished (42.42 %) or severely malnourished (42.42 %). Based on the GLIM criteria, 69.7 % of patients (n = 23) were severely malnourished. Among all participants, the highest impairments of QoL were observed in the environmental and psychological domains of the self-assessed satisfaction with own health questionnaire. Severe malnutrition significantly impairs QoL in the psychological (GLIM stage 2, p = 0.0033; SGA C, p = 0.0310) and somatic domains (GLIM stage 2, p = 0.0423). Conclusions: most patients with advanced cancer are malnourished or severely malnourished. Overall, the QoL of these patients is impaired. The severity of malnutrition has an impact on the QoL of cancer patients, which is observed as an impairment of mainly psychological and somatic aspects. This is the first study assessing the impact of malnutrition severity, as based on the new 2019 GLIM criteria, on the QoL of advanced cancer patients.

Review objective The objective of this review is to synthesize the best available evidence on the effectiveness of psychological and psychosocial interventions on quality of life (QoL) of patients with schizophrenia and related disorders. Review questions In patients with schizophrenia and related disorders: what is the effect of a psychological intervention as compared to usual care on QoL? what is the effect of a psychological intervention as compared to another psychological or psychosocial intervention on QoL? what is the effect of a psychosocial intervention as compared to usual care on QoL? what is the effect of a psychosocial intervention as compared to another psychosocial intervention or psychological intervention on QoL? Inclusion criteria Types of participants This review will consider studies that include patients with schizophrenia or related disorders (schizotypal and delusional disorders) in all stages of their illness and in all treatment settings. We will include studies where the majority of participants are adults (18 years or over) and were the majority of participants have a diagnosis of schizophrenia or a related disorder (schizotypal disorder, persistent delusional disorder, F20-F22; schizoaffective disorder, F-25) based on International Statistical Classification of Diseased and related health Problems 10 th Revision (ICD-10). Types of interventions This review will consider studies that evaluate psychological or psychosocial interventions. Included interventions will be family interventions, psychoeducation / patient education, cognitive-behavioral therapy, cognitive remediation, social skills training, and supported employment / vocational rehabilitation. These interventions are most often recommended in practice guidelines for the treatment of patients with schizophrenia 16,17,18,19 . The format of the intervention may be individual or group-based. The providers of interventions may include nurses, physicians, psychologists, social workers or other allied health providers. The control comparison will be any other psychological or psychosocial intervention or standard care (also called “treatment as usual”) defined as the care a person would normally receive if they would not been included in the research. Standard care includes any appropriate mental health care as deemed necessary by the clinician without program of the types described above. Types of outcomes This review will consider studies that include QoL as an outcome measure. Studies will be reviewed for evidence of standardized valid and reliable tools measuring subjective QoL, such as the Quality of Life Scale, the World Health Organization Quality of Life, the Lehmans Quality of Life Interview or the Manchester Short Assessment of Quality of Life.

IntroductionHybrid comprehensive telerehabilitation (HCTR) consisting of telecare (with psychological telesupport), telerehabilitation and remote monitoring of implantable devices might be an innovative option improving heart failure (HF) patients’ quality of life (QoL) and emotional health. The aim of the study was to investigate the influence of HCTR on various facets of QoL in HF patients in comparison with usual care (UC) alone.Material and methodsThe present analysis formed part of a multicenter, randomized trial that enrolled 850 HF patients (NYHA I–III, LVEF ≤ 40%). Patients were randomized 1 : 1 to HCTR plus UC or UC only. Patients underwent either an HCTR program or UC with observation. The psychological intervention in the HCTR group included supportive psychological counseling via mobile phone. The Medical Outcome Survey Short Form 36 Questionnaire was used to assess QoL. Measurements were made before and after a 9-week intervention (HCTR group)/observation (UC group).ResultsAfter the intervention, the HCTR group showed significant improvement in overall QoL, physical domain (PD) of QoL, and 4 areas of QoL (physical functioning (PhF), role functioning related to physical state (RF), general health (GH), vitality (VI)). A significant positive change in QoL in the UC group was observed only in VI and social functioning. There were also significant differences in QoL after 9-week intervention/observation between the two groups. The results showed greater improvement in HCTR for overall QoL (p = 0.009), PD of QoL (p = 0.0003) and three specific areas of QoL: PhF (p = 0.001), RF (p = 0.003), bodily pain (BP) (p = 0.015).ConclusionsIn comparison to UC, HCTR resulted in improvement in overall QoL, PD of QoL and 3 specific areas of QoL: PhF, RF and BP.

Maternal health outcomes associated with ambient air pollution: An umbrella review of systematic reviews and meta-analyses

Background:Managing the symptoms of cancer patients is challenging for health care providers and interventions individually designed are required to improve the quality of life (QOL) of cancer patients. Objective:to assess the efficacy of symptom management intervention on symptom reduction and the QOL of cancer patients. Methods:A Quasi-experimental study using pre and post-test design was conducted among 200 cancer patients selected by a convenient sampling technique from the selected cancer hospitals. The intervention group received symptom management intervention and the control group received routine clinical care. The data were collected from individuals who had been diagnosed with breast/head and neck cancer and were in the third or fourth stages of cancer, using symptom assessment and Functional Assessment of Cancer Therapy (FACT) QOL tool. After the pre-test, symptom management intervention was provided, and a post-test was conducted at one month and three months after the intervention. Results:The mean age was 50.93 years among the participants. Fifty-two percent and 68% of them were in stage IV cancer in the intervention group and control group respectively. The mean QOL score of head and Neck cancers in the intervention group increased from 20.76 (1.82) to 97.03 (3.33) and the mean scores of QOL of breast cancer patients in the intervention group increased from 22.44 (2.92) to 94.39 (8.30). Repeated measure ANOVA showed that the intervention program was effective in enhancing symptom reduction and QOL among cancer patients (Head and Neck cancers F(1.3, 114) =391.62, p< 0.001 and Breast cancer F (1, 75) =177.41.41, p=.001). Conclusion:Nurses play a vital role in providing care to cancer patients and improving their quality of life since nurses are more involved in care.

Aim: To determine the relationship between effective communication and the Quality of Life (QoL) of cancer patients through conducting a Meta-analysis (MA) to quantify and summarize the evidence and present the results of our local findings in the National Center for Cancer Care &amp; Research (NCCCR) of HMC in Qatar. Methods: MA was conducted via searching four online databases including PubMed, Medline, EMBASE and Psych info electronic and grey literature database, ProQuest dissertations. The MA encompassed published cross-sectional, longitudinal studies and a postgraduate PhD dissertation, that investigated the communication among cancer patients on one hand, and health care professionals (HCPs) and health caregivers (HCGs), and their impact in the QoL, on the other hand. Out of 20,796 hits, 204 full-text articles were assessed for eligibility. The final eligible studies were 19 articles that satisfied the inclusion criteria (18 published papers and one PhD dissertation). The quality of encompassed studies was calculated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Comprehensive (CMA) software version 2 was used to perform the MA. The pooled effect size was calculated using the random effect and ANOVAs were performed for moderation analyses for categorical moderators and meta regression analysis for continuous moderators. In addition, publications bias analysis was also performed. The Cochrane software “Review Manager v5.3” was employed to examine the quality of the included studies. Patient perception of physician’s communication skills was compared with the perception of physicians using the American Board of Internal Medicine (ABIM) communication assessment tool and QoL of cancer patients was assessed via FACTG questionnaire. Correlation coefficients of perception of patients were carried out using positive correlation analysis via SPSS V.26. Results: Communication had a significant positive impact on the QoL of cancer patients and a significant association and moderation was observed for the mental component summary (MCS). Furthermore, a significant positive impact of involving Health Caregivers (HCGs) in communication on the QoL of cancer patients was also found. Covariate analysis indicated a true variation in effect sizes between studies and confirmed the existence of inconsistencies among different studies due to the diverse definitions and assessment tools used to measure the outcomes. The heterogeneity assessment offered explanation where possible to the consistencies and diversities between studies. Clinical and design heterogeneities were observed and reported. Our local pilot study in Qatar suggested a significant positive correlation between QoL and patients perception of physicians’ communication skills, r = 0.222, P=0.3. Moreover, our pilot study suggests a significant discrepancy between the patients perceptions &amp; HCP perceptions, of the different communication skills set (Interpersonal, Content, Total Communication Skills). The patients reporting a lower perception 57% vs 86% total communication skills p=0.0028, 58% vs 88% for IP communication skills p=0.0003, and 55% vs 84% for content communication skills p=0.0042. Conclusion: This MA covered a gap that existed in the literature among published systematic reviews and meta-analyses. It confirmed a significant correlation between communication and QoL of cancer patients irrespective of cancer type, age group, culture, gender, prognosis, or year of study. These results were global, transcontinental, and transcultural. It clearly highlighted the significant need to communicate with cancer patients and how much its benefits improve their QoL, as well as medical services. The results can be used to inform policy makers and health practitioners. Future Interventions should take into account these results to improve the communication between health practitioners and cancer patients and the involvement of families in the communication process. The health care system should consider communication as a vital component of providing a holistic patient and family centered care. The umbrella of QoL, provides a clear picture about patients and their families’ conditions and dictates that their communication needs are addressed as part of a standard of care. Furthermore, communication with its wide list of components should undergo a crucial level of studying, researching, critiquing and standardization, so that patients’ right to access a high standard of care is guaranteed across all health care systems. Our local results in Qatar resonate with this MA and raise the attention needed to clinical communication practice.

Cancer often causes long-term physical and psychological impairments. Lifestyle modification and nature-based interventions (NBIs) can have a positive impact on patients' quality of life (QOL). This participants-blinded, non-randomized controlled study assessed parameters at weeks 0, 12, and 24, including, as a primary endpoint, QOL in cancer patients on the Functional Assessment of Cancer Therapy-General (FACT-G) at week 12. QOL in breast cancer patients, fatigue, well-being, stress, anxiety/depression, socio-psychological well-being, benefits of nature interaction, insomnia, self-efficacy, mindfulness, and self-compassion were assessed as secondary endpoints. N = 107 cancer patients (96.3% women; 52.5 ± 9.3 years, 80.4% breast cancer) were assigned to either a 12-week nature-based (NDC; n = 56) or conventional (DC; n = 51) oncology day care clinic program, whereby the assignment group was not known to the participants. There was no significant group difference for the primary endpoint. At week 24, QOL, fatigue, mindfulness and self-compassion scores were significantly higher, and at weeks 12 and 24, the insomnia score was significantly lower in NDC compared to DC. In conclusion, this study indicates positive and clinically relevant effects of the program on QOL, fatigue, and psychological parameters. NBIs seem to have a more pronounced effect.

The purpose of this study was to examine the predictors of quality of life (QOL) of women with breast cancer in Taiwan. A cross-sectional study assessed the quality of life of 394 women with breast cancer. Path models were used to test the direct and indirect effects of depression, anxiety, sleep quality and demographic factors on the four QOL domains. Mean age of the participants was 53.53 ± 7.82 years. The results of the path analysis showed that depression was the key predictor with direct effects on all four QOL domains from -0.248 to -0.580. Sleep quality was found to have direct effects from -0.171 to -0.278 on three QOL domains. Anxiety predicted the physical QOL directly (-0.249). Anxiety also indirectly predicted the physical and psychological QOLs through sleep quality (-0.088 and -0.054), respectively. As for the demographic factors, age had a negative direct effect (-0.125) on the physical QOL domain and economic status directly predicted the environmental QOL domain (0.225). Education had slight indirect effects of 0.108 and 0.090, respectively, on the physical and psychological QOL domains. The empirically validated causal model suggested that a multidimensional approach may be needed to improve the QOL of women with breast cancer.

Background: Cancer continues to cause major morbidity and mortality in low- and middle-income countries thereby contributing to unmet palliative care services. Palliative care among cancer patients aims to improve quality of life (QoL). This study was conducted to assess the QoL of cancer patients in palliative care. Methods: Through a descriptive and cross-sectional design, 158 cancer patients in palliative care services were assessed using the World Health Organization QOL-BREF tool which is a validated and reliable tool to assess QoL. The participants were assessed in four domains of QoL, namely physical, psychological, environment health, and social relationships. We also assessed individual’s overall perception to QoL and satisfaction with their health. Results: A total of 158 patients were interviewed with a mean age of 53 years and majority were females 102 (64.6%). The results show a significant positive correlation between the overall QoL and overall satisfaction and the scores of the physical and psychological domains, with r &gt; 0.4 ( P &lt; 0.001). Higher education ( P &lt; 0.05), being on palliative chemotherapy ( P &lt; 0.05) and longer duration of cancer ( P &lt; 0.05) were associated with better QoL. Morphine was found to be a significant negative predictor affecting both the physical domain (β = −9.24; P = 0.045) and Q1 (β = −0.53; P &lt; 0.05), but not psychological domain and overall satisfaction of health. Conclusion: Physical and psychological domains are the major determinants of overall QOL and satisfaction. The effectiveness of palliative care services in maintaining the overall QoL requires comprehensive supportive care.

Objective: To understand the changing trajectory of quality of life (QOL) during the treatment courses of breast cancer patients during chemotherapy and to investigate the factors in each treatment course that affect QOL.\nMethods: The M.D. Anderson Symptom Inventory Scale, the Hospital Anxiety and Depression Scale (HADS), and the Functional Assessment of Cancer Therapy-Breast (FACT-B) scale were used to perform a survey on 174 breast cancer patients who received the TAC (docetaxel, Adriamycin, and cyclophosphamide) chemotherapy regimen before postoperative chemotherapy and 5–7 days after each chemotherapy course.\nResults: The QOL scores of the breast cancer patients were the lowest before the postoperative chemotherapy (81.2 ± 19.6) and the highest after the second chemotherapy course (94.5 ± 14.4). After the fourth and fifth chemotherapy courses, the scores were much lower again, with values of 82.7 ± 13.9 and 82.6 ± 13.1, respectively. The scores improved again after the sixth chemotherapy course (93.9 ± 18.7). Furthermore, each treatment course had different related symptoms that affected the QOL of the patients.\nConclusions: More attention should be paid to the changing trajectory of QOL of patients in all treatment courses and to the influence of treatment-related symptoms on the QOL of patients; moreover, interventions should be adopted by medical care personnel to increase QOL in cancer patients.

Patients with head and neck cancers (HNCs) are at an increased risk of developing functional symptoms associated with eating, speaking, and breathing along with symptoms caused by a fungating tumour (e.g., cosmetic change, malodor, and bleeding). These may substantially reduce their physical functioning and quality of life (QoL). This observational study aimed to find out the QoL in patients with HNC in a tertiary care oncology centre. A prospective observational study was conducted in adult patients diagnosed with HNC. The patients were divided depending upon their disease extent into early, advanced, and very advanced local disease. The physical, cognitive, emotional, financial and social domains were assessed using a validated Hindi version of the European Organisation for Research and Treatment of cancer (EORTC)- QoL 30 and EORTC H&N 35 at baseline and 3 months. A total of 100 patients were assessed with a mean age of 49.3 ± 12.4 years. Most of the patients had carcinoma buccal mucosa (42%) followed by carcinoma tongue (17%). The patients experienced difficulties with physical functioning and deterioration in emotional functioning. Pain and fatigue were the major problematic symptoms especially in advanced disease patients resulting in poor QoL. There was a significant improvement in various domains of QoL at 3 months follow-up in those with advanced disease. The fatigue scores at baseline and follow-up showed a positive correlation with other symptoms. Patients with HNC have a high symptom burden that leads to poor QoL. Appropriate palliative care interventions help to decrease symptom burden and prevent deterioration of their QoL in patients with HNC.

Background and Aims Sleep quality and quality of life are critical aspects of health and well-being, particularly for individuals undergoing hemodialysis. Hemodialysis is a life-sustaining treatment for individuals with end-stage kidney disease (ESKD), but it can significantly impact various dimensions of their health, including sleep quality and overall quality of life. Understanding the relationship between sleep and quality of life in hemodialysis patients is essential for developing effective interventions to improve their overall well-being. Studies have shown that hemodialysis patients often experience poor sleep quality, characterized by difficulty falling asleep, frequent awakenings during the night, and early morning awakening. Moreover, sleep disturbances experienced by hemodialysis patients can also affect their ability to perform daily activities which can have a negative impact on their overall quality of life. Factors that have been shown to be associated with quality of sleep and quality of life in hemodialysis patients include age, sex, comorbidity, mode and schedule of hemodialysis, hemoglobin, phosphorus and albumin. Physicians can provide patient-centered care more effectively when they have a better grasp of the quality of life. However, the quality of life is not thoroughly studied in individuals with chronic kidney disease, particularly those undergoing hemodialysis. To address these issues, it is essential to prioritize sleep quality and quality of life in hemodialysis patients. The aims of this study were to determine the prevalence of ‘poor sleepers’ in patients undergoing hemodialysis using a validated sleep quality questionnaire and to examine the relationship between patients’ sleep quality with the quality of life using a validated kidney-disease specific quality of life questionnaire. Method This was a descriptive cross-sectional study conducted at The Medical City Ortigas from May to July 2023. The subjects recruited were adult hemodialysis patients enrolled in The Medical City Ortigas. To get a 95% confidence level, a minimum population of 80 patients should be included based on 71% prevalence from the study of Iliescu in 2003. This study evaluated a total of 85 patients through random selection. Patients excluded were those &amp;lt;18 years of age, had been on dialysis for less than 3 months, were not competent to give informed consent, and those with diagnosed sleeping disorder prior to having chronic kidney disease. Quality of sleep and quality of life were measured using validated self-administered questionnaires; the Pittsburgh Sleep Quality Index (PSQI) and the Kidney Disease Quality of Life-Short Form v1.3 (KDQOL) respectively. Results Among the respondents 67 (78.82%) were found to be poor sleepers (PSQI &amp;gt;5) with a mean global PSQI of 9.25. Age appeared to be a significant factor as the percentage of bad sleepers belong to the 46-65 and &amp;gt;65 age groups. In contrast, sex, marital status, 150 employment, hemodialysis shift, BMI, kt/V, hemodialysis type, albumin, phosphorus, and hemoglobin levels did not have significant association with quality of sleep. There is significantly a greater number of bad sleepers that have a lower functioning due to symptoms experienced (50.65 bad sleepers vs 62.85 good sleepers). Bad sleepers also have worse quality of life in domains of cognitive function (66.67 vs 55.22), sleep (56.67 vs 46.9), patient satisfaction (57.41 vs 45.27) overall health (54.44 vs 43.28) and general health (40.83 vs 32.16). Correlations between the global PSQI score and the domains of KDQOL computed via Pearson r coefficient showing an inverse correlation between PSQI and the mental (-.392) and physical (-0.320) component summaries. Conclusion Poor sleep is common in hemodialysis patients and is associated with poorer quality of life.

72 Background: Androgen deprivation therapy (ADT) is accompanied by a range of adverse effects including those of the musculoskeletal, metabolic, and cardiovascular systems, as well as compromised functioning and quality of life (QoL). Exercise has been shown to be an effective countermeasure to a number of these toxicities, although the effects of different modes or prescriptions on self-report QoL is unclear. Here we report the effects from a yearlong trial of 3 different exercise prescriptions involving aerobic, resistance, and impact loading modes on QoL in men with prostate cancer undergoing ADT. Methods: One hundred and fifty-four prostate cancer patients (43-90 yrs, BMI 28.7 ± 4.1) on ADT (Mdn 3 mths, IQR 2.0-4.0 mths) were randomized to exercise targeting the musculoskeletal system (impact loading + resistance training; ILRT, n=57) supervised for 12 months, cardiovascular and muscular systems (aerobic + resistance training; ART, n=50) supervised for 6 months followed by a 6-month home program, or delayed aerobic exercise (DelAer, n=47) receiving exercise information for 6 months followed by 6 months supervised stationary cycling exercise. Supervised exercise was undertaken twice weekly at a moderate intensity. QoL domains were assessed at baseline, 6, and 12 months using the Short Form-36 questionnaire. Results: There were no significant differences among groups in QoL domains at baseline. Following exercise there was a significant group x time interaction (p &lt; 0.05) for the domain role physical and the physical health composite score with increases at 12 months for ILRT and DelAer. There was also a significant time effect (p &lt; 0.001) for improvements in physical functioning, general health, vitality, and mental health, and also bodily pain (p = 0.037), with no between-group differences. Patients in the lowest tertile for QoL at baseline improved the most with exercise (Ptrend &lt; 0.001). Conclusions: Different exercise modes had similar effects on improving QoL in patients with prostate cancer undergoing ADT. Importantly, those with the lowest QoL derived the greatest benefits from exercise. Recommending patients on ADT to undertake exercise, regardless of mode, will help to preserve or improve quality of life. Clinical trial information: ACTRN12609000200280 .