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BACKGROUND: As treatments improve for colorectal cancer (CRC), interventions to improve quality of life and decrease long-term effects are needed. Physical activity (PA) is particularly important during cancer treatment because it may decrease treatment side effects, allow patients to more easily increase PA after treatment, and integrate with individuals’ motivation to make lifestyle changes after a cancer diagnosis. OBJECTIVES: This article aims to synthesize what is known about PA during CRC treatment. METHODS: A systematic literature search was conducted. Data were evaluated across 17 studies with a collective sample size of 1,184. Because of heterogeneity across studies, a narrative synthesis was conducted. FINDINGS: Studies included mostly college educated and married White men and women aged 50–60 years. Promising effects of PA were identified on several types of outcomes. The most common techniques to support PA included goal setting and providing instructions. The benefits of PA and how to best support PA during CRC treatment need to be better understood in future studies of racially and ethnically diverse patients with CRC.

It is not uncommon for sedentary individuals to cite leg fatigue as the primary factor for test termination during a cardiopulmonary exercise test (CPET) on a cycle ergometer. The purpose of this study was to examine the effect of 2 weeks of lower body resistance training (RT) on cardiopulmonary capacity in sedentary middle-aged females. Additionally, the impact of RT on muscle strength was evaluated. Following familiarization, 28 women (18 exercise group, 10 control group) completed a maximal CPET on a cycle ergometer to determine peak oxygen uptake and leg extensor strength assessed using isokinetic dynamometry. Participants in the exercise group performed 2 weeks (6 sessions) of lower body RT, which comprised leg press, leg curl, and leg extension exercises. A 2-way repeated-measures ANOVA was used to evaluate the difference in changes of peak oxygen uptake and peak torque (PT). Peak oxygen uptake significantly improved from 22.2 ± 4.5 mL·kg−1·min−1 to 24.3 ± 4.4 mL·kg−1·min−1 (10.8%, p < 0.05) as well as PT from 83.1 ± 25.4 Nm to 89.0 ± 29.7 Nm (6.1%, p < 0.05) in the exercise group with no change in the control group. These findings provide initial evidence that 2 weeks of lower body RT prior to a CPET may be a helpful preconditioning strategy to achieve a more accurate peak oxygen uptake during testing, enhancing tolerability to a CPET by improving lower body strength.

Objectives To examine longitudinal symptoms, mobility and function, and quality of life (QOL) in adults newly diagnosed with acute leukemia. Sample & setting 55 adults undergoing induction chemotherapy at the University of North Carolina Lineberger Comprehensive Cancer Center and the Duke Cancer Institute. Methods & variables A prospective, longitudinal study with measures of mobility and function, global physical and mental health, cancer-related fatigue, anxiety, depression, sleep disturbance, pain intensity, and leukemia-specific QOL was conducted. Data were analyzed using descriptive statistics, linear mixed modeling, and one-way analysis of variance. Results 49 adults with acute leukemia completed assessments during hospitalizations. Global mental health and pain intensity did not change significantly. Global physical health significantly improved. Fatigue, anxiety, depression, and sleep disturbance decreased significantly. QOL increased significantly. Implications for nursing The significant decrease in anxiety and fatigue during hospitalization may be attributable to understanding of the disease process, familiarity with the staff, and ability to communicate concerns.

Purpose: To investigate the use of electronic patient-reported outcomes (PROs) to assess symptoms and how they can provide opportunities to clinicians to address symptoms in a timely manner to improve clinical care. As part of a larger study to evaluate whether providing standardized symptom reports to the medical team would decrease the time to treatment of reported symptoms in hematopoietic stem-cell transplant recipients, we assessed nurses’ and providers’ perceptions of electronic symptom reporting. Methods: Semistructured interviews of RNs, MDs, NPs and PAs were conducted at an academic cancer center in the southeastern United States. Nurses’ and providers’ perceptions of electronic symptom reporting were explored. Interviews were audio-recorded, transcribed, and coded by two investigators to identify major themes. Results: Fourteen RNs and seven providers (MDs, PAs, and NPs) participated in the interviews. Three main themes emerged from the interviews: electronic symptom reporting may improve assessment and care, integrating symptom reporting into nurse workflow presents difficulties, and there are barriers for completion of surveys. Conclusion: The majority of nurses and providers believed that the inclusion of electronic symptom reporting in bone marrow transplantation inpatient units has the potential to improve care but that barriers to implementation remain.

This study examines the viability of utilizing a dynamical system model and heuristic parameter estimation algorithm to make predictions for maximum heart rate ( $$\mathrm {HR_{max}}$$ ) and maximal oxygen uptake ( $$\dot{\mathrm {V}}{\mathrm {O_{2max}}}$$ ) using data collected from a submaximal testing protocol. $$\dot{\mathrm {V}}{\mathrm {O_{2max}}}$$ is widely considered to be the best single measurement of overall fitness in humans. When a $$\dot{\mathrm {V}}{\mathrm {O_{2max}}}$$ assessment is not available, $$\mathrm {HR_{max}}$$ is often used to prescribe exercise intensities for training and rehabilitation. In the absence of maximal cardiopulmonary exercise testing (CPET), $$\mathrm {HR_{max}}$$ and $$\dot{\mathrm {V}}{\mathrm {O_{2max}}}$$ are typically estimated using traditional submaximal prediction methods with well-known limitations and inaccuracies. For this study, 12 regularly exercising healthy young adult males performed a bout of maximal CPET on a cycle ergometer to determine their true $$\mathrm {HR_{max}}$$ and $$\dot{\mathrm {V}}{\mathrm {O_{2max}}}$$ . Participants also performed a submaximal bout of exercise at varied intensities. A dynamical system model and heuristic parameter estimation algorithm were applied to the submaximal data to estimate the participants’ $$\mathrm {HR_{max}}$$ and $$\dot{\mathrm {V}}{\mathrm {O_{2max}}}$$ . The submaximal predictions were evaluated by computing the coefficient of determination $${R^2}$$ and the standard error of the estimate (SEE) through comparisons with the true maximal values for $$\mathrm {HR_{max}}$$ ( $${R^2 = 0.96}$$ , SEE = 2.4 bpm) and $$\dot{\mathrm {V}}{\mathrm {O_{2max}}}$$ ( $${R^2 = 0.93}$$ , SEE = 2.1 mL kg $$^{-1}$$ min $$^{-1}$$ ). The results from this study suggest that a dynamical system model and heuristic parameter estimation algorithm can provide accurate predictions for $$\mathrm {HR_{max}}$$ and $$\dot{\mathrm {V}}{\mathrm {O_{2max}}}$$ using data collected from a submaximal testing protocol.

Purpose: Patients undergoing a hematopoietic stem cell transplantation (HCT) have varied symptoms during their hospitalization. This study examined whether daily symptom reporting (with electronic patient-reported outcomes [PROs]) in an inpatient bone marrow transplant clinic reduced symptom burden on post-transplant days +7, +10, and +14. Methods: A prospective, single-institution1:1 pilot randomized, two-arm study recruited HCT patients. HCT inpatients (N=76) reported daily on 16 common symptoms using the PRO version of the Common Terminology for Adverse Events (PRO-CTCAE). Fisher���s exact test was used to examine differences in the proportion of patients reporting individual symptoms. Multivariable linear regression modeling was used to examine group differences in peak symptom burden, while controlling for symptom burden at baseline, age, comorbidity, and transplantation type (autologous or allogeneic). Results: HCT patients receiving the PRO intervention also experienced lower peak symptom burden (average of 16 symptoms) at days +7, +10, and +14 (10.4 vs 14.5, p =0.03). Conclusions: Daily use of electronic symptom reporting to nurses in an inpatient bone marrow transplant clinic reduced peak symptom burden and improved individual symptoms during the two weeks post-transplant. A multi-site site trial is warranted to demonstrate the generalizability, efficacy, and value of this intervention.

Introduction Despite the health benefits of physical activity for cancer survivors, nearly 60% of young adult cancer survivors (YACS) are physically inactive. Few physical activity interventions have been designed specifically for YACS. Purpose To describe the rationale and design of the IMPACT (IMproving Physical Activity after Cancer Treatment) trial, which tests the efficacy of a theory-based, mobile physical activity intervention for YACS. Methods A total of 280 physically inactive YACS (diagnosed at ages 18–39) will be randomized to a self-help control or intervention condition. All participants will receive an activity tracker and companion mobile app, cellular-enabled scale, individual videochat session, and access to a Facebook group. Intervention participants will also receive a 6-month mobile intervention based on social cognitive theory, which targets improvements in behavioral capability, self-regulation, self-efficacy, and social support, and incorporates self-regulation strategies and behavior change techniques. The program includes: behavioral lessons; adaptive goal-setting in response to individuals' changing activity patterns; tailored feedback based on objective data and self-report measures; tailored text messages; and Facebook prompts encouraging peer support. Assessments occur at baseline, 3, 6, and 12 months. The primary outcome is total physical activity min/week at 6 months (assessed via accelerometry); secondary outcomes include total physical activity at 12 months, sedentary behavior, weight, and psychosocial measures. Conclusions IMPACT uniquely focuses on physical activity in YACS using an automated tailored mHealth program. Study findings could result in a high-reach, physical activity intervention for YACS that has potential to be adopted on a larger scale and reduce cancer-related morbidity. ClinicalTrials.gov Identifier: NCT03569605.

There is limited research focused on patient reported fatigue symptom experiences in adults receiving treatment for acute leukemia. The purpose of this study was to prospectively examine fatigue in newly diagnosed adults with acute leukemia receiving induction chemotherapy. Weekly assessments captured fatigue using PROMIS measures. Data were analyzed using linear mixed modeling and adaptive regression modeling. Forty-nine adults with acute leukemia completed assessments from hospitalization through discharge. Mean age was 53 years, 18% minority, and majority had a diagnosis of AML (72%). Average length of stay was 34.8 (SD 14.0) days. Mean baseline fatigue (57.8; mean score in US population is 50 with SD 10) was not statistically significant but there were minimally important differences. Adults over 50 with acute leukemia experienced greater fatigue during hospitalization than those

Introduction. Fatigue is a distressing symptom for adults with acute leukemia, often impeding their ability to exercise. Objectives. 1) Examine effects of a 4-week mixed-modality supervised exercise program (4 times a week, twice a day) on fatigue in adults with acute leukemia undergoing induction chemotherapy. 2) Evaluate effects of exercise program on cognition, anxiety, depression, and sleep disturbance. 3) Evaluate effect of intervention on adherence to exercise. Methods. 17 adults (8 intervention, 9 control), aged 28-69 years, newly diagnosed with acute leukemia were recruited within 4 days of admission for induction treatment. Patient-reported outcomes (PROs) (fatigue, cognition, anxiety, depression, sleep disturbance, mental health, and physical health) and fitness performance-based measures (Timed Up and Go [TUG], Karnofsky Performance Status, and composite strength scoring) were assessed at baseline and at discharge. Changes in PRO and performance-based physical function measures from baseline to time of discharge were compared between groups using Wilcoxon Rank Sum tests. Results. With PROMIS (Patient-Reported Outcomes Measurement Information System) Fatigue, we found a median change in fatigue (−5.95) for the intervention group, which achieved a minimally important difference that is considered clinically relevant. Intervention group reduced their TUG performance by 1.73 seconds, whereas the control group remained fairly stable. A concerning finding was that cognition decreased for both groups during their hospitalization. 80% adherence of visits completed with a mean of 6 sessions attended per week. Conclusions. Our study provides information on the impact of exercise on symptomatology, with focus on fatigue and other psychosocial variables in acute leukemia.

Prior studies have investigated heart rate dynamics from a variety of perspectives, but are often inadequate for predicting heart rate responses across a broad range of transient exercise intensities. The aim of this study was to develop a nonlinear model to describe the heart rate response of an individual during cycling and to investigate whether heart rate is more accurately predicted by a combination of power output and cadence than by power output alone. The proposed model can account for the transient fluctuations of an individual’s heart rate while they participate in exercise that varies in intensity. The participants for this study each performed a fifty minute bout of cycling on an electric-braked cycle ergometer in the laboratory. The testing protocol for the cycling bout was designed to challenge the predictive capabilities of the model and the participants therefore abruptly changed their power outputs and cadences throughout the tests, which resulted in significant transient fluctuations in their heart rate responses. Due to the nonlinear nature of the proposed heart rate model, a heuristic algorithm was developed to perform the parameter estimation. The model predictions for heart rate matched very well with the experimental heart rate responses for each of the participants, especially when considering the challenges inherent to predicting abrupt transient behavior in the heart rate response. Model comparisons also indicated that heart rate is more accurately predicted by a combination of power output and cadence than by power output alone.

72 Background: Hepatocellular carcinoma (HCC) is a common cause of cancer-related morbidity and mortality worldwide, yet many patients with HCC never receive cancer-directed therapy, for reasons that are not well documented. In order to tailor interventions to increase access to appropriate therapy, it is critical to understand the barriers and facilitators to access to care and receipt of treatment in HCC. Methods: This study includes 10 patients with HCC, within 6 months of diagnosis, identified through either the University of North Carolina (UNC) multidisciplinary HCC clinic or the UNC Rapid Case Ascertainment (RCA) Core which identifies cancer patients through registrars at local hospitals. Recruitment is ongoing with a target of 20 patients, expected to complete in July 2018. In-depth, semi-structured interviews were conducted by two qualitative researchers. Interviews were audiotaped, transcribed verbatim, and coded independently by two coders, using a common codebook. Coding discrepancies were reconciled by consensus. Results: Most participants described that they had been incidentally diagnosed with HCC during evaluation for another health issue. Key facilitators of care were: physician knowledge about HCC; clear, honest, and timely communication regarding test results, plan of care, and prognosis; access to transportation; strong social support; and financial support through friends, family, insurance, or charity care. Barriers to care included: lack of transportation; delays in receipt of information or in scheduling appointments; or poor communication with the medical team. Conclusions: This study identifies key facilitators and barriers to accessing care for HCC in North Carolina (NC). Further investigation of a broader sample of HCC patients is warranted, and the qualitative data from this study will be used to create a survey to be administered to all patients with incident HCC in NC. Ultimately, this information will serve as the basis for tailored interventions aimed at improving access to appropriate, life-prolonging care for patients with HCC.

10038 Background: Limitations in functional status and reduced health status are common among older adults with cancer, yet occupational and physical therapy (OT/PT) remain underutilized (Pergolotti, et.al. JGO,2015). For this population, we evaluated an outpatient CAncer REhabilitation (CARE) program and compared it to usual care (UC). Methods: We recruited adults 65 years and older who had a diagnosis of cancer or recurrence within 5 years and had at least one functional limitation as measured by a geriatric assessment (GA). Participants were then randomized to OT/PT (CARE) or UC. CARE delivered individualized outpatient intervention; OT addressed functional activities, and PT strength/endurance needs. UC participants received a brochure on supportive care services. Primary outcome was functional status (Nottingham Extended Activities of Daily Living Scale [NEADL] (range 0-22)) and secondary outcomes were global Mental and Physical Health, and ability to participate in Social Roles (SR) and activities (Patient-Reported Outcomes Measurement Information System [PROMIS] (range 0-100)), for all measures, higher scores indicate better health. We used t-tests to compare groups. Results: 51 adults were randomized: median age 73 years, 55% male, 92% White, 33% with Leukemia/lymphoma, 26% Breast, 22% Colorectal, 67% in active treatment, and 37% with Stage 3 or 4. After 3 months, both groups experienced a significant decline in functional status ( p = .046; p = .005), but change in functional status (-1.5 UC, -1.1 CARE, p = .637) , physical health status (0.0 UC, 2.4 CARE, p = .121) and participation in SR (.11 in UC, 3.71 CARE, p = .088) between UC and CARE were not significant. However, change in mental health (-1.0 in UC, 3.0 CARE, p= .032) significantly different between groups. Conclusions: CARE was associated with a significant improvement in participant’s mental health status compared to a decline in UC. Results suggest CARE may influence ability to participate in social roles and activities and physical health, but further study is needed with larger sample sizes. We demonstrated that for older adults with cancer, OT/PT are promising interventions to improve mental health. Clinical trial information: NCT02306252.