Aktuelle Empfehlungen zu körperlicher Aktivität bei Cancer Survivors – ein narratives Review

Zusammenfassung

Krebserkrankungen sind nach Herz-Kreislauf-Erkrankungen die zweithäufigste Todesursache in Deutschland. Die Zahl der Krebsüberlebenden, sogenannten „Cancer Survivors“, nimmt aufgrund verbesserter Früherkennungsmethoden und Therapieformen stetig zu.

Allerdings ist die Gruppe der Cancer Survivors sehr heterogen und häufig von Spät- und Langzeitfolgen der Krebstherapie betroffen (u. a. Fatigue, Depressionen, Ängste). Viele dieser Nebenwirkungen können effektiv durch eine angepasste Bewegungstherapie gelindert werden. Derzeit existieren jedoch keine einheitlichen Empfehlungen zu körperlicher Aktivität, und es gibt keine standardisierte Bewegungstherapie für diese Zielgruppe.

Ziel dieses Artikels ist es, einen Überblick über die aktuellen Empfehlungen der Fachgesellschaften bei körperlicher Aktivität für Cancer Survivors zu geben und diese untereinander zu vergleichen. Einheitliche Empfehlungen, wie sie im Rahmen der aktuellen Erstellung der S3-Leitlinien „Bewegungstherapie bei onkologischen Erkrankungen“ formuliert werden, sowie strukturierte Survivorship-Programme, über die Betroffene einen Zugang zu Bewegungsangeboten erhalten, sind ein wichtiger Schritt im Rahmen der onkologischen Versorgung.

Summary

After cardiovascular diseases, cancer is the second most common cause of death in Germany. The number of cancer survivors is steadily increasing due to improved early detection methods and forms of therapy. However, the group of cancer survivors is very heterogeneous and often affected by late and long-term consequences of cancer therapy (including fatigue, depression, anxiety). Many of these side effects can be effectively alleviated by adapted exercise therapy. However, there are currently no uniform recommendations on physical activity, and there is no standardized exercise therapy for this target group. The objective of this article is to give an overview of the current recommendations of the professional societies for physical activity for cancer survivors and to compare them with each other. Uniform recommendations, as formulated in the context of the current preparation of the S3 guidelines “Exercise therapy for oncological diseases”, as well as structured survivorship programs, through which those affected gain access to exercise offers, are an important step in the context of oncological care.

Stichworte

Krebs - Survivorship - Nachsorge - körperliche Aktivität - Tertiärprävention - Empfehlungen.

Key words

cancer - survivorship - follow-up care - physical activity - tertiary prevention - recommendations.

Publication History

Received: 22 December 2022

Accepted: 08 February 2023

Article published online:
17 April 2023

• Literatur

• 1 Krebs RKI. in Deutschland für 2017/2018, 13. Ausgabe. 2021 Robert Koch Institut: Berlin
• 2 Arndt V. „Cancer survivorship“ in Deutschland – Epidemiologie und Definitionen. Forum. Das offizielle Magazin der Deutschen Krebsgesellschaft e.V. 2019; 34: 158-164
• 3 Janssen SHM, van der Graaf WTA, van der Meer DJ. et al. Adolescent and Young Adult (AYA) Cancer Survivorship Practices: An Overview. Cancers (Basel) 2021; 13: 19
• 4 Marzorati C, Riva S, Pravettoni G. Who Is a Cancer Survivor? A Systematic Review of Published Definitions. J Cancer Educ 2017; 32: 228-237
• 5 Division of Cancer Control and Population Sciences, N.C.I. Definitions. Survivorship. Zugriff am 04.10.2021; Available from: https://cancercontrol.cancer.gov/ocs/statistics
• 6 Shi Q, Smith TG, Michonski JD. et al. Symptom burden in cancer survivors 1 year after diagnosis: a report from the American Cancer Society’s Studies of Cancer Survivors. Cancer 2011; 117: 2779-2790
• 7 Harrington CB, Hansen JA, Moskowitz M. et al. It’s not over when it’s over: long-term symptoms in cancer survivors – a systematic review. Int J Psychiatry Med 2010; 40: 163-181
• 8 van Leeuwen M, Husson O, Alberti P. et al. Understanding the quality of life (QOL) issues in survivors of cancer: towards the development of an EORTC QOL cancer survivorship questionnaire. Health Qual Life Outcomes 2018; 16: 114
• 9 National Comprehensive Cancer Network. Survivorship (Version 2.2021). cited August 08, 2021; Available from: https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf
• 10 Chow EJ, Chen Y, Kremer LC. et al. Individual prediction of heart failure among childhood cancer survivors. J Clin Oncol 2015; 33: 394-402
• 11 Scott JM, Li N, Liu Q. et al. Association of Exercise With Mortality in Adult Survivors of Childhood Cancer. JAMA Oncol. 2018
• 12 Jones LW, Liu Q, Armstrong GT. et al. Exercise and risk of major cardiovascular events in adult survivors of childhood hodgkin lymphoma: a report from the childhood cancer survivor study. J Clin Oncol 2014; 32: 3643-3650
• 13 Campbell KL, Winters-Stone KM, Wiskemann J. et al. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc 2019; 51: 2375-2390
• 14 Friedenreich CM, Stone CR, Cheung WY. et al. Physical Activity and Mortality in Cancer Survivors: A Systematic Review and Meta-Analysis. JNCI Cancer Spectr 2020; 4: pkz080
• 15 Hong BS, Lee KP. A systematic review of the biological mechanisms linking physical activity and breast cancer. Phys Act Nutr 2020; 24: 25-31
• 16 Holmes MD, Chen WY, Feskanich D. Physical activity and survival after breast cancer diagnosis. JAMA 2005; 293: 2479-2486
• 17 Chen LH, Irwin MR, Olmstead R. Association of Physical Activity With Risk of Mortality Among Breast Cancer Survivors. JAMA Netw Open 2022; 5: e2242660
• 18 Devoogdt N, Van Kampen M, Geraerts I. et al. Physical activity levels after treatment for breast cancer: one-year follow-up. Breast Cancer Res Treat 2010; 123: 417-425
• 19 De Groef A, Geraerts I, Demeyer H. et al. Physical activity levels after treatment for breast cancer: Two-year follow-up. Breast 2018; 40: 23-28
• 20 Rock CL, Thomson CA, Sullivan KR. et al. American Cancer Society nutrition and physical activity guideline for cancer survivors. CA Cancer J Clin 2022; 72: 230-262
• 21 Rock CL, Thomson C, Gansler T. et al. American Cancer Society guideline for diet and physical activity for cancer prevention. CA Cancer J Clin 2020; 70: 245-271
• 22 Schmitz KH, Courneya KS, Matthews C. et al. American College of Sports, American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 2010; 42: 1409-1426
• 23 Schmitz KH, Campbell AM, Stuiver MM. et al. Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. CA Cancer J Clin 2019; 69: 468-484
• 24 Rock CL, Doyle C, Demark-Wahnefried W. et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 2012; 62: 243-274
• 25 (WCRF), W.C.R.F. and A.I.f.C.R. (AICR). Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. A summary of the Third Expert Report. 2018. Zugriff am 19.12.2022; Available from: https://www.wcrf.org/diet-activity-and-cancer/global-cancer-update-programme/
• 26 Shams-White MM, Brockton NT, Mitrou P. et al. Operationalizing the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations: A Standardized Scoring System. Nutrients. 2019 11.
• 27 Hayes SC, Newton RU, Spence RR. et al. The Exercise and Sports Science Australia position statement: Exercise medicine in cancer management. J Sci Med Sport 2019; 22: 1175-1199
• 28 Network, N.C.C. Survivorship (Version 1.2022). Zugriff am 16.12.2022; Available from: https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf
• 29 Bull FC, Al-Ansari SS, Biddle S. et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020; 54: 1451-1462
• 30 Stout NL, Santa Mina D, Lyons KD. et al. A systematic review of rehabilitation and exercise recommendations in oncology guidelines. CA Cancer J Clin 2021; 71: 149-175
• 31 Wiskemann J, Baumann F. Update: S3-Leitline Bewegungstherapie bei onkologischen Erkrankungen. Forum 2022; 37: 449-451
• 32 Salchow J, Mann J, Koch B. et al. Comprehensive assessments and related interventions to enhance the long-term outcomes of child, adolescent and young adult cancer survivors – presentation of the CARE for CAYA-Program study protocol and associated literature review. BMC Cancer 2020; 20: 16