Compelling scientific evidence suggests that physical activity reduces the risk of some types of cancer, mitigates symptoms and adverse events directly related to cancer and its treatment, and reduces mortality in cancer survivors.
Despite the scientific progress and the increased access to high quality information, the exercise oncology field in Brazil has not developed as in other countries. Several lines of evidence support this interpretation, including (i) the limited number of Brazilian studies determining the level of physical activity in cancer survivors or data on the knowledge and attitudes of health professionals involved in this area; (ii) the absence of Brazilian epidemiological studies in published systematic reviews and scientific positions around the world; (iii) the absence of guidelines and position stand articles from Brazilian scientific organizations and societies in oncology and physical activity areas; (iv) the low number of courses and training programs for health care in physical activity/exercise oncology; and (v) the limited number of physical activity and exercise programs for cancer survivors in Brazil.
This is particularly relevant given that cancer is the second leading cause of death in Brazil, a disease with increasing incidence that represents an important limiting factor for increasing life expectancy.
This paper aims to describe the development process and the results of the Brazilian physical activity recommendation for cancer prevention and control, an initiative of Brazilian researchers supported by scientific and health-care professional societies.
The target audience of these recommendations is health professionals, particularly those involved in the promotion of physical activity for cancer prevention and control.
The document ‘Brazilian physical activity recommendations for cancer prevention and control' was developed as part of an initiative of some Brazilian researchers and the Brazilian Society of Clinical Oncology (SBOC), with the support of the Brazilian Society of Physical Activity and Health (SBAFS) and the Brazilian National Cancer Institute (INCA). A working group was formed in August 2020, composed by nine researchers with experience in oncology, epidemiology, physical activity and evidence-based medicine. The work was completed in September 2021 when a draft version of the recommendation was presented for the societies and institutions representatives, who had the opportunity to provide feedback. The final document was approved through an informal consensus between the working group and the organization's representatives.
Three a priori decisions were made by consensus by the working group. First, the recommendations should focus on: 1) cancer prevention in the general population and 2) reduction of all-cause and cancer-specific mortality in cancer survivors. Second, the recommendations should use evidence-based approaches and tools. Third, it was agreed that the recommendations should be based on breast, prostate, colorectal and lung cancer. This decision was made considering that those are the most frequent types of cancer in Brazil,
What is the effect of physical activity (compared to non-exercise, physical inactivity or insufficient physical activity conditions) on the prevention of breast, prostate, colorectal and lung cancer in the general healthy population?
What is the effect of physical activity (compared to non-exercise, physical inactivity or insufficient physical activity conditions) on all-cause and cancer-specific mortality in breast, prostate, colorectal and lung cancer survivors?
For each PI/ECO (population, intervention/exposure, comparison and outcome) question, intensity, volume, frequency, dose-response relationship and physical activity domain were considered as important information.
A systematized, transparent and reproducible method was developed, following the recommendations of ‘appraisal of guidelines for research & evaluation' (AGREE-II).
Later, guidelines and position stands papers referring to the effect of physical activity on cancer prevention and/or reduction of all-cause and cancer-specific mortality in cancer survivors were identified. The guidelines were then graded using the AGREE-II instrument.
Guidelines and position stands papers were searched on Medical Literature Analysis and Retrieval System Online (MEDLINE, via PubMed), Embase and Latin American and Caribbean Health Sciences Literature (LILACS, via Biblioteca Virtual em Saúde) in November 2020, without publication date limit and language. Reference lists of related articles were also read for additional guidelines search. Two independent reviewers selected the guidelines.
Guidelines and position stands papers were included if they: 1) were commissioned and published by an organization whose work relates to cancer prevention or control and/or to physical activity promotion; and 2) included the effects of physical activity and/or exercise on the risk of incidence of breast, prostate, colorectal and/or lung cancer, or all-cause or cancer-specific mortality in cancer survivors as one of the primary outcomes. Guidelines and position stands papers were excluded if they: 1) used physical activity as secondary exposure or if the guideline mentioned physical activity as part of the treatment against cancer-specific complication (e.g., cancer-related fatigue); 2) focused only on pediatric population; 3) considered the effects of physical activity on cancer-related symptoms only (e.g., cancer-related fatigue, anxiety, health- related quality of life); or 4) were opinion papers, letters, or editorials.
Systematic reviews were searched on MEDLINE (via PubMed), Embase and LILACS (via BVS) from January 1st, 2016 to November 30th, 2020, using standardized search terms for cancer, physical activity and exercise (Appendix 1). The restriction in the search date was defined considering the absence of studies published since 2016 in the recent guidelines and position stands papers with the best classification in the AGREE II instrument.
Only systematic reviews that aimed to synthesize studies on the effects of physical activity on cancer prevention (in the general population) or reduction of all-cause and cause-specific mortality in breast, prostate, colorectal and lung cancer survivors as one of the primary outcomes were selected. Systematic reviews using physical activity as secondary exposure, or focused only on the pediatric population, or considered the effects of physical activity on cancer-related symptoms only (e.g., cancer-related fatigue, anxiety, health-related quality of life) were excluded.
A pre-established form was used to synthesize the evidence for each type of cancer (breast, prostate, colorectal, lung) and purpose (prevention or survival). Whenever available, observational studies from systematic reviews were also used to present information on the associations between volume, intensity and frequency of physical activity for prevention in the general population and survival in cancer survivors. In addition, the form contained fields to express scientific gaps and specific comments regarding each type of cancer studied, as well as adaptations to the Brazilian context. Based on the information from these forms, a general recommendation on the volume and intensity of physical activity was provided for prevention in the general population and for survival in cancer survivors.
The certainty of evidence was defined considering the following criteria: risk of bias; inconsistency; indirectness; imprecision; publication bias; for observational studies, magnitude of effect, dose-response gradient, and influence of confounding factors were also evaluated.
The final step was the definition of the guideline recommendations. A general recommendation on physical activity duration and intensity was provided for cancer prevention and reduction of all-cause and cancer-specific mortality in cancer survivors. To assess the strength of recommendation, the GRADE approach was used, which assesses the strength of health recommendations as high, moderate, low and very low (Appendix 2). The classification expresses the emphasis on adopting or rejecting a certain conduct, considering if the health problem is a priority, balance between harms and benefits, values and preferences, resources, equity, acceptability and feasibility.
A total of 15 guidelines and position stands papers were found, but eight were excluded. The seven guidelines included,
The physical activity guidelines advisory committee scientific reports that supported the physical activity recommendations from the United States
The search returned 1,009 articles (332 on the effects of physical activity on cancer prevention and 677 on the effects of physical activity on all-cause and cancer-specific mortality). After the exclusion of duplicates and of articles that have not met the inclusion criteria (after title and abstract screening), 44 reviews were selected for full-text screening (19 on the effects of physical activity on cancer prevention and 25 on the effects of physical activity on all-cause and cancer-specific mortality in cancer survivors). Systematic reviews with the most up-todate search strategy were listed for evaluation using the AMSTAR-2
Certainty of evidence was evaluated considering two main purposes: 1) cancer prevention, and 2) reduction of all-cause and cancer-specific mortality in cancer survivors. The certainty of evidence is summarized in
Figure 1 PRISMA flowchart for elected systematic reviews.
| Does moderate-to-vigorous physical activity reduce the risk of cancer in the general population (adults and older adults) and reduce all-cause and cancer-specific in cancer survivors? | |||
|---|---|---|---|
| Certainty of evidence | |||
| Cancer type | Risk of cancer | Risk of cancer-specific Mortality | Risk of all-cause Mortality |
| Breast | high | moderate | moderate |
| Prostate | low | moderate | low |
| Colon | high | moderate | moderate |
| Rectal | low | moderate | moderate |
| Lung | moderate | NSR | NSR |
| Is greater, compared to low amounts of physical activity associated with a reduced risk of cancer in the general population (adults and older adults) and reduce all-cause and cancer- specific mortality in breast, prostate, colon, rectal and lung cancer survivors? | |||
| Certainty of evidence | |||
| Cancer type | Risk of cancer | Risk of cancer-specific Mortality | Risk of all-cause Mortality |
| Breast | high | moderate | moderate |
| Prostate | low | low | low |
| Colon | high | moderate | moderate |
| Rectal | very low | moderate | moderate |
| Lung | moderate | NSR | NSR |
Level of evidence was based on PAGAC et al. (2018)
Level of evidence was based on WCRF/AICR Breast (2018)
Level of evidence was based on Benke et al. (2018)
Level of evidence was based on WCRF/AICR (2011)
Level of evidence was based on Wu et al. (2016)
Although the evidence of benefits for the prevention and control of certain types of cancers are low or very low, it does not mean that the practice of physical activity in these cases is contraindicated or harmful. The strength of recommendation for all cancer types studied is strong. Thus, general recommendations of physical activity for cancer prevention and control were formulated and presented for health-care professionals as a four-step guide and one golden rule format, as follows:
As a health-care professional, always encourage people at your work with or without a diagnosis of cancer to practice physical activity regularly. Engaging people in at least 150 minutes a week of moderate-intensity physical activity, or at least 75 minutes a week of vigorous-intensity physical activity, or an equivalent combination of moderate and vigorous activity, reduces the risk of developing cancer and mortality.
Every movement counts. Even when people do not reach the recommended levels of physical activity, regular physical activity reduces the risk of developing cancer and reduces cancer mortality, in addition to other health benefits.
Overall, physical activity for cancer patients is tolerable and safe, even when practiced during cancer treatment (chemotherapy, radiotherapy, hormonal therapy or others). Consider particularities of each cancer type, contraindications and possible adverse effects caused by the treatment when recommending physical activity.
When recommending physical activity, consider preferences, time availability and appropriate place to practice. The possibilities are many, from the ones we do on a daily basis such as walking, cycling, dancing, taking a walk with the pet and playing sports recreationally, to more systematic ones, such as gym classes and weight training.
The golden rule: promoting physical activity as a habit, to be incorporated into people's routine, is essential to prevent and control cancer and to overall health promotion.
There is scientific evidence that physical activity reduces the incidence and mortality of several types of cancer, as well as promotes positive effects on a broad variety of important health outcomes in individuals living with and beyond cancer. Furthermore, there is a growing need to translate scientific evidence into practice. Indeed, multiple international organizations have published recommendations for physical activity and exercise for cancer prevention for both patients living with cancer and for those who survived, including the American College of Sports Medicine (ACSM),
In response to that, we developed the Brazilian physical activity recommendations for cancer prevention and control, a document that updated and translated the most recent international scientific evidence on the exercise oncology field to support the work of Brazilian health-care professionals when recommending physical activity for cancer prevention and control. To the best of our knowledge, this is the first structured and evidence-based physical activity recommendation for cancer prevention and control published in the Global South. Thus, we consider it the first step to include Brazil into the international scenario to include physical activity and exercise standards in the oncology practice.
Cancer is the second leading cause of death in Brazil, the country with the second largest population in the Americas, among the top six worldwide.
The Brazilian physical activity recommendations for cancer prevention and control was primarily derived from the recent clinical evidence and relevant guidelines on the topic, considering local clinical practice. Using an evidence-based approach, we updated the international evidence and recommendation for the most frequent cancers in the Brazilian population with the aim to reach the highest number of patients living with and beyond cancer. Thus, although considered local specificities, it is also an important international scientific contribution because it contemplates the most recent findings of the exercise oncology field.
Our results demonstrated PAGAC
The selected guidelines demonstrated high certainty of evidence supporting the association between moderate-to-vigorous physical activity and lower risk of breast and colon cancer, evidence that was adopted for the Brazilian recommendations development. The selected guidelines did not answer the PI/ECO question or answered with low or moderate certainty of evidence for the preventive effect of physical activity on prostate, rectal and lung cancers; and the effect of physical activity on all-cause and cancers-specific mortality from breast, colon, rectal, prostate and lung cancer in cancer survivors. Then, a search for recent systematic reviews considering the effects of physical activity on cancer prevention and mortality returned 12 studies, all of them with critically low quality according to AMSTAR-2. In addition, the GRADE demonstrated low evidence for the four most recent systematic reviews. Indeed, the low quality of the systematic reviews has enabled us to make significant progress on the recommendations made by PAGAC
Although the formulation of a set of statements based on the current scientific evidence was an important component of this proposal, our primary focus was to facilitate appropriate preventive and treatment counseling among Brazilian health-care professionals. Despite the cancer diagnosis may represent an important trigger to make survivors more receptive to include health behavior in their lives,
The effects of physical activity on symptom control in individuals with cancer undergoing treatment and after treatment are another critical dimension in cancer control and should be the object of review and elaboration of recommendations shortly. New scientific publications are expected in the coming years, and we hope that some methodological aspects will be improved so that the quality of evidence is even better. We also expect that Brazilian researchers take ownership of the topic and produce evidence considering the local context, which may vary according to different regions of Brazil.
In conclusion, the Brazilian physical activity recommendations for cancer prevention and control may be considered the first step to include Brazil into the international agenda to make physical activity and exercise standards in oncology practice. Of note, it is the first initiative like this among the Global South countries. We expect the recommendations will support health-care professionals recommending physical activity, which may contribute to a reduction in physical inactivity in the general population and cancer survivors in Brazil.
| Key question | What is the effect of physical activity on cancer prevention? | ||
|---|---|---|---|
| population | Healthy adults without a diagnosis of cancer | ||
| Intervention | Activity or exercise | ||
| Study design | Systematic Review | ||
| comparison | Inactive (or less active) | ||
| Outcome | Incidence of cancer | ||
| Base | Date | Strategy | |
| Medline/Pubmed | November, 2020 | (((Exercise[mh] OR Exercise*[tiab] OR Physical Activit*[tiab] OR Health Activit*[tiab] OR Training[tiab] OR Physical[tiab] OR Walking[mh] OR Walking[tiab] OR Cycling[tiab] OR Aerobic[tiab] OR Sports[mh] OR Sport*[tiab] OR Active Commuting[tiab] OR Physical Endurance[mh] OR Athletes[mh] OR Athlete*[tiab] OR Active Transport[tiab] OR Cardiorespiratory Fitness[mh] OR Cardiorespiratory Fitness[tiab] OR Cardiovascular Fitness[tiab] OR Tai Ji[mh] OR Tai Ji[tiab] OR Tai Chi[tiab] OR Tai Ji Quan[tiab] OR Taijiquan[tiab] OR Tai Chi Chuan[tiab] OR Yoga[mh] OR Yoga[tiab] OR Resistance Training[mh] OR Muscle Stretching Exercises[mh] OR Stretching[tiab] OR Muscle Strength[mh] OR Arthrogenic Muscle Inhibition[tiab]) AND ((Prevention and Control[sh] OR Primary Prevention[mh] OR Primary Prevention[tiab] OR Disease Pre- vention[tiab] OR Prevention[tiab]) AND (Radiation Oncology[mh] OR Medical Oncology[mh] OR Surgical Oncology[mh] OR Oncology[tiab] OR Neoplasms[mh] OR Neoplas*[tiab] OR Cancer*[tiab] OR Carcinoma[mh] OR Carcinoma[tiab] OR Epithelioma*[tiab] OR Adenocarcinoma[mh] OR Adenocarcinoma[tiab] OR Sarcoma[mh] OR Sarcoma[tiab] OR Tumor*[tiab] OR Tumour*[tiab] OR Malignan*[tiab] OR Therapeutic Radiology[tiab] OR Drug Therapy[mh] OR Drug Therap*[tiab] OR Chemotherap*[tiab] OR Radiotherapy[mh] OR Radiotherapy, Adjuvant[mh] OR Radiotherapy, Conformal[mh] OR Radiotherap*[tiab]))) AND Systematic[sb]) AND (“2016/01/01“[PDat] : “2020/09/16“[PDat]) NOT (Child*[tw] OR Infant[tw] OR Pediatric*[tw] OR Paediatric*[tw]) | |
| Embase | November, 2020 | ('exercise'/mj OR 'biometric exercise':ti, ab OR 'effort':ti, ab OR 'exercise':ti, ab OR 'exercise capacity':ti, ab OR 'exercise performance':ti, ab OR 'exercise training':ti, ab OR 'exertion':ti, ab OR 'fitness training':ti, ab OR 'physical conditioning, human':ti, ab OR 'physical effort':ti, ab OR 'physical exercise':ti, ab OR 'physical exertion':ti, ab OR 'physical activity'/mj OR 'activity, physical':ti, ab OR 'physical activity':ti, ab OR 'health activit*':ti, ab OR 'training'/mj OR 'athletic training':ti, ab OR 'athletic training program':ti, ab OR 'athletic training programme':ti, ab OR 'military training':ti, ab OR 'physical training':ti, ab OR 'sport specific training':ti, ab OR 'technical training':ti, ab OR 'training':ti, ab OR 'training athlete':ti, ab OR 'training course':ti, ab OR 'train- ing program':ti, ab OR 'training programme':ti, ab OR 'training, athletic':ti, ab OR 'training, phys- ical':ti, ab OR 'walking'/mj OR 'walking':ti, ab OR 'cycling'/mj OR 'bicycling':ti, ab OR 'cycling':ti, ab OR 'aerobic exercise'/mj OR 'aerobic exercise':ti, ab OR 'aerobics':ti, ab OR 'aerobics exercise':ti, ab OR 'exercise, aerobic':ti, ab OR 'low impact aerobic exercise':ti, ab OR 'low impact aerobics':ti, ab OR 'sport'/mj OR 'competitive sport':ti, ab OR 'sport':ti, ab OR 'sports':ti, ab OR 'active commuting':ti, ab OR 'endurance'/mj OR 'endurance':ti, ab OR 'physical endurance':ti, ab OR 'athlete'/mj OR 'athlete':ti, ab OR 'athletes':ti, ab OR 'sportman':ti, ab OR 'sportmen':ti, ab OR 'sports player':ti, ab OR 'sports players':ti, ab OR 'sportsman':ti, ab OR 'sportsmen':ti, ab OR 'sportspeople':ti, ab OR 'sportsperson':ti, ab OR 'sportspersons':ti, ab OR 'sportsplayers':ti, ab OR 'sportswoman':ti, ab OR 'sportswomen':ti, ab OR 'sportwomen':ti, ab OR 'active transport'/ mj OR 'active biological transport':ti, ab OR 'active transport':ti, ab OR 'biological transport, active':ti, ab OR 'transport, active':ti, ab OR 'cardiorespiratory fitness'/mj OR 'cardiorespiratory fitness':ti, ab OR 'cardiovascular fitness':ti, ab OR 'tai chi'/mj OR 'tai chi':ti, ab OR 'tai chi ch- uan':ti, ab OR 'tai ji':ti, ab OR 'taiji quan':ti, ab OR 'taijiquan':ti, ab OR 'yoga'/mj OR 'yoga':ti, ab OR 'yogic meditation':ti, ab OR 'resistance training'/mj OR 'resistance exercise':ti, ab OR 'resistance exercise training':ti, ab OR 'resistance training':ti, ab OR 'strength training':ti, ab OR 'weight bearing exercise':ti, ab OR 'stretching exercise'/mj OR 'muscle stretching exercises':ti, ab OR 'stretching exercise':ti, ab OR 'stretching exercises':ti, ab OR 'muscle strength'/mj OR 'dynamic strength, muscle':ti, ab OR 'dynamic strength, muscular':ti, ab OR 'force, muscle':ti, ab | |
| Embase | November, 2020 | OR ‘muscle dynamic strength':ti, ab OR ‘muscle force':ti, ab OR ‘muscle force velocity relationship':ti, ab OR ‘muscle power':ti, ab OR ‘muscle strength':ti, ab OR ‘muscular dynamic strength':ti, ab OR ‘muscular force':ti, ab OR ‘muscular power':ti, ab OR ‘muscular strength':ti, ab OR ‘strength, muscle':ti, ab OR ‘arthrogenic muscle inhibition':ti, ab) AND (‘radiation oncology'/mj OR ‘radiation oncology':ti, ab OR ‘oncology'/mj OR ‘cancerology':ti, ab OR ‘clinical oncology':ti, ab OR ‘medical oncology':ti, ab OR ‘oncology':ti, ab OR ‘surgical oncology'/mj OR ‘surgical oncology':ti, ab OR ‘neoplasm'/exp OR ‘acral tumor':ti, ab OR ‘acral tumour':ti, ab OR ‘neoplasia':ti, ab OR ‘neoplasm':ti, ab OR ‘neoplasms':ti, ab OR ‘neoplasms by histologic type':ti, ab OR ‘neoplastic disease':ti, ab OR ‘tumor':ti, ab OR ‘tumour':ti, ab OR ‘malignant neoplasm'/mj OR ‘cancer':ti, ab OR ‘cancers':ti, ab OR ‘malignant neoplasia':ti, ab OR ‘malignant neoplasm':ti, ab OR ‘malignant neoplastic disease':ti, ab OR ‘malignant tumor':ti, ab OR ‘malignant tumour':ti, ab OR ‘neoplasia, malignant':ti, ab OR ‘tumor, malignant':ti, ab OR ‘tumour, malignant':ti, ab OR ‘carcinoma'/mj OR ‘carcinoma':ti, ab OR ‘carcinoma 63':ti, ab OR ‘carcinoma, neuroendocrine':ti, ab OR ‘carcinoma, scirrhous':ti, ab OR ‘epithelial carcinoma':ti, ab OR ‘epithelial malignant tumor':ti, ab OR ‘epithelial malignant tumour':ti, ab OR ‘internal carcinoma':ti, ab OR ‘malignant epithelial tumor':ti, ab OR ‘malignant epithelial tumour':ti, ab OR ‘microcarcinoma':ti, ab OR ‘neoplasm, malignant epithelial':ti, ab OR ‘primary carcinoma':ti, ab OR ‘epithelium tumor'/mj OR ‘epithelial tumor':ti, ab OR ‘epithelial tumour':ti, ab OR ‘epithelioma':ti, ab OR ‘epithelium tumor':ti, ab OR ‘epithelium tumour':ti, ab OR ‘necrotising epithelioma':ti, ab OR ‘necrotizing epithelioma':ti, ab OR ‘tumor, epithelial':ti, ab OR ‘tumour, epithelial':ti, ab OR ‘adenocarcinoma'/exp OR 'adenocancer':ti, ab OR 'adenocarcinoma':ti, ab OR 'adenocarcinoma, clear cell':ti, ab OR 'adenocarcinoma, follicular':ti, ab OR 'adenocarcinoma, papillary':ti, ab OR 'adenocarcinoma, scirrhous':ti, ab OR 'adenocarcinoma, sebaceous':ti, ab OR 'adenoepidermoid carcinoma':ti, ab OR 'adenoid basal carcinoma':ti, ab OR 'follicular adenocarcinoma':ti, ab OR 'glandular carcinoma':ti, ab OR 'papillary adenocarcinoma':ti, ab OR 'scirrhous adenocarcinoma':ti, ab OR 'villous adenocarcinoma':ti, ab OR 'sarcoma'/mj OR 'histioblastoma':ti, ab OR 'histiosarcoma':ti, ab OR 'malignant sarcoma':ti, ab OR 'mast cell sarcoma':ti, ab OR 'mast-cell sarcoma':ti, ab OR 'neoplasm, mesenchymal':ti, ab OR 'sarcoma':ti, ab OR 'sarcoma 37':ti, ab OR 'sarcoma 37 cell':ti, ab OR 'sarcoma e 100':ti, ab OR 'sarcoma l 1':ti, ab OR 'sarcoma sa 1':ti, ab OR 'sarcoma tawa':ti, ab OR 'sarcoma, mast-cell':ti, ab OR 'radiotherapy'/mj OR 'bioradiant therapy':ti, ab OR 'bucky irradiation':ti, ab OR 'bucky radiation':ti, ab OR 'bucky radiotherapy':ti, ab OR 'bucky ray':ti, ab OR 'bucky ray radiation':ti, ab OR 'bucky therapy':ti, ab OR 'fractionated radiotherapy':ti, ab OR 'irradiation therapy':ti, ab OR 'irradiation treatment':ti, ab OR 'radiation repair':ti, ab OR 'radiation therapy':ti, ab OR 'radiation treatment':ti, ab OR 'radio therapy':ti, ab OR 'radio treatment':ti, ab OR 'radiohypophysectomy':ti, ab OR 'radiology, therapeutic':ti, ab OR 'radiotherapy':ti, ab OR 'radiotherapy setup errors':ti, ab OR 'radiotreatment':ti, ab OR 'roentgen irradiation, therapeutic':ti, ab OR 'roentgen therapy':ti, ab OR 'roentgen treatment':ti, ab OR 'rontgen therapy':ti, ab OR 'therapeutic radiology':ti, ab OR 'therapy, irradiation':ti, ab OR 'therapy, radiation':ti, ab OR 'therapy, roentgen':ti, ab OR 'treatment, irradiation':ti, ab OR 'treatment, radiation':ti, ab OR 'treatment, roentgen':ti, ab OR 'x radiotherapy':ti, ab OR 'x ray therapy':ti, ab OR 'x ray treatment':ti, ab OR 'x-ray therapy':ti, ab OR 'drug therapy'/mj OR 'drug therapy':ti, ab OR 'drug treatment':ti, ab OR 'medicament therapy':ti, ab OR 'medicament treatment':ti, ab OR 'medication':ti, ab OR 'medicinal therapy':ti, ab OR 'medicinal treatment':ti, ab OR 'pharmaceutical therapy':ti, ab OR 'pharmaceutical treatment':ti, ab OR 'pharmaco-therapy':ti, ab OR 'pharmaco-treatment':ti, ab OR 'pharmacological therapy':ti, ab OR 'pharmacological treatment':ti, ab OR 'pharmacotherapy':ti, ab OR 'pharmacotreatment':ti, ab OR 'therapeutic uses':ti, ab OR 'therapy, drug':ti, ab OR 'therapy, pharmacological':ti, ab OR 'treatment, drug':ti, ab OR 'treatment, pharmacological':ti, ab OR 'chemotherapy'/mj OR 'chemotherapeutics':ti, ab OR 'chemotherapy':ti, ab OR 'adjuvant radiotherapy'/mj OR 'adjuvant radiotherapy':ti, ab OR 'radiotherapy, adjuvant':ti, ab OR 'conformal radiotherapy'/mj OR '3-di- mensional conformal radiation therapy':ti, ab OR '3-dimensional conformal radiotherapy':ti, ab OR '3d conformal radiation therapy':ti, ab OR '3d conformal radiotherapy':ti, ab OR 'conformal radiation therapy':ti, ab OR 'conformal radiotherapy':ti, ab OR 'radiotherapy, conformal':ti, ab OR 'three-dimensional conformal radiation therapy':ti, ab OR 'three-dimensional conformal radiotherapy':ti, ab) AND ('prevention and control'/exp OR 'prevention and control':ti, ab OR 'primary prevention'/exp OR 'primary prevention':ti, ab OR 'disease prevention':ti, ab OR 'prevention'/exp OR 'prevention':ti, ab) AND [embase]/lim NOT ([embase]/lim AND [medline]/lim) AND ([english]/ lim OR [portuguese]/lim OR [spanish]/lim) AND [2016-2020]/py AND ([cochrane review]/lim OR [systematic review]/lim OR [meta analysis]/lim) AND [humans]/lim AND [humans]/lim AND ([adult]/lim OR [young adult]/lim OR [middle aged]/lim OR [aged]/lim OR [very elderly]/lim) | |
| Lilacs | November, 2020 | (tw:(Exercise* OR “Physical Activity” OR “Physical Activities” OR “Health Activity” OR “Health Activities” OR Training OR Physical OR Walking OR Cycling OR Aerobic OR Sport* OR “Active Commuting” OR “Physical Endurance” OR Athlete* OR “Active Transport” OR “Cardiorespiratory Fitness” OR “Cardiovascular Fitness” OR “Tai Ji” OR “Tai Ji” OR “Tai Chi” OR “Tai Ji Quan” OR Taijiquan OR “Tai Chi Chuan” OR Yoga OR “Resistance Training” OR “Muscle Stretching Exercises” OR Stretching OR “Muscle Strength” OR “Arthrogenic Muscle Inhibition” OR Exercicio* OR “Atividade física” OR “Atividades fisicas” OR “Atividade de saude” OR Treinamento OR Fisico OR Caminhada OR Ciclismo OR Aerobico OR Esporte* OR “Deslocamento ativo” OR “Resistencia fisica” OR Atleta* OR “Transporte ativo” OR “Aptidao cardiorrespiratoria” OR “Aptidao cardiovascular” OR Ioga OR “Treinamento de resistencia” OR “Exercicios de alongamento muscu- lar” OR alongamento OR “Forca muscular” OR “Inibicao muscular artrogenica” OR Ejercicio* OR “Actividad física” OR “Actividades físicas” OR “Actividad de salud” OR Entrenamiento OR Caminar OR “Andar en bicicleta” OR Deporte* OR “Desplazamientos activos” OR “Resistencia fisica” OR “Transporte activo” OR “Aptitud cardiorrespiratoria” OR “Aptitud cardiovascular” OR “Entrenamiento de resistencia” OR “Ejercicios de estiramiento muscular” OR estiramiento OR “Fuerza muscular” OR “Inhibicion de los musculos artrogenicos“)) AND (tw:(“Radiation Oncology” OR “Medical Oncology” OR “Surgical Oncology” OR Oncology OR Neoplasms OR Neoplas* OR Cancer* OR Carcinoma OR Epithelioma* OR Adenocarcinoma OR Sarcoma OR Tumor* OR Tumour* OR Malignan* OR “Therapeutic Radiology” OR “Drug Therapy” OR “Drug Therapies“ OR Chemotherap* OR Radiotherap* OR “Oncologia de radiacao” OR “oncologia radiologica“ OR “Oncologia medica” OR “oncologia cirurgica” OR epitelioma* OR “radiologia terapeutica” OR “terapia por drogas” OR quimioterapia* OR radioterapia* OR “Oncologia radioterapica” OR “Oncologia quirurgica” OR “Terapia con medicamentos” OR oncologia)) AND (tw:(“Prevention and Control” OR “Primary Prevention” OR “Disease Prevention” OR Prevention OR “Prevencao e Controle” OR “Prevencao Primaria” OR “Prevencao de doencas” OR Prevencao OR “Prevencion y control” OR “prevencion primaria” OR “prevencion de enfermedades” OR prevencion)) AND (db:(“LILACS“)) AND (year_cluster:[2016 TO 2020]) AND (type_of_study:(“systematic_reviews“)) | |
| Key question | What is the effect of physical activity on cancer survival? | ||
|---|---|---|---|
| population | Adults diagnosed with cancer (any cancer) | ||
| Intervention | Activity or exercise | ||
| Study design | Systematic review | ||
| comparison | Inactive (or less active) | ||
| Outcome | Incidence of cancer | ||
| Base | Date | Strategy | |
| Medline/Pubmed | November, 2020 | ((((Exercise[mj] OR Exercise*[tiab] OR Physical Activit*[tiab] OR Health Activit*[tiab] OR Training[tiab] OR Physical[tiab] OR Walking[mj] OR Walking[tiab] OR Cycling[tiab] OR Aerobic[tiab] OR Sports[mh] OR Sport*[tiab] OR Active Commuting[tiab] OR Physical Endurance[mj] OR Athletes[mj] OR Athlete*[tiab] OR Active Transport[tiab] OR Cardiorespiratory Fitness[mj] OR Cardiorespiratory Fitness[tiab] OR Cardiovascular Fitness[tiab] OR Tai Ji[mj] OR Tai Ji[tiab] OR Tai Chi[tiab] OR Tai Ji Quan[tiab] OR Taijiquan[tiab] OR Tai Chi Chuan[tiab] OR Yoga[mj] OR Yoga[tiab] OR Resistance Training[mj] OR Muscle Stretching Exercises[mj] OR Stretching[tiab] OR Muscle Strength[mj] OR Arthrogenic Muscle Inhibition[tiab]) AND (Radiation Oncology[mj] OR Medical Oncology[mj] OR Surgical Oncology[mj] OR Oncology[tiab] OR Neoplasms[mj] OR Neoplas*[tiab] OR Cancer*[tiab] OR Carcinoma[mj] OR Carcinoma[tiab] OR Epithelioma*[tiab] OR Adenocarcinoma[mj] OR Adenocarcinoma[tiab] OR Sarcoma[mj] OR Sarcoma[tiab] OR Tumor*[tiab] OR Tumour*[tiab] OR Malignan*[tiab] OR Therapeutic Radiology[tiab] OR Drug Therapy[mj] OR Drug Therap*[tiab] OR Chemotherap*[tiab] OR Radiotherapy[mj] OR Radiotherapy, Adjuvant[mj] OR Radiotherapy, Conformal[mj] OR Radiotherap*[tiab])) AND (Survival[mj] OR Survivors[mj] OR Survival Analysis[mj] OR Survival Rate[mj] OR Survival[tiab] OR Survivor*[tiab] OR Mortality[mj] OR Mortalit*[tiab] OR Case Fatality Rate*[tiab] OR Death[mj] OR Death[tiab])) AND (Clinical Trial[sb] OR Meta- Analysis[sb] OR Observational Study[sb] OR Randomized Controlled Trial[sb] OR Systematic Review[sb])) AND (English[lang] OR Portuguese[lang] OR Spanish[lang]) AND (“2018/01/01“[PDat] : “2020/09/16“[PDat]) NOT (Child*[tw] OR Infant[tw] OR Pediatric*[tw] OR Paediatric*[tw]) | |
| Embase | November, 2020 | (‘exercise'/mj OR ‘biometric exercise':ti, ab OR ‘effort':ti, ab OR ‘exercise':ti, ab OR ‘exercise capacity':ti, ab OR ‘exercise performance':ti, ab OR ‘exercise training':ti, ab OR ‘exertion':ti, ab OR ‘fitness training':ti, ab OR ‘physical conditioning, human':ti, ab OR ‘physical effort':ti, ab OR ‘physical exer- cise':ti, ab OR ‘physical exertion':ti, ab OR ‘physical activity'/mj OR ‘activity, physical':ti, ab OR ‘physical activity':ti, ab OR ‘health activit*':ti, ab OR ‘training'/mj OR ‘athletic training':ti, ab OR ‘athletic training program':ti, ab OR ‘athletic training programme':ti, ab OR ‘military training':ti, ab OR ‘physical training':ti, ab OR ‘sport specific training':ti, ab OR ‘technical training':ti, ab OR ‘training':ti, ab OR ‘training athlete':ti, ab OR ‘training course':ti, ab OR ‘training program':ti, ab OR ‘training programme':ti, ab OR ‘training, athletic':ti, ab OR ‘training, physical':ti, ab OR ‘walking'/mj OR ‘walking':ti, ab OR ‘cycling'/mj OR ‘bicycling':ti, ab OR ‘cycling':ti, ab OR ‘aerobic exercise'/mj OR ‘aerobic exercise':ti, ab OR ‘aerobics':ti, ab OR ‘aerobics exercise':ti, ab OR ‘exercise, aerobic':ti, ab OR ‘low impact aerobic exer- cise':ti, ab OR ‘low impact aerobics':ti, ab OR ‘sport'/mj OR ‘competitive sport':ti, ab OR ‘sport':ti, ab OR ‘sports':ti, ab OR ‘active commuting':ti, ab OR ‘endurance'/mj OR ‘endurance':ti, ab OR ‘physical endurance':ti, ab OR ‘athlete'/mj OR ‘athlete':ti, ab OR ‘athletes':ti, ab OR ‘sportman':ti, ab OR ‘sport- men':ti, ab OR ‘sports player':ti, ab OR ‘sports players':ti, ab OR ‘sportsman':ti, ab OR ‘sportsmen':ti, ab OR ‘sportspeople':ti, ab OR ‘sportsperson':ti, ab OR ‘sportspersons':ti, ab OR ‘sportsplayers':ti, ab OR ‘sportswoman':ti, ab OR ‘sportswomen':ti, ab OR ‘sportwomen':ti, ab OR ‘active transport'/mj OR ‘active biological transport':ti, ab OR ‘active transport':ti, ab OR ‘biological transport, active':ti, ab OR ‘transport, active':ti, ab OR ‘cardiorespiratory fitness'/mj OR ‘cardiorespiratory fitness':ti, ab OR ‘cardiovascular fitness':ti, ab OR ‘tai chi'/mj OR ‘tai chi':ti, ab OR ‘tai chi chuan':ti, ab OR ‘tai ji':ti, ab OR ‘taiji quan':ti, ab OR ‘taijiquan':ti, ab OR ‘yoga'/mj OR ‘yoga':ti, ab OR ‘yogic meditation':ti, ab OR ‘resistance training'/mj OR ‘resistance exercise':ti, ab OR ‘resistance exercise training':ti, ab OR ‘resistance training':ti, ab OR ‘strength training':ti, ab OR ‘weight bearing exercise':ti, ab OR ‘stretching exercise'/mj OR ‘muscle stretching exercises':ti, ab OR ‘stretching exercise':ti, ab OR ‘stretching exercises':ti, ab OR ‘muscle strength'/mj OR ‘dynamic strength, muscle':ti, ab OR ‘dynamic strength, muscular':ti, ab OR ‘force, muscle':ti, ab OR ‘muscle dynamic strength':ti, ab OR ‘muscle force':ti, ab OR ‘muscle force velocity relationship':ti, ab OR ‘muscle power':ti, ab OR ‘muscle strength':ti, ab OR ‘muscular dynamic strength':ti, ab OR ‘muscular force':ti, ab OR ‘muscular power':ti, ab OR ‘muscular strength':ti, ab OR ‘strength, muscle':ti, ab OR ‘arthrogenic muscle inhibition':ti, ab) AND (‘radiation oncology'/mj OR ‘radiation oncology':ti, ab OR ‘oncology'/mj OR ‘cancerology':ti, ab OR ‘clinical oncology':ti, ab OR ‘medical oncology':ti, ab OR ‘oncology':ti, ab OR ‘surgical oncology'/mj OR ‘surgical oncology':ti, ab OR ‘neoplasm'/exp OR ‘acral tumor':ti, ab OR ‘acral tumour':ti, ab OR ‘neoplasia':ti, ab OR ‘neoplasm':ti, ab OR ‘neoplasms':ti, ab OR ‘neoplasms by histologic type':ti, ab OR ‘neoplastic disease':ti, ab OR ‘tumor':ti, ab OR ‘tumour':ti, ab OR ‘malignant neoplasm'/mj OR ‘cancer':ti, ab OR ‘cancers':ti, ab OR ‘malignant neoplasia':ti, ab OR ‘malignant neoplasm':ti, ab OR ‘malignant neoplastic disease':ti, ab OR ‘malignant tumor':ti, ab OR ‘malignant tumour':ti, ab OR ‘neoplasia, malignant':ti, ab OR ‘tumor, malignant':ti, ab OR ‘tumour, malignant':ti, ab OR ‘carcinoma'/mj OR ‘carcinoma':ti, ab OR ‘carcinoma 63':ti, ab OR ‘carcinoma, neuroendocrine':ti, ab OR ‘carcinoma, scirrhous':ti, ab OR ‘epithelial carcinoma':ti, ab OR ‘epithelial malignant tumor':ti, ab OR ‘epithelial malignant tumour':ti, ab OR ‘internal carcinoma':ti, ab OR ‘malignant epithelial tumor':ti, ab OR ‘malignant epithelial tumour':ti, ab OR ‘microcarcinoma':ti, ab OR ‘neoplasm, malignant epithelial':ti, ab OR ‘primary carcinoma':ti, ab OR ‘epithelium tumor'/mj OR ‘epithelial tumor':ti, ab OR ‘epithelial tumour':ti, ab OR ‘epithelioma':ti, ab OR ‘epithelium tumor':ti, ab OR ‘epithelium tumour':ti, ab OR ‘necrotising epithelioma':ti, ab OR ‘necrotizing epithelioma':ti, ab OR ‘tumor, epithelial':ti, ab OR ‘tumour, epithelial':ti, ab OR ‘adenocarcinoma'/exp OR ‘adenocancer':ti, ab OR ‘adenocarcinoma':ti, ab OR ‘adenocarcinoma, clear cell':ti, ab OR ‘adenocarcinoma, follicular':ti, ab OR ‘adenocarcinoma, papillary':ti, ab OR ‘adenocarcinoma, scirrhous':ti, ab OR ‘adenocarcinoma, sebaceous':ti, ab OR ‘adenoepidermoid carcinoma':ti, ab OR ‘adenoid basal carcinoma':ti, ab OR ‘follicular adenocarcinoma':ti, ab OR ‘glandular carcinoma':ti, ab OR ‘papillary adenocarcinoma':ti, ab OR ‘scirrhous adenocarcinoma':ti, ab OR ‘villous adenocarcinoma':ti, ab OR ‘sarcoma'/mj OR ‘histioblastoma':ti, ab OR ‘histiosarcoma':ti, ab OR ‘malignant sarcoma':ti, ab OR ‘mast cell sarcoma':ti, ab OR ‘mast-cell sarcoma':ti, ab OR ‘neoplasm, mesenchymal':ti, ab OR ‘sarcoma':ti, ab OR ‘sarcoma 37':ti, ab OR ‘sarcoma 37 cell':ti, ab OR ‘sarcoma e 100':ti, ab OR ‘sarcoma l 1':ti, ab OR ‘sarcoma sa 1':ti, ab OR ‘sarcoma tawa':ti, ab OR ‘sarcoma, mast-cell':ti, ab OR ‘radiotherapy'/mj OR ‘bioradiant therapy':ti, ab OR ‘bucky irradiation':ti, ab OR ‘bucky radiation':ti, ab OR ‘bucky radiotherapy':ti, ab OR ‘bucky ray':ti, ab OR ‘bucky ray radiation':ti, ab OR ‘bucky therapy':ti, ab OR ‘fractionated radiotherapy':ti, ab OR ‘irradiation therapy':ti, ab OR ‘irradiation treatment':ti, ab OR ‘radiation repair':ti, ab OR ‘radiation therapy':ti, ab OR ‘radiation treatment':ti, ab OR ‘radio therapy':ti, ab OR ‘radio treatment':ti, ab OR ‘radiohypophysectomy':ti, ab OR ‘radiology, therapeutic':ti, ab OR ‘radiotherapy':ti, ab OR ‘radiotherapy setup errors':ti, ab OR ‘radiotreatment':ti, ab OR ‘roentgen irradiation, therapeutic':ti, ab OR | |
| Embase | November, 2020 | ‘roentgen therapy':ti, ab OR ‘roentgen treatment':ti, ab OR ‘rontgen therapy':ti, ab OR ‘therapeutic radiology':ti, ab OR ‘therapy, irradiation':ti, ab OR ‘therapy, radiation':ti, ab OR ‘therapy, roent- gen':ti, ab OR ‘treatment, irradiation':ti, ab OR ‘treatment, radiation':ti, ab OR ‘treatment, roentgen':ti, ab OR ‘x radiotherapy':ti, ab OR ‘x ray therapy':ti, ab OR ‘x ray treatment':ti, ab OR ‘x-ray therapy':ti, ab OR ‘drug therapy'/mj OR ‘drug therapy':ti, ab OR ‘drug treatment':ti, ab OR ‘medicament therapy':ti, ab OR ‘medicament treatment':ti, ab OR ‘medication':ti, ab OR ‘medicinal ther- apy':ti, ab OR ‘medicinal treatment':ti, ab OR ‘pharmaceutical therapy':ti, ab OR ‘pharmaceutical treatment':ti, ab OR ‘pharmaco-therapy':ti, ab OR ‘pharmaco-treatment':ti, ab OR ‘pharmacological therapy':ti, ab OR ‘pharmacological treatment':ti, ab OR ‘pharmacotherapy':ti, ab OR ‘pharma- cotreatment':ti, ab OR ‘therapeutic uses':ti, ab OR ‘therapy, drug':ti, ab OR ‘therapy, pharmacolog- ical':ti, ab OR ‘treatment, drug':ti, ab OR ‘treatment, pharmacological':ti, ab OR ‘chemotherapy'/ mj OR ‘chemotherapeutics':ti, ab OR ‘chemotherapy':ti, ab OR ‘adjuvant radiotherapy'/mj OR ‘adjuvant radiotherapy':ti, ab OR ‘radiotherapy, adjuvant':ti, ab OR ‘conformal radiotherapy'/mj OR ‘3-dimensional conformal radiation therapy':ti, ab OR ‘3-dimensional conformal radiotherapy':ti, ab OR ‘3d conformal radiation therapy':ti, ab OR ‘3d conformal radiotherapy':ti, ab OR ‘conformal radiation therapy':ti, ab OR ‘conformal radiotherapy':ti, ab OR ‘radiotherapy, conformal':ti, ab OR ‘three-dimensional conformal radiation therapy':ti, ab OR ‘three-dimensional conformal radiotherapy':ti, ab) AND (‘survival'/mj OR ‘survival':ti, ab OR ‘survivor'/mj OR ‘survi- vor':ti, ab OR ‘survivors':ti, ab OR ‘survivorship'/mj OR ‘survivorship':ti, ab OR ‘survival analysis'/ mj OR ‘survival analysis':ti, ab OR ‘survival rate'/mj OR ‘rate, survival':ti, ab OR ‘survival curve':ti, ab OR ‘survival probability':ti, ab OR ‘survival rate':ti, ab OR ‘mortality'/mj OR ‘excess mortality':ti, ab OR ‘mortality':ti, ab OR ‘mortality model':ti, ab OR ‘cancer mortality'/mj OR ‘cancer death':ti, ab OR ‘cancer mortality':ti, ab OR ‘mortality, cancer':ti, ab OR ‘case fatality rate'/mj OR ‘case fatalities':ti, ab OR ‘case fatality':ti, ab OR ‘case fatality rate':ti, ab OR ‘case fatality ratio':ti, ab OR ‘case fatality risk':ti, ab OR ‘death'/mj OR ‘death':ti, ab OR ‘mors':ti, ab OR ‘mortality rate'/mj OR ‘death rate':ti, ab OR ‘death rate model':ti, ab OR ‘fatal outcome rate':ti, ab OR ‘fatality rate':ti, ab OR ‘lethal outcome rate':ti, ab OR ‘mortality rate':ti, ab OR ‘rate, mortality':ti, ab) AND [embase]/lim NOT ([embase]/lim AND [medline]/lim) AND ([english]/lim OR [portuguese]/lim OR [spanish]/lim) AND [2018-2020]/ py AND ([cochrane review]/lim OR [systematic review]/lim OR [meta analysis]/lim OR [controlled clinical trial]/lim OR [randomized controlled trial]/lim) AND [humans]/lim AND [humans]/lim AND ([adult]/lim OR [young adult]/lim OR [middle aged]/lim OR [aged]/lim OR [very elderly]/lim) | |
| (tw:(Exercise* OR “Physical Activity” OR “Physical Activities” OR “Health Activity” OR “Health Activities” OR Training OR Physical OR Walking OR Cycling OR Aerobic OR Sport* OR “Active Commut- ing” OR “Physical Endurance” OR Athlete* OR “Active Transport” OR “Cardiorespiratory Fitness” OR “Cardiovascular Fitness” OR “Tai Ji” OR “Tai Ji” OR “Tai Chi” OR “Tai Ji Quan” OR Taijiquan OR “Tai Chi Chuan” OR Yoga OR “Resistance Training” OR “Muscle Stretching Exercises” OR Stretching OR “Muscle Strength” OR “Arthrogenic Muscle Inhibition” OR Exercicio* OR “Atividade física” OR “Atividades fisicas” OR “Atividade de saude” OR Treinamento OR Fisico OR Caminhada OR Ciclismo OR Aerobico OR Esporte* OR “Deslocamento ativo” OR “Resistencia fisica” OR Atleta* OR “Transporte ativo” OR “Aptidao cardiorrespiratoria” OR “Aptidao cardiovascular” OR Ioga OR “Treinamento de resistencia” OR “Exercicios de alongamento muscular” OR alongamento OR “Forca muscular” OR “Inibicao muscular artrogenica” OR Ejercicio* OR “Actividad física” OR “Actividades físicas” OR “Actividad de salud” OR Entrenamiento OR Caminar OR “Andar en bicicleta” OR Deporte* OR “Desplazamientos activos” OR “Resistencia fisica” OR “Transporte activo” OR “Aptitud cardiorrespiratoria” OR “Aptitud cardiovascular” OR “Entrenamiento de resistencia” OR “Ejercicios de estiramiento muscular” OR estiramiento OR “Fuerza muscular” OR “Inhibicion de los musculos artrogenicos“)) AND (tw:(“Radiation Oncology” OR “Medical Oncology” OR “Surgical Oncology” OR Oncology OR Neoplasms OR Neoplas* OR Cancer* OR Carcinoma OR Epithelioma* OR Adenocarcinoma OR Sarcoma OR Tumor* OR Tumour* OR Malignan* OR “Therapeutic Radiology” OR “Drug Therapy” OR “Drug Therapies” OR Chemotherap* OR Radiotherap* OR “Oncologia de radiacao” OR “oncologia radiologica” OR “Oncologia medica” OR “oncologia cirurgica” OR epitelioma* OR “radiologia terapeutica” OR “terapia por drogas” OR quimioterapia* OR radioterapia* OR “Oncologia radioterapica” OR “Oncologia quirurgica” OR “Terapia con medicamentos” OR oncologia)) AND (tw:(Survival OR Survivor* OR “Survival Analysis” OR “Survival Rate” OR Mortality OR “Case Fatality Rate” OR Death OR Sobrevivencia OR Sobrevivente* OR “Analise de Sobrevivencia” OR “Taxa de Sobrevivencia” OR Mortalidade OR “Taxa de Fatalidade” OR Morte OR Supervivencia OR Superviviente* OR “Analisis de supervivencia” OR “Tasa de supervivencia” OR Mortalidad OR “Tasa de mortalidad” OR Muerte)) AND (db:(“LILACS“)) AND (year_cluster:[2018 TO 2020]) AND (type_of_study:(“screening_studies” OR “prevalence_studies” OR “prognostic_studies” OR “risk_factors_studies” OR “systematic_reviews” OR “clinical_trials” OR “observational_studies” OR “incidence_studies“)) | |||
Wu W et al. Pre- and post-diagnosis physical activity is associated with survival benefits of colorectal cancer patients: a systematic review and meta-analysis. Oncotarget. 2016;7(32):52095-52103.
| PHYSICAL ACTIVITY VERSUS NO PHYSICAL ACTIVITY FOR PEOPLE WITH COLORECTAL CANCER | ||||
|---|---|---|---|---|
| Patient or population: colorectal cancer Context: - Intervention: with physical activity Comparison: no physical activity | ||||
| Potential absolute effects* (IC 95%) Outcomes Risk without Risk with physical physical activity activity | Relative Risk (IC 95%) | Number of participants (studies) | Certain of evidence (GRADE) | Comments |
| Mortality from all causes - - Follow-up: 4.9 to 11.9 years | RR 0.71 (0,63-0,81) | 9,251 (7 observational studies) | ⨁○○○ VERY LOW a,b | - |
| Mortality from colorectal cancer - - Follow-up: 3.8 to 11.9 years | RR 0.77 (0,63-0,94) | 8,419 (6 observational studies) | ⨁○○○ VERY LOW c,d | - |
Subtitle
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk of the comparator group and the relative effect of the intervention (and its 95% CI). CI: Confidence Interval; RR: relative risk.
A. Methodological limitations. Only 1 of the 7 studies had the highest score in the quality assessment by the New Castle-Ottawa tool and the others had a score of 7 or 8. Reduced by one level (-1).
B. Inconsistency. I2 = 53.3%. Reduced one level (-1).
C. Methodological limitations. All studies scored in the New Castle-Ottawa tool 7 or 8 (maximum value = 9). Reduced one level (-1).
D. Inconsistency. I2 = 60.3%. Reduced one level (-1).
There was no reduction in certainty due to imprecision, indirect evidence and publication bias.
There was no increase in certainty by effect size, confounding factor control or dose-response gradient.
High: we are very confident that the true effect is close to the estimated effect
Moderate: We are moderately confident in the effect estimate: the true effect is likely to be close to the effect estimate, but there is a possibility that it will be substantially different.
Low: Our confidence in the effect estimate is limited: The actual effect may be substantially different from the effect estimate.
Very low: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the effect estimate.
| Patient or population: colorectal cancer Context: - Intervention: high physical activity Comparison: low physical activity | ||||||
|---|---|---|---|---|---|---|
| Outcomes | Potential absolute effects* (IC 95%) | Relative Risk (IC 95%) | Number of participants (studies) | Certain of evidence (GRADE) | Comments | |
| Risk without physical activity | Risk with physical activity | |||||
| Mortality from all causes Follow-up: 3.8 to 11.9 years | - | - | RR 0.58 (0,49-0,68) | 7,426 (6 observational studies) | ⨁○○○ VERY LOW a | - |
| Mortality from colorectal cancer Follow-up: 6.8 to 11.9 years | - | - | RR 0.56 (0,38-0,83) | 6,594 (5 observational studies) | ⨁○○○ VERY LOWb | - |
Subtitle
* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk of the comparator group and the relative effect of the intervention (and its 95% CI). CI: Confidence Interval; RR: relative risk.
A. Methodological limitations. Only 1 of the 7 studies had the highest score in the quality assessment by the New Castle-Ottawa tool and the others had a score of 7 or 8. Reduced by one level (-1).
B. Methodological limitations. All studies scored in the New Castle-Ottawa tool 7 or 8 (maximum value = 9). Reduced one level (-1).
There was no reduction in certainty due to inconsistency, imprecision, indirect evidence and publication bias. There was no increase in certainty by effect size, confounding factor control or dose-response gradient.
High: we are very confident that the true effect is close to the estimated effect
Moderate: We are moderately confident in the effect estimate: the true effect is likely to be close to the effect estimate, but there is a possibility that it will be substantially different.
Low: Our confidence in the effect estimate is limited: The actual effect may be substantially different from the effect estimate. Very low: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the effect estimate.
Spei ME, Samoli E, Bravi F, La Vecchia C, Bamia C, Benetou V. Physical activity in breast cancer survivors: A systematic review and meta-analysis on overall and breast cancer survival. Breast. 2019;44:144-152.
RECREATIONAL PHYSICAL ACTIVITY VERSUS NO ACTIVITY FOR PEOPLE WITH BREAST CANCER Patient or population: breast cancer
Context: -
Intervention: recreational physical activity
Comparison: no recreational physical activity
| Outcomes | Potential absolute effects* (IC 95%) | Relative Risk (IC 95%) | Number of participants | Certain of evidence (GRADE) | Comments | |
|---|---|---|---|---|---|---|
| Risk without physical activity | Risk with physical activity | |||||
| Mortality from all causes Follow-up: 3.5 to 12.7 years | - | - | HR 0.58 (0,45-0,75) | 19,443 (8 observational studies) | ⨁○○○ VERY LOWa,b | - |
| Breast cancer mortality Follow-up: 3.5 to 12.7 years | - | - | HR 0.60 (0,36-0,99) | 8,330 (5 observational studies) | ⨁○○○ VERY LOWa,b | - |
Subtitle
* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk of the comparator group and the relative effect of the intervention (and its 95% CI). CI: Confidence Interval; RR: relative risk.
A. Methodological limitations. Half of the studies had moderate methodological quality and the other half had high (NewCastle-Ottawa). Reduced one level (-1).
B. Inconsistency. I2 = 70.4. Reduced two levels (-2)
There was no reduction in certainty due to imprecision, indirect evidence and publication bias. There was no increase in certainty by effect size, confounding factor control or dose-response gradient.
High: we are very confident that the true effect is close to the estimated effect
Moderate: We are moderately confident in the effect estimate: the true effect is likely to be close to the effect estimate, but there is a possibility that it will be substantially different.
Low: Our confidence in the effect estimate is limited: The actual effect may be substantially different from the effect estimate. Very low: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the effect estimate.
| Patient or population: breast cancer Context: - Intervention: moderate to vigorous physical activity Comparison: no physical activity (or low) | ||||||
|---|---|---|---|---|---|---|
| Outcomes | Potential absolute effects* (IC 95%) | Relative Risk (IC 95%) | Number of participants | Certain of evidence (GRADE) | Comments | |
| Risk without physical activity | Risk with physical activity | |||||
| Mortality from all causes Follow-up: 3.5 to 12.7 years | - | - | HR 0.50 (0,360,68) | 5,271 (2 observational studies) | ⨁○○○ VERY LOW a | - |
| Breast cancer mortality Follow-up: 3.5 to 12.7 years | - | - | HR 0.61 (0,361,03) | 2,910 (1 observational study) | ⨁○○○ VERY LOW b,c | - |
Subtitle
* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk of the comparator group and the relative effect of the intervention (and its 95% CI). CI: Confidence Interval; RR: relative risk.
A. Methodological limitations. The included studies (Irwin 2011; Bertram 2011) presented a critical risk of bias by the ROBINS-I tool. Reduced two levels (-2).
B. Methodological limitations. The included study (Irwin 2011) presented a critical risk of bias by the ROBINS-I tool. Reduced two levels (-2).
There was no reduction in certainty due to imprecision, indirect evidence and publication bias. There was no increase in certainty by effect size, confounding factor control or dose-response gradient
High: we are very confident that the true effect is close to the estimated effect
Moderate: We are moderately confident in the effect estimate: the true effect is likely to be close to the effect estimate, but there is a possibility that it will be substantially different.
Low: Our confidence in the effect estimate is limited: The actual effect may be substantially different from the effect estimate.
Very low: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the effect estimate.
MODERATE PHYSICAL LEISURE ACTIVITY VERSUS NO PHYSICAL ACTIVITY FOR PEOPLE WITH BREAST CANCER Patient or population: breast cancer
Context: -
Intervention: moderate leisure physical activity
Comparison: no physical activity
| Outcomes | Potential absolute effects* (IC 95%) | Relative Risk (IC 95%) | Number of participants | Certain of evidence (GRADE) | Comments | |
|---|---|---|---|---|---|---|
| Risk without physical activity | Risk with physical activity | |||||
| Mortality from all causes Follow-up: 3.5 to 12.7 years | - | - | HR 0.52 (0,39-0,69) | 7,392 (2 observational studies) | ⨁○○○ VERY LOWa | - |
| Breast cancer mortality Follow-up: 3.5 to 12.7 years | - | - | HR 0.55 (0,36-0,84) | 7,392 (2 observational studies) | ⨁○○○ VERY LOWa | - |
Subtitle
* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk of the comparator group and the relative effect of the intervention (and its 95% CI). CI: Confidence Interval; RR: relative risk.
A. Methodological limitations. The included studies (Irwin 2011; Holick 2008 showed critical risk of bias by the ROBINS-I tool. Reduced by two levels (-2).
There was no reduction in certainty due to imprecision, indirect evidence and publication bias. There was no increase in certainty by effect size, confounding factor control or dose-response gradient.
High: we are very confident that the true effect is close to the estimated effect
Moderate: We are moderately confident in the effect estimate: the true effect is likely to be close to the effect estimate, but there is a possibility that it will be substantially different.
Low: Our confidence in the effect estimate is limited: The actual effect may be substantially different from the effect estimate.
Very low: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the effect estimate.
| GENERAL PHYSICAL ACTIVITY VERSUS NO PHYSICAL ACTIVITY FOR PEOPLE WITH BREAST CANCER | ||||||
|---|---|---|---|---|---|---|
| Patient or population: breast cancer Context: - Intervention: general physical activity Comparison: no physical activity | ||||||
| Outcomes | Potential absolute effects* (IC 95%) | Relative Risk (IC 95%) | Number of participants | Certain of evidence (GRADE) | Comments | |
| Risk without physical activity | Risk with physical activity | |||||
| Mortality from all causes Follow-up: 3.5 to 12.7 years | - | - | HR 0.53 (0,24-1,20) | 2,658 (2 observational studies) | ⨁○○○ VERY LOW a,b | - |
| Breast cancer mortality Follow-up: 3.5 to 12.7 years | - | - | HR 0.81 (0,48-1,36) | 2,658 (2 observational studies) | ⨁○○○ VERY LOW a,b | - |
Subtitle
* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk of the comparator group and the relative effect of the intervention (and its 95% CI). CI: Confidence Interval; RR: relative risk.
A. Methodological limitations. The included studies (Irwin 2011; Sternfeld 2009) presented a critical risk of bias by the ROBINS-I tool. Reduced two levels (-2).
B. Inaccuracy: 95% CI estimates compatible with significant risk reduction, no effect on risk or significant increase in risk of death)
There was no reduction in certainty due to indirect evidence and publication bias. There was no increase in certainty by effect size, confounding factor control or dose-response gradient.
High: we are very confident that the true effect is close to the estimated effect
Moderate: We are moderately confident in the effect estimate: the true effect is likely to be close to the effect estimate, but there is a possibility that it will be substantially different.
Low: Our confidence in the effect estimate is limited: The actual effect may be substantially different from the effect estimate.
Very low: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the effect estimate.
Mahmood S, MacInnis RJ, English DR, Karahalios A, Lynch BM. Domain-specific physical activity and sedentary behaviour in relation to colon and rectal cancer risk: a systematic review and meta-analysis. Int J Epidemiol. 2017;46(6):1797-1813.
| Patient or population: adults without rectal cancer Context: - Intervention: physical activity (highest level) Comparison: no physical activity (lowest level) | ||||||
|---|---|---|---|---|---|---|
| Outcomes | Potential absolute effects* (IC 95%) | Relative Risk (IC 95%) | Number of participants | Certain of evidence (GRADE) | Comments | |
| Risk without physical activity | Risk with physical activity | |||||
| rectal cancer incidenceTracking: Information unavailable | - | - | HR 0.87 (0,75-1,01) | 1,227.158 (12 observational studies) | NOT EVALUATED | The authors do not present the assessment of the methodological quality of each study |
Subtitle
* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk of the comparator group and the relative effect of the intervention (and its 95% CI). CI: Confidence Interval; RR: relative risk.
High: we are very confident that the true effect is close to the estimated effect
Moderate: We are moderately confident in the effect estimate: the true effect is likely to be close to the effect estimate, but there is a possibility that it will be substantially different.
Low: Our confidence in the effect estimate is limited: The actual effect may be substantially different from the effect estimate.
Very low: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the effect estimate.
Benke IN, Leitzmann MF, Behrens G, Schmid D. Physical activity in relation to risk of prostate cancer: a systematic review and meta-analysis. Annals of Oncology. 2018;29:1154-1179
| Patient or population: men without prostate cancer Context: - Intervention: physical activity (highest level) Comparison: physical activity (lowest level) | ||||||
|---|---|---|---|---|---|---|
| Outcomes | Potential absolute effects* (IC 95%) | Relative Risk (IC 95%) | Number of participants | Certain of evidence (GRADE) | Comments | |
| Risk without physical activity | Risk with physical activity | |||||
| Incidence of ProstateCancer Tracking: Information unavailable | - | - | RR 0.99 (0,75-1,01) | 2,454.147 (31 observational studies) | ⨁○○○ VERY LOW a,b | - |
Subtitle
* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk of the comparator group and the relative effect of the intervention (and its 95% CI). CI: Confidence Interval; RR: relative risk.
A. Methodological limitations. An important part of the studies included in the meta-analysis had methodological limitations according to the NewCastle-Ottawa tool (only 4 studies scored 8 or 9, out of a total of 9 points). Reduced two levels (-2).
B. Inconsistency. I2 = 68%. Reduced one level (-1)
There was no reduction in certainty due to indirect evidence and publication bias. There was no increase in certainty by effect size, confounding factor control or dose-response gradient.
High: we are very confident that the true effect is close to the estimated effect
Moderate: We are moderately confident in the effect estimate: the true effect is likely to be close to the effect estimate, but there is a possibility that it will be substantially different.
Low: Our confidence in the effect estimate is limited: The actual effect may be substantially different from the effect estimate.
Very low: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the effect estimate.
Four independent reviewers rated each selected Guideline using the AGREE-II tool consisting of 23 key items organized in six domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, editorial independence, and two overall evaluation items (AGREE). Each item was graded using a scale of 7 points: from 1, meaning “Strongly disagree,” to 7, meaning “Strongly agree.” The total was presented as a percentage of the maximum possible score for that domain (from 0 to 100%). We also categorized each Guideline according to the extent to which they successfully addressed AGREE-II: Strongly recommended (++), Guidelines whose standardized score exceeds 60% in ≥ 4 AGREE-II domains; the scores of the remaining domains must be ≥ 30% and > 60% for the domain rigor of development. Recommended (+), Guidelines whose standardized score ranges from 30 to 60% in ≥ 4 AGREE-II domains; the rigor of development score must be between 30 and 60%. Not recommended (-), Guidelines whose standardized score is < 30% in ≥ 4 AGREE-II domains or if rigor of development score is less than 30%. In all cases, discrepancies were resolved by a consensus of the whole team.
| Guide - year of publication | AGREE-II domain scores (From 0 to 100%) Guideline | Guideline Quality 1=lowest, 7= highest | Recommended (++, +, -) | |||||
|---|---|---|---|---|---|---|---|---|
| Scope & Purpose | Stakeholders involvement | Rigor in the elaboration | Clarity of presentation | Applicability | Editorial independence | |||
| PAGAC et al. 2018 | 97 | 79 | 82 | 90 | 58 | 16 | 5 | ++ |
| WCRF/AICR 2018 | 86 | 63 | 86 | 91 | 41 | 16 | 5 | + |
| Patel et al. 2019 | 64 | 8 | 12 | 41 | 12 | 69 | 2 | - |
| Pollan et al. 2020 | 40 | 19 | 22 | 36 | 20 | 27 | 2 | - |
| Rock et al. 2020 | 54 | 36 | 42 | 80 | 44 | 52 | 3 | - |
| Median | 64 | 39 | 42 | 80 | 41 | 27 | 3 | |
| Mean (SD) | 68 (23) | 47 (23) | 55 (40) | 67 (27) | 35 (18) | 36 (23) | 3 (1) | |
++: Strongly recommended, +: Recommended, -: Not recommended; SD: Standard Deviation;
| Guide - year of publication | AGREE-II domain scores (From 0 to 100%) Guideline | Guideline Quality 1=lowest, 7= highest | Recommended (++, +, -) | |||||
|---|---|---|---|---|---|---|---|---|
| Scope & Purpose | Stakeholders involvement | Rigor in the elaboration | Clarity of presentation | Applicability | Editorial independence | |||
| Howell et al. 2011 | 94 | 72 | 64 | 55 | 27 | 97 | 5 | + |
| PAGAC et al. 2018 | 97 | 79 | 82 | 90 | 58 | 16 | 5 | ++ |
| WCRF/AICR Breast 2018 | 84 | 52 | 78 | 75 | 26 | 33 | 4 | ++ |
| Patel et al. 2019 | 64 | 8 | 12 | 41 | 12 | 69 | 2 | - |
| Pollan et al. 2020 | 40 | 19 | 22 | 36 | 20 | 27 | 2 | - |
| Median | 84 | 52 | 64 | 55 | 26 | 33 | 4 | |
| Mean (SD) | 76 (23) | 46 (31) | 51 (32) | 59 (22) | 29 (17) | 48 (33) | 3 (1) | |
++: Strongly recommended, +: Recommended, -: Not recommended; SD: Standard Deviation;
Items following items were judged of critical importance: Comprehensiveness of the literature search (item 4); Included studies described in adequate detail (item 8); Adequacy of Risk of bias assessment of primary studies (item 9); Appropriateness of meta-analytical methods (item 11); Consideration of risk of bias when interpreting the results of the review (item 13). According to the responses to critical items, a final overall judgment of the whole review can be: High quality: No or one non-critical weakness: the systematic review provides an accurate and comprehensive summary of the results of the available studies that address the question of interest. Moderate quality: More than one non-critical weakness but no critical flaws. It may provide an accurate summary of the results of the available studies that were included in the review. Low quality: one critical flaw with or without non-critical weaknesses: the review may not provide an accurate and comprehensive summary of the available studies that address the question of interest Critically low quality: More than one critical flaw with or without non-critical weaknesses: the review should not be relied on to provide an accurate and comprehensive summary of the available studies. (Shea et al. 2017).
| Systematic reviews | Amstar II critical items | Quality assessment | ||||||
|---|---|---|---|---|---|---|---|---|
| Item 2 | Item 4 | Item 7 | Item 9 | Item 11 | Item 13 | Item 15 | ||
| Kruk et al. 2016 | No | P Yes | No | No | No | Yes | No | Critically low quality |
| Neil-Sztramko et al. 2017 | No | No | No | Yes | Yes | Yes | No | Critically low quality |
| Neilson et al. 2017 | Yes | Yes | No | Yes | Yes | No | Yes | Critically low quality |
| Mahmood et al. 2017 | Yes | P Yes | No | No | Yes | No | Yes | Critically low quality |
| Benke et al. 2018 | No | No | No | Yes | Yes | Yes | Yes | Critically low quality |
| Brookman-May et al. 2019 | No | No | No | No | No MA | No | No | Critically low quality |
| Dinu et al. 2019 | Yes | Yes | No | Yes | Yes | Yes | No | Critically low quality |
| Chen et al. 2019 | No | P Yes | No | Yes | Yes | Yes | Yes | Critically low quality |
| % Yes | 43 | 29 | 0 | 57 | 71 | 57 | 43 | |
| % Partial Yes | - | 43 | 0 | 0 | - | - | - | |
| % No | 57 | 29 | 100 | 43 | 29 | 43 | 57 | |
P Yes, partial yes; No MA, meta-analysis not performed.
| Systematic reviews | Amstar II critical items | Quality assessment | ||||||
|---|---|---|---|---|---|---|---|---|
| Item 2 | Item 4 | Item 7 | Item 9 | Item 11 | Item 13 | Item 15 | ||
| Wu et al. 2016 | No | P Yes | No | Yes | Yes | No | Yes | Critically low quality |
| Lee et al. 2018 | No | P Yes | No | No | No | No | Yes | Critically low quality |
| Abdin et al. 2019 | Yes | No | No | Yes | No MA | Yes | No MA | Critically low quality |
| Spei et al. 2019 | P Yes | No | No | Yes | Yes | Yes | Yes | Critically low quality |
| % Yes | 25 | 0 | 0 | 75 | 50 | 50 | 75 | |
| % Partial Yes | 25 | 50 | 0 | 0 | - | - | - | |
| % No | 50 | 50 | 100 | 25 | 50 | 50 | 25 | |
P Yes, partial yes; No MA, meta-analysis not performed.
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Journal: Brazilian Journal of Oncology
DOI: 10.1055/s-00059887
e-issn: 2526-8732
Publisher: Thieme Revinter Publicações Ltda.
Publisher address: Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
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