Diagnosis and treatment for cancer represent a major life-time stressor for any patient. While the diagnosis of a life-threatening illness is stressful, undergoing treatment for cancer including surgery, radiotherapy and chemotherapy result in stress to the patient. In addition, cancer treatment frequently is associated with fatigue, physical de-conditioning and metabolic abnormalities characteristic of the metabolic syndrome, leading to speculations that cancer therapy may render survivors more prone to developing metabolic syndrome and its sequelae, cardiovascular disease. In a recently conducted study we detected a high incidence of hyperlipidemia and increased body fat content, decreased aerobic performance and musculoskeletal functioning and a high frequency of parameters of psychological distress in long-term survivors of pediatric sarcoma (1, 3). Based on these data and findings, it appears desirable to devise a program that would help cancer survivors not only to improve musculoskeletal functioning and aerobic performance, as a physical exercise program would offer, but in addition relieve psychological stress and enhance the well-being of cancer survivors after completion of treatment with multimodality therapy. Tai Chi Chuan (TCC) has been used in Asian culture for centuries to improve wellness, reduce stress, and to promote healing by improving the flow of Qi. While a number of studies have provided scientific support for these claims in different populations, a beneficial role for TCC in the management of cancer survivors has not been established. We received a total 233 referrals from PRPL since the study began, 135 of which were referred in the past year since 8/31/07. Of these 233 referrals, 55 (24%) have been enrolled on-study, 13 (6%) are potential candidates currently in the screening process, 53 (23%) were ineligible by phone screen, 12 (5%) are to be re-evaluated later to determine eligibility, and 100 (43%) were not interested, not good candidates, or lost-to-follow-up. Thus, since our last annual report, we have enrolled an additional 37 study participants on-study (49% increase since last year). Of the total 55 study participants enrolled on-study, 8 of them completed the wait-list control arm and were re-randomized into one of the exercise interventions;thus, there are a total of 63 total evaluable participants. Of these, 36 (57%) completed the 12 week study period, 19 (30%) are in process (2 are completing the current cohort, 10 are enrolled for the fall 2008 cohort, and 7 have requested a future cohort), and 9 (14%) withdrew prior to beginning or while participating on-study. Of the 9 participants who withdrew, 4 withdrew prior to starting the study (1 due to pregnancy, 2 due to family/work scheduling conflicts, and 1 didnt want to be in the control group) and 5 withdrew while on-study (1 due to worsening plantar fascitis and 4 due to conflicts with work schedule). Three additional participants who completed the wait list control group chose to withdraw participation before re-randomization;their reasons for withdrawing included relocation from the area, scheduling conflicts due to a disabled daughter, and not wanting to be in the cycling arm of the study. This study aims to compare in a randomized, wait-list controlled design, the efficacy of TCC to an exercise program in improving aerobic exercise capacity and endurance, reducing stress and improving Quality of Life in adult survivors of malignant solid tumors.
