A Dyadic Exercise Intervention to Reduce Psychological Distress Among Lesbian, Gay, and Heterosexual Cancer Survivors

Contact Name: 
Charles Kamen, PhD
Publication Author(s): 
Kamen, Charles; Heckler, Charles; Janelsins, Michelle; Peppone, Luke; McMahon, James; Morrow, Gary; Bowen, Deborah; Mustian, Karen
Quality of Life
Target Population: 
Cancer Site: 
Setting Description: 

Within Strong Memorial Hospital, subjects were seen at the PEAK Human Performance Clinical Research Core Laboratory.

Project Description: 

The purpose of the study was to see whether exercise can improve the health and well-being of cancer survivors and their caregivers. 42 potentially eligible subjects were asked to wear a monitor and pedometer for a week prior to their baseline assessment which included a fasting blood draw, fitness testing and computerized questionnaires. After completing baseline measures, subjects were randomized to one of two conditions (survivor and caregiver to exercise together as a dyad or survivor to exercise alone) and subjects were shown how to perform all home-based exercises. The intervention took place over a six-week period with weekly calls from a coordinator who provided updates, encouragement and reminded subjects to fill out their daily diaries. After the intervention, each subject, again, wore the monitor and pedometer for a week and then came in for their post-intervention visit, which included the same assessments as the baseline visit.

Significance of Findings: 

At baseline (before the intervention), lesbian and gay cancer survivors reported more depressive symptoms than their heterosexual counterparts, regardless of whether they engaged in survivor-only exercise or paired exercise with a caregiver. At post-intervention, our analyses did not detect differences in depressive symptoms between lesbian/gay and heterosexual cancer survivors, indicating that exercise may reduce disparities in depression experienced by lesbian/gay survivors. In addition, the current study indicates that dyadic exercise (i.e., including a caregiver) may reduce depressive symptoms among lesbian, gay and heterosexual cancer survivors, relative to exercise for the survivor alone.

Key Takeaways or Implications for Patients or Caregivers: 
Exercise may reduce disparities in psychological distress among lesbian and gay cancer survivors. Paired exercise may reduce psychological distress among survivors of diverse sexual orientations.
Key Takeaways for Practice: 
Opportunities for Future Research or Takeaways for Other Researchers: 
Given the pilot nature of the current study, all results need to be replicated in a larger, Phase II or III trial, with the goal of elaborating on inter-partner models (like social control theory) that have yet to be validated among LGBT survivors and their caregivers. A larger trial could also test mediational hypotheses regarding the role of change in social support and control factors (i.e., partner support and exercise adherence) in predicting change in psychological distress among lesbian, gay, and heterosexual survivors. Future studies should include additional time points and additional mechanistic measurements (e.g., inflammatory biomarkers) in order to establish pathways by which exercise can affect distress among lesbian, gay, and heterosexual survivors. Future studies should also focus on recruiting bisexual and transgender cancer survivors, so as to characterize cancer-related symptoms and side effects across the spectrum of sexual and gender minorities.
Patient, Caregiver and/or Communities Research Engagement: 
Recruitment was done through local community organizations that serve lesbian and gay communities as well as self-identified lesbian and gay referrals from oncologists and nurses at the Wilmot Cancer Center at the University of Rochester. Heterosexual subjects were also referred by the same oncologists and nurses.

National Cancer Institute grants K07 CA190529, R25CA102618-05, and UG1 CA189961, and by a research seed grant from the James P. Wilmot Cancer Institute.