"Despite mounting evidence that exercise programs can improve cancer outcomes, access to them remains limited.
Observational research has
long suggested that exercise improves cancer survival, particularly for breast cancer patients. Last year, a
landmark randomized controlled trial showed that colon cancer patients who participated in a structured exercise program with a trainer-coach over three years were less likely to see their cancers come back and had a better quality of life. Among those in the program, 90 percent were alive after eight years, compared with 83 percent in the control group.
A later study showed the program, which altogether cost $3,000 per person, also
saved the health system money — “a home run,” said Dr. Scott Ramsey, a cancer researcher and health economist at the Fred Hutch Cancer Center in Washington State."
Has anyone read the study to check they accounted for the obvious re: drop-out rates/those too ill won't be signing up in the first place so it is more of a filter of 'those who were wellest could exercise' than anything else?
Or to be more precise if you are actually just using a program as a filter to get those who’ve the spare time, health and resources to consistently attend an organised programme vs the control not filtering those out. It’s like comparing stay at home ill people who can choose to work if it’s nice and works for them vs those struggling to keep a noisy mouldy roof over their kids heads being asked to turn up twice a week at a hospital 2hrs by bus 11-3 on weekdays. Not exercise. Who knows how much exercise in total any who even dropped out did.
7% sounds like a more than feasible figure between the control group and program completers as what could be accounted for in this - particularly if you consider ability to keep turning up to the appointments filters out those iller and the rest get fitter (not due to program but because they aren’t the unlucky ones with their illness so time heals) so the entireity of those who 'were ever assigned' really is more appropriate as a comparator but of course thos in charge would say that if that meant it included people who didn't do the programme then their lack of doing well shouldn't count and that's fallacial (hence why you then end up getting the silly studies basically focusing on compliance and 'acceptability' of a program because they 'reframe' the cause of the drop-outs rather than seeing the obvious that they did worse because they were the unlucky 7% that shows in the control group but just gets disappeared as a drop-out in the sample).
I'm imagining theoretically that how they recruited would be an interesting one to know too because if it is a poster, list of 'can sign up for' trials people would visit or even newsletter type email as a push communication then likely only those who felt up to and were into an exercise program would volunteer, because they were into eg badminton and jogging anyway. And might be if they are put int the control group doing a bit of exercise anyway therefore even if it isn't 'the program', it is simply the difference that they don't need to drop out if they can't turn up for the appointment for a few weeks or start not going because they find they are going backwards - where the ones who are on the program side do.
POtentially both groups were really probably doing exercise/program didn't matter - I don't believe 'organised' vs not makes the difference because those into exercise will be doing it in a pretty organised fashion anyway, so I'd also believe any difference found was in effect 'manufactured' by the process regarding drop-outs because both groups who were well were also probably exercising as much as each other unless they couldn't or were getting iller (and those people get hidden in the sample and included in the control). This group is perhaps more likely to have people who didn't want to give up exercise but they'd also be more body-aware that it isn't normal for them to keep getting less fit/worse feeling so bad eg 8 weeks in.
Whereas if there is someone's medical team members suggesting it to them as a good idea then you include an additional group of people who might not be into exercise and so don't if they aren't on the program, or maybe they do take it as impetus to do the couch to 5km or tai chi class instead but they were less 'into' exercise anyway and maybe it takes less for them to think I'm not up to doing my jog today - I'm trying to think how that translates into those people being in a program (vs control where they aren't reporting to anyone so just don't) that their dr suggested and I think the fact is that whatever happens in the middle or early on with trying to 'do the right thing' by the end of enough weeks lets be honest the person in charge of the program is probably telling them if they feel they are getting worse to drop out too at which point that effect of 'shoulds' combines
-
that very human issue undermines the pretence of the control, not that you'd want the ethics of someone forcing someone who is getting iller to keep doing it either 'just to make sure they are included in the sample, having done all the program'.
It is also pretty interesting when you think about whether when it is something like this as a piece of research that I'd bet they'd happily let the participant drop out because they can at that point probably deep down see they are getting worse, and yet the very same people in a different circumstance then can't see that in someone in front of them or acknowledge in ME/CFS that it isn't BS like false beliefs or being over-sensitive to bodily sensations - ie how what they see or decide as a judgement call might well depend on whether / how it is on their 'scorecard',
....and hence reminds me of how big an issue the move to then change the measure used
after such has been signed off and it goes into implementation to BS like PROMS are for KPIs is which don't care if they made someone worse as long as the person completed, following a study that makes claims about making someone better that were based on outcome but allowed removal of those who got worse by using 'complete the course' as a filter?
We've got a sausage machine issue where in the first round the illest are removed to create an effect that can be claimed is 'for all' and in the implementation/second round the measure gets changed to just checking people completed it with those people who would have been dropped out being then presented as non-compliant or needing extra motivation and getting iller
because of those reasons
It underlines the importance to me of how in daily care PROMS need to
never be the only measure and all departments, and certainly not be taken to be assumed to explain those who deteriorate, particularly rehab-related ones need to be required to have someone else making independent assessments (ie not rehab staff) related to whether the illness has got worse
rehab surely should only be allowed to use something that assesses the staff and maybe looks at the group that weren't deteriorating to see if they found it worthwhile or not adding anything
but most importantly be being asked questions why they are excluding the ones who actually were most in need of medical treatment instead of focusing on making sure they get the
right treatment as that's the group
all this research should be concerned about and yet this method is an 'anything but' charade?
