Medicine and Health Sciences Commons^™

The Effects Of Exercise On The Body’S Tolerance To Breast Cancer Treatments, Lindsay C. Lim

Nursing | Student Research Posters

Background: Breast cancer is known as one of the most common types of cancer. Treatments for this cancer include chemotherapy, radiation therapy, and surgery. These treatments, however, can cause negative side effects such as extra pain and fatigue. Exercise is a common intervention that is used in order to keep the body strong while these treatments are occurring.

Objective: The objective of this thesis is to find a correlation between exercise and how it can decrease negative side effects in patients with breast cancer. This thesis includes a literature review which talks about what types of exercise are best, if …

A Lifestyle Management Coaching Intervention For Fear Of Cancer Recurrence In Young Breast Cancer Survivors, Lisa R. Murphy

DNP Research Projects

Abstract

Objective: A significant challenge facing young breast cancer (BC) survivors is learning how to manage fear of cancer recurrence (FCR) during survivorship. Limited tailored FCR interventions and age-appropriate support exist. This Doctor of Nursing (DNP) project, based upon best practice guidelines, aimed to evaluate how a Lifestyle Management Coaching Intervention (LMCI) could help young female BC survivors learn how to decrease and manage their FCR more effectively and experience improved health outcomes.

Method: Eligible participants were female BC survivors aged 18-59 with Stage I-III BC demonstrating elevated baseline FCR screening scores during the extended survival period recruited from the …

Exercise Counselling And Referral In Cancer Care: An International Scoping Survey Of Health Care Practitioners’ Knowledge, Practices, Barriers, And Facilitators, Imogen Ramsey, Alexandre Chan, Andreas Charalambous, Yin Ting Cheung, H. S. Darling, Lawson Eng, Lisa Grech, Nicolas H. Hart, Deborah Kirk, Sandra A. Mitchell, Dagmara Poprawski, Elke Rammant, Margaret I. Fitch, Raymond J. Chan

Research outputs 2022 to 2026

Purpose:

Evidence supports the role of prescribed exercise for cancer survivors, yet few are advised to exercise by a healthcare practitioner (HCP). We sought to investigate the gap between HCPs’ knowledge and practice from an international perspective.

Methods:

An online questionnaire was administered to HCPs working in cancer care between February 2020 and February 2021. The questionnaire assessed knowledge, beliefs, and practices regarding exercise counselling and referral of cancer survivors to exercise programs.

Results:

The questionnaire was completed by 375 participants classified as medical practitioners (42 %), nurses (28 %), exercise specialists (14 %), and non-exercise allied health practitioners (16 …

Physical Activity In Older Adults With Metastatic Gastrointestinal Cancer: A Pilot And Feasibility Study, Justin C. Brown, Elizabeth Brighton, Nancy Campbell, Nadine J. Mccleary, Thomas A. Abrams, James M. Cleary, Peter C. Enzinger, Kimmie Ng, Douglas Rubinson, Brian M. Wolpin, Matthew B. Yurgelun, Jeffrey A. Meyerhardt

School of Medicine Faculty Publications

No abstract provided.

Adverse Events Reporting Of Clinical Trials In Exercise Oncology Research (Advance): Protocol For A Scoping Review, Hao Luo, Oliver Schumacher, Daniel A. Galvão, Robert U. Newton, Dennis R. Taaffe

Research outputs 2022 to 2026

Introduction: Adequate, transparent, and consistent reporting of adverse events (AEs) in exercise oncology trials is critical to assess the safety of exercise interventions for people following a cancer diagnosis. However, there is little understanding of how AEs are reported in exercise oncology trials. Thus, we propose to conduct a scoping review to summarise and evaluate current practice of reporting of AEs in published exercise oncology trials with further exploration of factors associated with inadequate reporting of AEs. The study findings will serve to inform the need for future research on standardisation of the definition, collection, and reporting of AEs for …

Association Between Energy Balance-Related Factors And Clinical Outcomes In Patients With Ovarian Cancer: A Systematic Review And Meta-Analysis, Stephanie Stelten, Christelle Schofield, Yvonne A. W. Hartman, Pedro Lopez, Gemma G. Kenter, Robert U. Newton, Daniel A. Galvão, Meeke Hoedjes, Dennis R. Taaffe, Luc R. C. W. Van Lonkhuijzen, Carolyn Mcintyre, Laurien M. Buffart

Research outputs 2022 to 2026

Background:

This systematic review and meta-analysis synthesized evidence in patients with ovarian cancer at diagnosis and/or during first-line treatment on; (i) the association of body weight, body composition, diet, exercise, sedentary behavior, or physical fitness with clinical outcomes; and (ii) the effect of exercise and/or dietary interventions.

Methods:

Risk of bias assessments and best-evidence syntheses were completed. Meta-analyses were performed when ≥ 3 papers presented point estimates and variability measures of associations or effects.

Results:

Body mass index (BMI) at diagnosis was not significantly associated with survival. Although the following trends were not supported by the best-evidence syntheses, the meta-analyses …

Changes In Physical Activity And Relationships To Submaximal Exercise Capacity And Cardiac Function During Breast Cancer Therapy, Moriah P. Bellissimo

Theses and Dissertations

Background: Breast cancer (BC) survivors are at high risk for heart failure due to curative cancer therapies. In non-cancer populations, physical activity is a first line treatment for preventing cardiovascular disease. This study examined whether more physical activity was associated with better submaximal exercise capacity and cardiac function during the first three months of cancer therapy.

Methods: Participants included 223 women with stage I-III BC before therapy and after three months of undergoing treatment and 126 controls. Leisure time physical activity was reported using the Godin Sheppard leisure time exercise questionnaire. Cardiac function was assessed by cardiac magnetic resonance, and …

The Effects Of Physical Activity On Cancer Patients Undergoing Treatment With Immune Checkpoint Inhibitors: A Scoping Review., Amy L Shaver, Swapnil Sharma, Nikita Nikita, Daniel S Lefler, Atrayee Basu-Mallick, Jennifer M Johnson, Meghan Butryn, Grace Lu-Yao

Department of Medical Oncology Faculty Papers

BACKGROUND: Cancer therapies are associated with multiple adverse effects, including (but not limited to) cancer-related fatigue (CRF). Fatigue is one of the most common side effects of immune checkpoint inhibitors (ICIs), occurring in up to 25% of patients. Physical activity has been shown to help reduce CRF through modulating the immune system, and may synergistically aid in the anti-tumor effects of ICIs. This review describes the nature and scope of evidence for the effects associated with concurrent physical activity while undergoing ICI therapy.

METHOD: Scoping review methodology was utilized to identify studies, extract data, and collate and summarize results.

RESULTS: …

The Effects Of Physical Activity On Cancer Patients Undergoing Treatment With Immune Checkpoint Inhibitors: A Scoping Review, Amy L Shaver, Swapnil Sharma, Nikita Nikita, Daniel S Lefler, Atrayee Basu Mallick, Jennifer Johnson, Meghan Butryn, Grace Lu-Yao

Department of Medical Oncology Faculty Papers

Background: Cancer therapies are associated with multiple adverse effects, including (but not limited to) cancer-related fatigue (CRF). Fatigue is one of the most common side effects of immune checkpoint inhibitors (ICIs), occurring in up to 25% of patients. Physical activity has been shown to help reduce CRF through modulating the immune system, and may synergistically aid in the anti-tumor effects of ICIs. This review describes the nature and scope of evidence for the effects associated with concurrent physical activity while undergoing ICI therapy.

Method: Scoping review methodology was utilized to identify studies, extract data, and collate and summarize results.

Results: …

Returning To Sport: Female Athletes Living With And Beyond Cancer., Anna L. Schwartz, Christopher Terry

Kimmel Cancer Center Faculty Papers

Many athletes living with and beyond cancer can continue to train and, in some cases, compete during treatment. Following cancer treatment, athletes can return to competitive sport but need to learn to adapt their physical strength and training to the lingering effects of cancer. It is critical for oncology healthcare providers to use the principles of assess, refer and advise to exercise oncology programs that are appropriate for the individual. Managing side effects of treatment is key to being able to train during and immediately following cancer treatment. Keen attention to fatigue is important at any point in the cancer …

Exercise And Nutrition Induced Weight Loss For Prostate Cancer Patients, Rebekah Louise Wilson

Theses: Doctorates and Masters

This thesis encompasses six main chapters - two reviews and four experimental chapters, in addition to a general introduction and discussion.

Review 1 (Chapter 2) is a discussion of the negative impact of obesity on prostate cancer prognosis and common prostate cancer treatments.

Review 2 (Chapter 3) is an evaluation of the current literature examining prostate cancer patients receiving androgen deprivation therapy (ADT) and how exercise and nutrition interventions can be used to induce fat loss, while preserving or improving lean mass.

Study 1 (Chapter 4) is an examination of the efficacy of a weight loss program in altering body …

Immediate Versus Delayed Exercise In Men Initiating Androgen Deprivation: Effects On Bone Density And Soft Tissue Composition, Dennis R. Taaffe, Daniel A. Galvao, Nigel Spry, David Joseph, Suzanne K. Chambers, Robert A. Gardiner, Dickon Hayne, Prue Cormie, David H.K. Shum, Robert U. Newton

Research outputs 2014 to 2021

OBJECTIVES: To examine whether it is more efficacious to commence exercise medicine in men with prostate cancer at the onset of androgen-deprivation therapy (ADT) rather than later on during treatment to preserve bone and soft-tissue composition, as ADT results in adverse effects including: reduced bone mineral density (BMD), loss of muscle mass, and increased fat mass (FM).

PATIENTS AND METHODS: In all, 104 patients with prostate cancer, aged 48-84 years initiating ADT, were randomised to immediate exercise (IMEX, n = 54) or delayed exercise (DEL, n = 50) conditions. The former consisted of 6 months of supervised resistance/aerobic/impact exercise and …

Yoga-Specific Enhancement Of Quality Of Life Among Women With Breast Cancer: Systematic Review And Exploratory Meta-Analysis Of Randomized Controlled Trials, Daline El-Hashimi, Kevin M. Gorey

Social Work Publications

Physical activities during and after cancer treatment have favorable psychosocial effects. Increasingly, yoga has become a popular approach to improving the quality of life (QoL) of women with breast cancer. However, the extant synthetic evidence on yoga has not used other exercise comparison conditions. This meta-analysis aimed to systematically assess yoga-specific effects relative to any other physical exercise intervention (eg, aerobics) for women with breast cancer. QoL was the primary outcome of interest. Eight randomized controlled trials with 545 participants were included. The sample-weighted synthesis at immediate postintervention revealed marginally statistically and modest practically significant differences suggesting yoga’s potentially greater …

Oxytocin And Cancer: An Emerging Link, Ben Lerman, Trisheena Harricharran, Olorunseun O. Ogunwobi

Publications and Research

The neuropeptide hormone oxytocin, which is released from the posterior pituitary gland, is involved in a number of physiological processes. Understanding of its effects is gradually increasing due to new research in this area. While mostly recognized as a reproductive system hormone, oxytocin also regulates other organ systems such as the brain and cardiovascular system. Recently, research has focused on unraveling its involvement in cancer, and emerging evidence suggests a potential role for oxytocin as a cancer biomarker. This review summarizes observations linking oxytocin and cancer, with a special emphasis on prostate cancer, where it may promote cell proliferation. Research …

Patient Experiences Of A Physiotherapy-Led Multidisciplinary Rehabilitative Intervention After Successful Treatment For Oesophago-Gastric Cancer, Annemarie Bennett, L. O'Neill, D. Connolly, E. M. Guinan, L. Boland, Suzanne Doyle, J. O'Sullivan, J. V. Reynolds, J. Hussey

Articles

Purpose To qualitatively explore the perceived impact of a 12-week rehabilitative intervention for oesophago-gastric cancer survivors on their physical, mental and social wellbeing. Methods Of the 21 participants who completed the intervention, 19 took part in a semi-structured focus group interview. Four audio-taped focus groups were held, ranging in size from two to eight participants. Focus groups were transcribed and analysed using a descriptive qualitative approach. Results At recruitment, participants were 23.5 ± 15.2 months post-surgery and all had suboptimal fitness levels. Participants reported improvements in their physical capacity and ability to carry out activities of daily living during the …

Feasibility And Preliminary Efficacy Of A 10-Week Resistance And Aerobic Exercise Intervention During Neoadjuvant Chemoradiation Treatment In Rectal Cancer Patients, Favil Singh, Daniel A. Galvão, Robert Newton, Nigel A. Spry, Michael K. Baker, Dennis Taaffe

Research outputs 2014 to 2021

Background:

Neoadjuvant chemoradiation treatment (CRT) in rectal cancer patients is associated with a reduction in physical capacity, lean mass and increased fatigue. As a countermeasure to these treatment-related adverse effects, we examined the feasibility and preliminary efficacy of a 10-week exercise program during CRT.

Methods:

Ten rectal cancer patients (7 men, aged 27-70 years, body mass index = 26.4 ± 3.8 kg/m2) receiving CRT undertook supervised resistance and aerobic exercise twice weekly. Assessments were undertaken pre- and post-intervention for upper and lower body muscle strength by 1-RM, muscle endurance, physical performance tests, body composition by dual X-ray absorptiometry, quality of …

Overwhelming Research And Clinical Evidence Of Exercise Medicine Efficacy In Cancer Management—Translation Into Practice Is The Challenge Before Us, Robert Newton

Research outputs 2014 to 2021

The paper “Connecting people with cancer to physical activity and exercise programs: a pathway to create accessibility and engagement”1 is very timely. As the authors have convincingly demonstrated, rigorous clinical and research evidence support something of which most medical and allied health professionals are cognizant: the benefit of physical activity and exercise for people with cancer.

Agenda For Translating Physical Activity, Nutrition, And Weight Management Interventions For Cancer Survivors Into Clinical And Community Practice., Karen Basen-Engquist, Catherine M Alfano, Melissa Maitin-Shepard, Cynthia A Thomson, Kathryn H Schmitz, Bernardine M Pinto, Kevin Stein, David S Zucker, Karen L Syrjala, Elizabeth Fallon, Colleen Doyle, Wendy Demark-Wahnefried

Articles, Abstracts, and Reports

Evidence supporting physical activity, diet, and weight management for cancer survivors has grown, leading to the development of guidelines and interventions. The next step is to identify necessary practice and policy changes and to develop a research agenda to inform how interventions can be delivered to survivors most effectively and efficiently in health care settings and by community-based organizations. Here, an agenda is proposed for research, practice, and policy that incorporates recommendations for a range of programming options, a patient-centered, tailored screening and referral approach, and training needs for survivorship care providers and providers of exercise, nutrition, and weight management …

Effects And Moderators Of Exercise On Quality Of Life And Physical Function In Patients With Cancer: An Individual Patient Data Meta-Analysis Of 34 Rcts, Laurien M. Buffart, Joeri Kalter, Maike G. Sweegers, Kerry S. Courneya, Robert U. Newton, Neil K. Aaronson, Paul B. Jacobsen, Anne M. May, Daniel A. Galvao, Mai J. Chinapaw, Karen Steindorf, Melinda L. Irwin, Martjin M. Stuiver, Sandi Hayes, Kathleen A. Griffith, Alejandro Lucia, Ilse Mesters, Ellen Van Weert, Hans Knoop, Martine M. Goedendorp, Nanette Mutrie, Amanda J. Daley, Alex Mcconnachie, Martin Bohus, Lene Thorsen, Karl-Heinz Schulz, Camille E. Short, Erica L. James, Ron C. Plotnikoff, Gill Arbane, Martina E. Schmidt, Karin Potthoff, Marc Van Beurden, Hester S. Oldenburg, Gabe S. Sonke, Wim H. Van Harten, Rachel Garrod, Kathryn H. Schmitz, Kerri M. Winters-Stone, Miranda J. Velthuis, Dennis Taaffe, Willem Van Mechelen, Marie-Jose Kersten, Frans Nollet, Jennifer Wenzel, Joachim Wiskemann, Irma M. Verdonck-De Leeuw, Johannes Brug

Research outputs 2014 to 2021

This individual patient data meta-analysis aimed to evaluate the effects of exercise on quality of life (QoL) and physical function (PF) in patients with cancer, and to identify moderator effects of demographic (age, sex, marital status, education), clinical (body mass index, cancer type, presence of metastasis), intervention-related (intervention timing, delivery mode and duration, and type of control group), and exercise-related (exercise frequency, intensity, type, time) characteristics.

Relevant published and unpublished studies were identified in September 2012 via PubMed, EMBASE, PsycINFO, and CINAHL, reference checking and personal communications. Principle investigators of all 69 eligible trials were requested to share IPD from …

Effects Of Different Exercise Modalities On Fatigue In Prostate Cancer Patients Undergoing Androgen Deprivation Therapy: A Year-Long Randomised Controlled Trial, Dennis Taaffe, Robert Newton, Nigel Spry, David Joseph, Suzanne K. Chambers, Robert Gardiner, Brad Wall, Prue Cormie, Kate Bolam, Daniel A. Galvao

Research outputs 2014 to 2021

Background

Physical exercise mitigates fatigue during androgen deprivation therapy (ADT); however, the effects of different exercise prescriptions are unknown.

Objectives

To determine the long-term effects of different exercise modes on fatigue in prostate cancer patients undergoing ADT.

Design, setting, and participants

Between 2009 and 2012, 163 prostate cancer patients aged 43–90 y on ADT were randomised to exercise targeting the musculoskeletal system (impact loading + resistance training; ILRT; n = 58), the cardiovascular and muscular systems (aerobic + resistance training; ART; n = 54), or to usual care/delayed exercise (DEL; n = 51) for 12 mo across university-affiliated exercise clinics …

Case Study Of Persons With Cancer Participating In A Community-Based Exercise Program: An Exploration Of Meaning And Change, Barbara K. Haas, Melinda Hermanns, Christina Melin-Johansson

The Qualitative Report

Increasingly, research supports the importance of incorporating exercise into the cancer care paradigm. While quantitative studies have substantiated the significant effects of exercise on physical functioning, the individual’s perspective of participating in an exercise program has rarely been considered. The purpose of this study was to explain the impact of a community based exercise program on the lives of persons with cancer and their caregivers. Based on Bandura’s Social Cognitive Theory, a single explanatory case study with multiple embedded units of analyses was conducted. Interviews were conducted with 10 individuals representing participants with cancer, their caregivers, and health care providers. …

An Overview Of Cancer Rehabilitation And Exercise In The Literature: Promoting Increased Referrals To Improve Oncology Outcomes, Leslie J. Waltke

Journal of Patient-Centered Research and Reviews

Medical management for malignant neoplastic diseases includes surgery, chemotherapy, radiation, and hormonal and biological therapies. Each of these antineoplastic interventions has unique impacts on physiological, musculoskeletal and functional performance. Cancer rehabilitation is the area of physical medicine responsible for addressing impairments associated with cancer treatment and survivorship, advanced disease and end of life. Although it is expected that more than one-half of persons being treated for cancer will suffer moderate pain and physical and functional decline, and that most will describe fatigue, referrals to rehabilitation are traditionally low. Evidence suggests that referrals to rehabilitation before, during and after treatment for …

A Rehabilitation Program For Lung Cancer Patients During Postthoracotomy Chemotherapy, Amy J. Hoffman, Ruth Ann Britnall, Alexander Von Eye, Lee W. Jones, Gordon Alderink, Lawrence H. Patzelt, Jean K. Brown

Peer Reviewed Articles

Objective: The objective of this pilot study was to describe the effects of a 16-week home-based rehabilitative exercise program on cancer-related fatigue (CRF), other symptoms, functional status, and quality of life (QOL) for patients with non-small cell lung cancer (NSCLC) after thoracotomy starting within days after hospital discharge and continuing through the initiation and completion of chemotherapy.

Materials and methods: Five patients with NSCLC completed the Brief Fatigue Inventory (measuring CRF severity) and the MD Anderson Symptom Inventory (measuring symptom severity) before and after thoractomy, and at the end of each week of the 16-week exercise program. Additionally, the Medical …

Improving Sexual Health In Men With Prostate Cancer: Randomised Controlled Trial Of Exercise And Psychosexual Therapies, Prue Cormie, Suzanne K. Chambers, Robert U. Newton, Robert A. Gardiner, Nigel Spry, Dennis R. Taaffe, David Joseph, M Akhlil Hamid, Peter Chong, David Hughes, Kyra Hamilton, Daniel A. Galvão

Research outputs 2014 to 2021

Background: Despite being a critical survivorship care issue, there is a clear gap in current knowledge of the optimal treatment of sexual dysfunction in men with prostate cancer. There is sound theoretical rationale and emerging evidence that exercise may be an innovative therapy to counteract sexual dysfunction in men with prostate cancer. Furthermore, despite the multidimensional aetiology of sexual dysfunction, there is a paucity of research investigating the efficacy of integrated treatment models. Therefore, the purpose of this study is to: 1) examine the efficacy of exercise as a therapy to aid in the management of sexual dysfunction in men …

Recommendations For High-Priority Research On Cancer-Related Fatigue In Children And Adults., Andrea M. Barsevick, Michael R. Irwin, Pamela Hinds, Andrew Miller, Ann Berger, Paul Jacobsen, Sonia Ancoli-Israel, Bryce B Reeve, Karen Mustian, Ann O'Mara, Jin-Shei Lai, Michael Fisch, David Cella

Department of Medical Oncology Faculty Papers

Over the past decades, some scientific progress has been made in understanding and treating cancer-related fatigue (CRF). However, three major problems have limited further progress: lack of agreement about measurement, inadequate understanding of the underlying biology, and problems in the conduct of clinical trials for CRF. This commentary reports the recommendations of a National Cancer Institute Clinical Trials Planning Meeting and an ongoing National Cancer Institute working group to address these problems so that high-priority research and clinical trials can be conducted to advance the science of CRF and its treatment. Recommendations to address measurement issues included revising the current …

Exercise Medicine For Prostate Cancer, Robert U. Newton, Daniel A. Galvao

Research outputs 2013

Since initial reports in the mid-1980s, there has been increasing interest in the application of exercise as medicine for the prevention and management of cancer. A large number of high-quality, randomised, controlled trials with cancer survivors have confirmed both aerobic and resistance exercise to be highly beneficial for improving body composition, quality of life, mental health functional capacity and reducing risk of cancer recurrence and development of other chronic diseases. Such benefits have ultimately been realised in reduced cancer mortality between 30 and 60 % in large cohort retrospective studies. Treatments for prostate cancer are increasingly effective with quite high …

Characteristics And Quality Of Life Of Patients Presenting To Cancer Support Centres: Patient Rated Outcomes And Use Of Complementary Therapies, Bonnie J. Furzer, Kemi E. Wright, Anna S. Petterson, Karen E. Wallman, Timothy R. Ackland, David Jl Joske

Research outputs 2013

Background: In order to effectively target and provide individualised patient support strategies it is crucial to have a comprehensive picture of those presenting for services. The purpose of this study was to determine the characteristics and patient rated outcomes of individuals presenting to SolarisCare cancer support centres and their choices regarding complementary and integrated therapies (CIT).Methods: A cohort with a current or previous cancer diagnosis aged 18 - 87 years presenting to a SolarisCare centre during a 5-day period completed a questionnaire. Four SolarisCare centres participated in the trial including regional and metropolitan locations. Outcomes included medical and demographic characteristics, …

Is Weight Lifting Effective In Reducing Lymphedema In Breast Cancer Survivors?, Diana Petrucello

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not weight lifting is effective in reducing lymphedema in breast cancer survivors.

STUDY DESIGN: Systematic review of three English language primary studies published in 2009 and 2010.

DATA SOURCES: Three single blind, randomized controlled trials comparing progressive weight lifting and other treatments in breast cancer survivors were found using the Cochrane Database of Systematic Reviews and PubMed.

OUTCOMES MEASURED: Incidence of breast cancer-related lymphedema onset measured by blinded certified lymphedema therapists using a standardized clinical evaluation derived from the Common Toxicity Criteria version 3.0, comprising of interlimb …

Oncolog Volume 55, Number 01, January 2010, Bryan Tutt, Bita Esmaeli

OncoLog MD Anderson's Report to Physicians (All issues)

"

• Ocular Cancer: Tumors of the eye threaten sight and often indicate presence of extensive disease
• Eye Care for Cancer Patients
• Doctors Team Up to Battle Retinoblastoma
• Compass Winter 2010: Ductal Carcinoma In Situ: Choosing Treatment for a Common Group of Early, Confined Breast Cancers
• Toward Tomorrow
• House Call: Three Targets for New Year's Resolutions

"

Oncolog, Volume 52, Number 02, February 2007, Diane Witter

OncoLog MD Anderson's Report to Physicians (All issues)

• New Findings on Aspirin and Heart Attacks
• Kicking Off a Trend: Cancer-Related Deaths Decline
• House Call: Working Out How to Lower Your Risk of Cancer