Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)



First Advisor

Anees B. Chagpar

Second Advisor

John Geibel

Subject Area(s)



Beyond its cardiovascular and metabolic benefits, physical activity (PA), may improve the quality of life (QOL) of cancer survivors. However, most studies have been in limited cancer types (breast, colon and prostate) and relatively little focus has been given to its effect on less common cancers. Aim 1 was to conduct a systematic review of the effect of PA on the outcomes of head and neck (H&N) cancer survivors. Aim 2 was to determine the effect of the PA guidelines from the Centers for Disease Control (CDC) on the QOL of a diverse sample of cancer survivors. To do so, we used the results of the 2010 National Health Interview Survey (NHIS). Since the NHIS does not provide verified information regarding cancer severity and treatment, Aim 3 was to determine the effect of meeting the CDC guidelines on QOL after accounting for these variables. This cross-sectional study was conducted at the Breast Center – Smilow Cancer Hospital at Yale-New Haven using patient surveys and treatment information.

In Aim 1 we found that PA improved strength, gait speed, pain, fatigue and physical well-being. In Aim 2 only 10.4% of cancer survivors reported meeting CDC recommendations. Meeting guidelines was associated with good QOL on multivariate analysis. It was also associated with more relationship satisfaction, less fatigue, and better mental and physical health on univariate analyses (p<0.05 for all). Lastly, the aerobic guidelines were predictors of good QOL (p<0.001), independent of sociodemographic factors, while the strength training guidelines were not (p=0.948). In Aim 3, 12% of patients met full CDC PA guidelines, while 60% met aerobic guidelines. On univariate analysis, meeting aerobic guidelines was correlated with higher education level (p=0.032), better insurance status (p=0.014), and fewer financial problems due to cancer (p=0.003). Completion of aerobic activity guidelines was correlated with better QOL (p=0.051); meeting strength training and combined CDC guidelines was not, p=0.618 for both. On multivariate analysis, aerobic activity remained correlated with QOL (p=0.030), independent of sociodemographic and cancer-specific variables. Thus we found that PA, including strength training, improved multiple domains of QOL in H&N cancer survivors. In both diverse national and local clinical samples the CDC aerobic activity guidelines predicted QOL, while those for strength training did not. This association was independent of pathological and treatment related factors. New guidelines may better counsel cancer survivors on strength training for improvement of QOL, and more cancer survivors should be encouraged to meet cardiovascular activity guidelines.


This is an Open Access Thesis.

Open Access

This Article is Open Access