INTRODUCTION: An optimal relative dose intensity (RDI) of adjuvant chemotherapy is associated with better survival in patients with breast cancer. Little is known about the role of physical fitness in attaining an adequate RDI in patients with early stage breast cancer. We investigated the association between pre-treatment physical fitness and RDI in this population.METHODS: We pooled individual patient data from two randomized exercise trials that studied exercise programs in early breast cancer: the PACES (n = 230) and the PACT (N = 204) study. Logistic regression models were used to evaluate the association between pre-treatment fitness and achieving an optimal RDI (≥85%). In addition, we added an interaction term to the model to explore the potential moderating effect of participating in an exercise program.RESULTS: Data were available for 419 patients (mean age at diagnosis 50.0 ± 8.6 years). In the total sample, lower pre-treatment physical fitness was associated with significantly lower odds of achieving ≥85% RDI: age-adjusted OR 0.66 [95%CI 0.46-0.94]. In patients allocated to the supervised exercise intervention during chemotherapy (n = 173), the association between pretreatment physical fitness and RDI was almost completely mitigated (OR 0.95 (95%CI 0.54-1.56)), while it was more pronounced in patients who received care as usual (n = 172, OR 0.31 (95%CI 0.13-0.63) pinteraction: 0.022).CONCLUSION: Early stage breast cancer patients with relatively lower levels of pretreatment physical fitness have lower odds of achieving an optimal dose of chemotherapy. Given that physical fitness is modifiable and our results suggest that following a moderate-to-high intensity exercise training during chemotherapy could improve treatment completion, clinicians should not refrain from referring patients to supportive exercise programs because of low fitness.
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We analyze how ‘original’ residents in different gentrifying working class areas in Amsterdam North experience and evaluate the changes in their neighborhood in terms of social cohesion – in other words, whether they feel at home in their changing neighborhood and whether they feel connected to other residents. Policy interventions often focus on establishing connections between residents with different socioeconomic or cultural backgrounds, in order to stimulate mutual understanding. An underlying policy aim is to uplift vulnerable original residents through contact with higher income groups. Based on our empirical data, we critically assess the concept of ‘bridging capital’ (Putnam, 2000) that underpins several of the social activities that are organized in areas such as the ones in our study. Subsequently, we discuss the importance of ‘bonding capital’ or the sense of interconnectedness and strong ties amongst original residents. Our empirical data – based on both interviews and participatory observation – suggest that activities within the ‘own’ community contribute importantly to feelings of belonging in the neighborhood. In the final section of the article, we discuss how different types of local meeting places offer opportunities for ‘lighter’ forms of interactions without aiming directly at strong connections between differently positioned neighborhood residents.
