Berglund et al., 1994b). Anthropometric benefits reported following exercise interventions include positive effects on weight and adiposity as gauged by waist and hip measurements (Winningham et al., 1989; Burnham and Wilcox, 2002). One study demonstrated significant improvement in such biomarkers as blood pressure, heart rate, hemoglobin, and circulating hormone levels in patients with breast cancer participating in a home-based physical activity intervention (Pinto et al., 2005). Another found a favorable effect of exercise on biomarkers associated with the metabolic syndrome, including insulin-like growth factor and insulin-like growth factor-binding protein 3 (Fairey et al., 2003).

It should be noted, however, that many trials of exercise interventions had methodological shortcomings, including nonrandom treatment assignments and small sample sizes. Also, patients with breast cancer were the predominant diagnostic group targeted for study, and the generalizability of those findings to patients with other cancer diagnoses is not clear. Nonetheless, collective results suggest that exercise is associated with many benefits for the cancer survivor, although a positive impact on survival has not been established. Future trials are needed to elucidate the optimal type and intensity of exercise for patients with cancer, particularly those with unique vulnerabilities resulting from cancer-related therapies, such as limb-sparing surgery or anthracycline chemotherapy. Moreover, because regular physical activity and healthy dietary practices are both important to weight maintenance, continued follow-up in ongoing trials will be important to determine the effectiveness of addressing energy balance through multicomponent behavioral interventions targeting both exercise and dietary modification (Demark-Wahnefried et al., 2002, 2003a,b; Rock and Demark-Wahnefried, 2002).

Provision of Material and Logistical Resources

Receiving treatment for cancer in medical settings, complying with prescribed treatments while at home, caring for oneself or a family member, and performing important family and social roles despite illness require patients and caregivers to have certain material and logistical resources. These include transportation, lodging for patients and caregivers when they must travel long distances for outpatient therapy, child care, wigs and prostheses (breast, limb, other), and supplies for managing the side effects of cancer and its treatment (e.g., compression bandages or sleeves for lymphedema control, ostomy supplies). As noted earlier in this chapter, informal sources of support can often provide many of these services, such as transportation or child care. When the service is covered by insurance or a patient has other financial means, material resources can be purchased. When informal supports and/or financial resources are limited, however, services are needed

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