Exercise and Cancer Outcomes

Assoc Prof Sandi Hayes

QUT, IHBI, School of Public Health

CRICOS No. 00213J

Reduced Functional

status

Gastro-intestinal

side effects

depression

neuropathy

fatigue

depression

arthralgia

sleeping difficulties

poor body image

changes in BC

Quality and quantity of survival

Survivorship concerns

Function, quality of life and survival

Fatigue

depression

Functional status

CIPNArthralgias

Bone outcomes

CV late effects

Survivorship concerns: common, do not sit in isolation and persist

Schmitz et al; Cancer, 2012, 118(8):S2217-2225

(n=160) Post-diagnosis

6m 12m 18m 6y

0 symptoms 60 (37.5) 80 (50.0) 92 (57.5) 68 (42.5)

1 symptom 43 (26.9) 38 (23.8) 28 (17.5) 41 (25.6)

2 symptoms 26 (16.3) 22 (13.8) 21 (13.1) 27 (16.9)

3+ symptoms 31 (19.4) 20 (12.5) 19 (12.0) 24 (15.0)

No cancer(%)

< 5 year cancer

survivor (%)

5+ year cancer survivor (%)

A: Any physical restriction 13 31 31

B: Any limitation in physical performance

21 53 54

Survivorship concerns: associated with cancer and its treatment

Ness et al, AEP, 2006, 16:197

Limitations in physical performance and participation restrictions:

• Impacts all aspects of quality of life• Associated with increased health care costs• May influence survival

Individual Impact Public health Impact

So what?

Concerns following cancer

• improves the function of all of our physiological systems• being physically active =

– Reduces risk of specific cancers by up to 60%– Reduces risk of heart disease and hypertension by 40%– Reduces risk of stroke by 27%– Reduces risk of type II diabetes by 58%– Is twice as effective in treating type II diabetes than insulin– Decreases depression as effectively as prozac or

behavioural therapy• Physical inactivity = greater risk of dying than smoking, obesity,

hypertension, high cholesterol

Relevance of exercise?

Exercise and cancer outcomes

Preservation or improvements:

Reductions:

• Muscle mass, strength, power• Cardiorespiratory fitness• Physical function• Physical activity levels• Range of motion• Immune function• Chemotherapy completion rates• Body image, self esteem and mood

• Number of symptoms and side- effects reported, such as nausea, fatigue and pain• Intensity of symptoms reported• Duration of hospitalisation• Psychological and emotional stress• Depression and anxiety

Hayes S, et al. (2009). J Sci Med Sport;12:428-34 ; Schmitz KH, et al. (2005). Cancer Epi & Biomarkers ;14.1588-95.

Cardiovascular disease

Osteoporosis

Diabetes

Hypertension

Other cancers

Improves cancer survival: 4-18%

Exercise and survival following cancer

Exercise prescription guidelines

Feasibility and clinical concerns

• Participation in exercise post-diagnosis is feasible

• Clinical concerns:– Immunosuppressive effect of exercise– Potential for exacerbating treatment-

related side effects such as fatigue, lymphoedema, nausea, pain

– Reduced exercise tolerance in cancer survivors

• Exercise is considered to be safe• Adverse effects have been rare and mild

State of play

Majority enter cancer diagnosis insufficiently active

Majority stop exercising or experience declines in physical activity levels during treatment

Majority never regain pre-cancer physical activity levels

Cancer diagnosis

Limits to our knowledge

• Evidence heavily derived from studying women with breast cancer

• Small samples with response bias– Representativeness?– Conservative estimate of effect

• Lack of understanding of mechanisms– Focus on specific outcomes in isolation

• Cost-effectiveness• Survival

Exercise and Gynaecological Cancer

Significant scope for advancing knowledge

Name: ECHO Trial

Design: a phase III, RCT evaluating the effects of an exercise intervention during chemotherapy for ovarian cancer

Outcomes: physical wellbeing, chemotherapy-related side effects and adherence, physical function, QoL, progression-free survival, health resource use.

Team: Hayes, Friedlander, Obermair, Mileshkin, Janda, Gordon, Barnes, Beesley, Sommeijer, Martyn

App#: 1063509

Greatest challenge in exercise intervention trials is recruitment:

Need for clinician support