MUNICH, Germany - Including exercise or sport as part of cancer care can significantly improve symptom management, quality of life and fitness during and after treatment, French researchers have concluded in two presentations to be reported at the ESMO 2018 Congress in Munich. Even among patients at highest risk of poor quality of life, exercise can make a difference.
More than 3,500 patients with cancer already participate in exercise programmes each year at over 80 cancer centres in France, at a cost of approximately €400 per patient, and the number continues to rise, explained Dr. Thierry Bouillet, Medical Oncologist, Ile de France, American Hospital of Paris, Neuilly Sur Seine, France, and author of one of the new studies. (1) Classes are run by trainers with specialist knowledge of cancer and its treatment who can adapt exercise programmes to individual needs.
“We have found that patients get the greatest benefit if they exercise two or three times a week for at least an hour during the six months of their chemotherapy or radiotherapy and then for a further six months so that physical activity becomes a part of their life,” said Bouillet.
“With 20 years’ experience, we have also seen that patients find it easier to exercise in on-site classes and feel more secure than if we give them exercise information and leave them to do it themselves or go to classes away from the hospital with trainers who do not know about the special needs of patients with cancer,” added Bouillet.
In one of the French studies to be presented at ESMO, (1) twice-weekly, 60-minute strength training and aerobic exercise classes significantly reduced pain and fatigue scores at 3 and 6 months in 114 patients undergoing cancer treatment, 83% for breast cancer and 21% with metastatic disease. Fatigue scores fell from 3.3 at baseline to 2.8 (p<0.05) at 3 months and pain scores from 2.8 to 2.3 respectively (p<0.05). In 71 patients with data at baseline and 6 months, fatigue scores fell from 3.1 at baseline to 2.1 at 6 months (p<0.05) and pain scores from 3 to 1.9 respectively (p<0.05).
There were also significant reductions in body fat, while lean body mass remained stable. In the overall group, fat mass fell from 33.9% at baseline to 33.2% at 3 months (p<0.05), while lean body mass remained stable (43.6 and 43.8 kg respectively). In the 71 patients with 6-month data, fat mass fell from 34.3% at baseline to 32.4% at 6 months, while lean mass was 42.8 kg at both time points. In addition, significant improvements were seen in overall fitness in terms of quadriceps endurance, strength of both arms and non-dominant leg balance (p<0.05 for all).
“Patients are often fatigued and have started to lose muscle before they are diagnosed with cancer, so it is essential to start exercise as soon as possible after the first consultation. We should see it as ‘emergency treatment’ for their initial symptoms and later to help with the side effects of treatment,” said Bouillet.
In a second study to be presented at ESMO 2018, (2) researchers not only reported the value of exercise for patients with cancer, but also demonstrated that it is possible to identify patients at greatest risk of poor quality of life during treatment so they can receive extra help.
In the study of 2525 patients with stage I-III breast cancer undergoing adjuvant chemotherapy, those who took 75 minutes of vigorous or 150 minutes of moderate exercise per week had significantly better overall quality of life at six and 12 months after treatment than those who were inactive (Table 1). They also had significantly better physical well-being and less fatigue, pain and breathlessness. Vigorous exercise included activities such as aerobic dance, heavy gardening or fast swimming, while moderate exercise included brisk walking, water aerobics or volleyball.
“Around 60% of patients were physically active before and after chemotherapy and, although their quality of life was adversely affected by chemotherapy, they scored consistently better on a variety of physical, emotional and symptom scales than those who were inactive,” explained Dr. Antonio Di Meglio, study author and Medical Oncologist, Institut Gustave Roussy, Villejuif, France.
The study showed that patients who had a mastectomy or additional illnesses, smoked or had a low income were particularly at risk of poor quality of life following chemotherapy for breast cancer, but they too benefited from exercise.
“Using a novel approach, we showed that it is possible to identify breast cancer patients whose quality of life will be worst affected by chemotherapy so we can now target those patients for dedicated interventions including those aimed at increasing physical activity to WHO-recommended levels,” (3) added Di Meglio.
Commenting from ESMO, Dr. Gabe Sonke, Medical Oncologist, Netherlands Cancer Institute, Amsterdam, the Netherlands, underlined the importance of the French studies in demonstrating the value of physical therapy in everyday clinical practice, previously seen in clinical trials and supported by current ESMO recommendations for exercise as part of standard care for all cancer survivors. (4)
“The insights from the new studies in patients with metastatic breast cancer are particularly timely as a large study is getting underway from the international PREFERABLE Consortium to further explore the value of exercise in this group of patients,” he said.
Sonke pointed out that this and other studies are endeavouring to confirm early signs that physical activity programmes may improve adherence to chemotherapy and radiotherapy and thus improve treatment outcomes so that insurance companies are more encouraged to pay for exercise initiatives.
“Insurers may ask why they should pay for exercise for patients with cancer when they don’t pay for it in the general population. But if we can show that there is improved treatment adherence and an added survival benefit for patients with cancer, this will strengthen our case for payment,” said Sonke.
He also wants to see more patients routinely asked to participate in exercise programmes, including those who do not normally exercise: “We know that patients who are already active are getting into these exercise programmes, but those who are not active are missing out, particularly those with low income and less healthy lifestyle. The new results must encourage us to focus on how to be more inclusive so that all patients can benefit from exercise in improving quality of life during chemotherapy,” he concluded.
Table 1. Quality of life scores before and after chemotherapy in active and inactive patientsa
a European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ)-C30.
b Higher scores indicate better functioning
c Higher scores indicate worse symptoms
Statistical significance between active and inactive patients (p<0.05) for all values
Notes to Editors
Please make sure to use the official name of the meeting in your reports: ESMO 2018 Congress
Official Congress hashtag: #ESMO18
References
- Abstract 1753P_PR ‘Benefits of Physical Activity and Sport integrated into the care pathway of oncology patient’ will be presented by Laurence Vanlemmens during the Poster Display Session on Monday, 22 October, 12:45 to 13:45 (CEST) in the Poster Area Networking Hub - Hall A3. Annals of Oncology, Volume 29 Supplement 8 October 2018
- Abstract 1684PD_PR ‘Physical activity (PA) and patterns of quality of life (QOL) after adjuvant chemotherapy (CT) for breast cancer (BC)’ will be presented by Antonio Di Meglio during the Poster Discussion Session on Saturday, 20 October, 09:30-10:30 in Room 21 - Hall B3. Annals of Oncology, Volume 29 Supplement 8 October 2018
- World Health Organisation. Global recommendations on physical activity for health.
- ESMO Handbook on Rehabilitation Issues During Cancer Treatment and Follow Up.
About the European Society for Medical Oncology (ESMO)
ESMO is the leading professional organisation for medical oncology. With 18,000 members representing oncology professionals from over 150 countries worldwide, ESMO is the society of reference for oncology education and information. ESMO is committed to offer the best care to people with cancer, through fostering integrated cancer care, supporting oncologists in their professional development, and advocating for sustainable cancer care worldwide.
1684PD_PR - Physical activity (PA) and patterns of quality of life (QOL) after adjuvant chemotherapy (CT) for breast cancer (BC)
A. Di Meglio1, M. El-Mouhebb2, S. Michiels3, D. Carene1, S. EVERHARD4, A.L. Martin5, P.H. Cottu6, F. Lerebours7, C. Coutant8, A. Lesur9, O. Tredan10, P. SOULIE11, L. Vanlemmens12, P. Arveux13, S. Delaloge14, P. Ganz15, F. André16, A.H. Partridge17, L. Jones18, I. Vaz-Luis1
1Medical Oncology, Institut Gustave Roussy, Villejuif, France, 2Medical Oncology, Gustave Roussy, Villejuif, France, 3Team Oncostat, CESP, Gustave Roussy, Villejuif, France, 4UCBG, UNICANCER, Paris, France, 5Research & Develpment, UNICANCER, Paris, France, 6Medical Oncology, Institut Curie, Paris, France, 7Medical Oncology, Institut Curie Saint Cloud, Saint Cloud, France, 8Medical Oncology, Centre Georges-François Leclerc (Dijon), Dijon, France, 9Medical Oncology, Institut de Cancérologie de Lorraine, Nancy, France, 10Medical Oncology, Centre Léon Bérard, Lyon, France, 11Medical Oncology, Centre Paul Papin, Angers, France, 12Medical Oncology, Centre Oscar Lambret, Lille, France, 13Medical Oncology, Centre Georges-François Leclerc (Dijon), Dijon, France, 14Medical Oncology, Gustave Roussy, Villejuif, France, 15Medical Oncology, UCLA, Los Angeles, CA, USA, 16Medical Oncology, Gustave Roussy - Cancer Campus, Villejuif, France, 17Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA, 18Exercise Oncology Research Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Background: We aimed to describe longitudinal patterns of QOL and the interplay between PA and risk of QOL deterioration among BC patients (pts).
Methods: We used a French prospective longitudinal clinical study (CANTO, NCT01993498) to identify 2525 stage I-III BC pts treated with adjuvant CT from 2012-14. PA exposure (GPAQ 16) and QOL (EORTC QLQ C30/B23) were reported by pts before CT, and at 3-6 and 12 months after CT. Pts with levels of PA ≥10 MET-hours/week were considered physically active (as per WHO recommendations on PA). Poor QOL was defined by functional scores <60 and symptoms scores ≥40 (Giesinger, 2016). We used multivariate mixed models to assess patterns of QOL and group based trajectory models to identify clusters of pts with poor QOL and associated risk factors, adjusting for PA as time dependent covariate.
Results: Mean age (Standard Deviation, SD) was 52 y (11). 57%, 62% and 63% pts were physically active before CT, 3-6 and 12 months after CT, respectively. QOL scores before CT were higher among physically active vs inactive pts, including (mean [SD]): global health status (GHS) (69 [1.4] vs 65 [1.4]), physical (90 [1.1] vs 87 [1.1]) and emotional function (65 [1.9] vs 62 [1.9]) (all adjusted p<.05). QOL significantly worsened after CT, but scores remained higher among active pts (p<.001). A cluster of 33% pts had high and persistent risk of poor GHS: associated factors included comorbidities vs no (adjusted odds ratio 1.4 [95% Confidence Interval 1.1-1.9]), low income vs high (1.6 [1.2-2.0]), smoking vs no (1.3 [1.1-1.6]), mastectomy vs partial surgery (1.2 [1.1-1.6]). A significant interaction between recommended levels of PA and risk of poor GHS was observed (p<.001). Consistent with GHS, we found clusters of pts with high risk of poor QOL across physical, emotional and multiple other QOL domains, with similar risk factors and significant interactions with recommended levels of PA.
Conclusions: Among this large cohort of BC survivors, QOL significantly worsened after CT. We were able to group pts following distinct longitudinal patterns of QOL and to identify clinical, socio-economical, and treatment risk factors for poor QOL, including PA behavior. Interventional strategies that also promote PA may help prevent QOL deterioration after CT.
Clinical trial identification: NCT01993498
Legal entity responsible for the study: UNICANCER
Funding: A. Di Meglio: Recipient of the 2017 ESMO Clinical Research Fellowship Award. I. Vaz-Luis: Research grants: Susan Komen for the Cure, and "Association pour la Recherche sur le Cancer (ARC)"
Disclosure: All authors have declared no conflicts of interest
1753P_PR - Benefits of physical activity and sport integrated into the care pathway of oncology patient
L. Vanlemmens1, H. Mocaer1, T. Ginsbourger2, J.M. Descotes2, N. Masselin1, H. Deroubaix1, C. Fabre3, J. Devriendt2, T. Bouillet4, E. Lartigau1
1Nord, Centre Oscar Lambret, Lille, France, 2Paris, National Federation CAMI Sport and Cancer, Paris, France, 3Nord, University of Lille, URePSSS EA7369, Lille, France, 4Ile de France, American Hospital of Paris, Neuilly Sur Seine, France
Background: Strong evidence exists supporting the beneficial effect of physical activity for cancer patients on health-related quality of life (HRQoL) involving physical, psychological and social components. French Comprehensive Cancer Center Oscar Lambret (COL) and National Federation CAMI Sport & Cancer opened Sport and Cancer center on 9/2016 with supervised exercise programs. The objective of this work was to evaluate effectiveness of this intervention from 9/2016 to 2/2018.
Methods: Patients undergoing treatment (chemotherapy, target therapy, radiotherapy, hormone therapy) were oriented by the health professionals to the medico-sportive educator (MSE). The MSE was responsible for the patient’s safety while maintaining a high enough level of intensity of physical activity, for helping patients achieve clinical goals in a coordinated program. PAS (Physical Activity and Sportive trainings were performed during 6 months with 2 sessions of 60 minutes per week of strength training and aerobic exercise. The sessions were held collectively (12 participants maximum) or individually or in pairs. Evaluations were made at baseline (M0), 3 months (M3) and 6 months (M6): fatigue and pain were evaluated by auto questionnaires, biometric measures by diagnostic scale, and physical capacities by objective tests.
Results: are available for 114 cancer patients at M3 and for 74 patients at M6. 83% had breast cancer and 21% had metastasis. The mean age was 53 years (range: 30 -70). 92 % complained of fatigue and 72 % of pain before program. 35 patients were overweight and 27 were obese. Fatigue and pain decreased significantly at M3 and M6 (P< 0.05). We found a significant reduction in body fat mass with a stable percentage of lean body mass. PAS allowed a significant improvement in overall fitness (quadriceps endurance, strength of both arms, non-dominant leg balance) and cardiovascular endurance.
Conclusions: These results showed that PAS improves symptom management and physical functioning during treatment. Indeed, the supervised program allowed patients to maintain and/or develop their physical capacity during their training. These results are comforting in our proposal for management in PAS as soon as possible in the treatment course.
Legal entity responsible for the study: Centre Oscar Lambret
Funding: Has not received any funding
Disclosure: All authors have declared no conflicts of interest
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