Exercise for Cancer Patients and Survivors Kerry S. Courneya, PhD - - PowerPoint PPT Presentation
Exercise for Cancer Patients and Survivors Kerry S. Courneya, PhD Professor and Canada Research Chair in Physical Activity and Cancer Director, Behavioral Medicine Laboratory Faculty of Kinesiology, Sport, and Recreation University of
Kerry S. Courneya, PhD Professor and Canada Research Chair in Physical Activity and Cancer Director, Behavioral Medicine Laboratory Faculty of Kinesiology, Sport, and Recreation University of Alberta, Edmonton, Canada
>200,000 Canadians diagnosed each year. lifetime probability of getting cancer almost 50%. >80,000 deaths from cancer (25% of all deaths). 5 year relative survival rate about 60% . over 1.7 million cancer survivors in Canada!
Cancer Survivorship Issues
treatments are complex, difficult, prolonged. surgery, chemotherapy, radiation therapy,
hormone therapy, immunotherapy.
acute effects include nausea and vomiting,
diarrhea, fatigue, neuropathy, pain, menopausal symptoms, insomnia, depression.
chronic/late effects include cancer recurrence,
second cancers, heart problems, osteoporosis.
Exercise Oncology Questions
is it safe/feasible to exercise during cancer treatment? will exercise interfere with treatment or response? can exercise help manage treatment side effects? can exercise improve recovery after cancer and lower
the risk of cancer recurrence?
what is the optimal exercise program for benefit? are there any exercise programs for cancer patients?
Exercise Oncology Reviews
>1,000 EX intervention studies in cancer patients. dozens of systematic reviews in past 20 years. early reviews on “exercise oncology”. targeted reviews have focused on specific:
cancers (e.g., breast, prostate, hematologic, lung, CRC) phases (pre-treatment, treatment, survivorship, palliative) outcomes (e.g., fatigue, depression, QoL, sleep, survival) exercise interventions (e.g., aerobic, resistance, combined) combinations (breast on Tx, prostate on ADT)
Supervised Trial of Aerobic versus Resistance Training (START)
RCT examining AET versus
RET versus UC in 242 BC patients on chemotherapy.
multicenter trial: Edmonton,
Ottawa, and Vancouver.
(Courneya et al. JCO 2007;25:4396-4404)
Chemotherapy Received (RDI)
75 80 85 90 95
Relative Dose Intensity
UC RET AET
(Courneya et al. JCO 2007;25:4396-4404)
P=.033 P=.266
Disease-Free Survival
8-year DFS was 82.7% for EX vs. 75.6% for UC
(Courneya et al. MSSE 2014;46:1744-51)
Healthy Exercise for Lymphoma Patients (HELP) Trial
RCT comparing AET to UC in 122 lymphoma
patients on chemotherapy (n=54) or off Tx (n=68).
12 weeks supervised exercise training. primary endpoint was QoL. secondary endpoints were treatment outcomes.
(Courneya et al. J Clin Onc 2009;27:4605-12)
Effects of Exercise on Chemotherapy Completion Rate
50 60 70 80 90 100 110
% Completion Rate
% of minimum % of maximum
UC AET
(Courneya et al. J Clin Onc 2009;27:4605-12)
P=.45 P=.20
Effects of Exercise on Treatment Response
10 20 30 40 50 60
% With Response
Stable Partial Complete
UC AET
(Courneya et al. J Clin Onc 2009;27:4605-12)
13/28 8/26 P=.24
Effects of Exercise on Treatment Response
10 20 30 40 50 60 70 80 90
% With Response
Partial Complete
UC AET
(Morielli et al., unpublished)
P=.020 3/17 10/18
Summary of Evidence
EX is safe/feasible during cancer treatment and does
not interfere with treatments or worsen symptoms.
EX maintains/improves health-related fitness even
during difficult cancer treatments.
EX prevents/manages some side effects during
treatment (especially for symptomatic patients).
EX during treatment may improve treatment
completion, response, and long term cancer outcomes.
Exercise Recommendations
150 minutes/week of moderate intensity aerobic EX. 75 minutes/week of vigorous intensity aerobic EX. 2-3 days/week of strength exercises of major muscle
groups using 8-12 repetitions and 1-2 sets.
add “activity supplements” throughout the day. older adults may add balance exercises.
General Exercise Principles
avoid inactivity; sedentary behavior may be bad. some exercise is better than none. more exercise is better (dose-response). start easy/progress slowly (exercise to tolerance). exercise must be individualized based on patient
function, side effects, goals, and preferences.
(Cormie et al. Med J Aus 2018;1-4)
Two Models of Exercise Promotion
CLINICAL MODEL: (on treatment/late stage)
higher risk:benefit ratio. medical consultation often needed. personalized exercise prescription needed. supervised exercise recommended focus on cancer-specific outcomes.
PUBLIC HEALTH MODEL: (off treatment/cured)
lower risk:benefit ratio. home-based exercise feasible/distance-based support. general exercise recommendations more appropriate. focus on disease prevention and health promotion.
(https://www.albertacancerexercise.com/)
Cancer-specific Motives/Benefits
prepare for treatments (“prehabilitation”). complete treatments. respond to treatments. manage treatment side effects. recover after treatments. reduce risk of recurrence/death from cancer.
Cancer-specific Social Influencers
oncologists (medical, radiation, surgical). oncology care providers (nurse, phyiso/nut., psych.). cancer treatment centers. cancer societies/support groups (CCS, ACS). other cancer survivors.
Cancer-specific Barriers/Constraints
side effects/toxicities from treatment (fatigue,
nausea, diarrhea, neuropathy, pain, hand-foot syndrome, urinary incontinence, skin problems, dyspnea, mouth problems, anxiety, depression).
medical appointments, work-related issues. access to programs/qualified personnel.
Safety (risks) of EX in Cancer Patients
Who is Likely to Benefit from a Cancer-Specific EX Intervention?
newly diagnosed cancer patients starting treatments. patients receiving or recovering from treatments. cancer patients with poor or modest prognosis. patients with advanced or metastatic cancer. EXCEPTION: long term survivors of early stage
cancers with good prognosis and few morbidities.
EX Intervention Recommendations in Cancer Survivors
incorporate cancer-specific benefits where supported
by the evidence,
invoke cancer-specific social influencers important to
the individual,
address cancer-specific barriers and precautions, all of which may vary by cancer type, disease stage,
treatments received, and cancer trajectory.
Summary and Conclusions
cancer is a compelling disease for most people. most cancer patients want cancer-specific EX
information, not general health information.
cancer affects all aspects of EX behavior change
interventions including motives, barriers, social influences, and delivery (who, what, when, where).
Acknowledgements
Many colleagues, students, staff and study
participants have contributed to this research.
K.S. Courneya is supported by the Canada
Research Chairs Program, a CIHR Foundation Grant, and Apple Fitness.