abstract: Feasibility of a lifestyle intervention for ovarian cancer patients receiving adjuvant chemotherapy

OBJECTIVES

This study aimed to assess the feasibility of a lifestyle intervention for promoting physical activity (PA) and diet quality during adjuvant chemotherapy for ovarian cancer.

METHODS:

Patients were enrolled post-operatively and received PA and nutrition counseling, at every chemotherapy visit for six cycles. Quality of life (QoL) was measured with the Functional Assessment of Cancer Therapy (FACT-G), PA with the Leisure Score Index (LSI), dietary intake with 3-day food records, and symptom severity/distress by the Memorial Symptom Assessment Scale (MSAS). Pedometer step count was collected during chemotherapy cycles.

RESULTS:

Recruitment was 73% with 27 patients enrolled. Mean [95% confidence interval] change in minutes of PA from cycle #3 to following cycle #6 was 61min [-3, 120] p=0.063, and from baseline to after cycle #6 was 73min [-10, 15]; p=0.082. Mean change in total fruit and vegetable consumption between baseline and during chemotherapy was 0.56 [-0.09, 0.64]; p=0.090. FACT-G increased from 75.4 at baseline to 77.6 during chemotherapy and 83.9 following chemotherapy (p=0.001 for change from baseline to post-chemotherapy).


Mean total MSAS ( Memorial Symptom Assessment Scale) score was 20.6 at baseline, 26.6 at cycle #3 and decreased to 17.0 following chemotherapy (p=0.01 comparison of cycle #3 and following chemotherapy). Increased moderate to strenuous PA was correlated with higher physical well-being during chemotherapy (r=0.48, p=0.037).

CONCLUSIONS:

Lifestyle counseling during adjuvant chemotherapy for ovarian cancer is feasible and may improve PA and diet quality. Randomized controlled trials examining the effects of lifestyle counseling on quality of life and treatment outcomes in ovarian cancer patients are warranted.

EvidenceUpdates- A randomized controlled trial of home-based exercise for cancer-related fatigue in women during and after chemotherapy with or without radiation therapy

CONCLUSIONS: Our home-based exercise intervention had no effect on fatigue or related symptoms associated with cancer treatment. The optimal timing of exercise remains to be determined.
IMPLICATIONS FOR PRACTICE: Clinicians need to be aware that some physical activity is better than none, and there is no harm in exercise as tolerated during cancer treatment. Further analysis is needed to examine the adherence to exercise. More frequent assessments of fatigue, sleep disturbance, depression, and pain may capture the effect of exercise.

Comments from Clinical Raters
Oncology - Gynecology

Impact will be muted, as this is a negative trial: exercise is not harmful but doesn't seem to improve any of the outcomes measured, including fatigue.

Time Course of Risk Factors in Cancer Etiology and Progression — JCO

Blogger's Note: in the absence of the full paper, 'may' is not definitive

 Abstract

Patients with cancer increasingly ask what they can do to change their lifestyles and improve outcomes. Risk factors for onset of cancer may differ substantially from those that modify survival with implications for counseling. This review focuses on recent data derived from population-based studies of causes of cancer and of patients with cancer to contrast risk factors for etiology with those that impact survival. For different cancer sites, the level of information to inform the timing of lifestyle exposures and risk of disease onset or progression after diagnosis is often limited. For breast cancer, timing of some exposures, such as radiation, is particularly important. For other exposures, such as physical activity, higher levels may prevent onset and also improve survival. For colon cancer, study of precursor polyps has provided additional insight to timing. Extensive data indicate that physical activity reduces risk of colon cancer, and more limited data suggest that exposure after diagnosis improves survival. Dietary factors including folate and calcium may also reduce risk of onset. More limited data on prostate cancer point to obesity increasing risk of aggressive or advanced disease. Timing of change in lifestyle for change in risk of onset and for survival is important but understudied among patients with cancer. Counseling patients with cancer to increase physical activity and avoid weight gain may improve outcomes. Advice to family members on lifestyle may become increasingly important for breast and other cancers where family history is a strong risk factor.

New Guidelines Emphasize the Need for Cancer Patients to Exercise

Note: "some gynecologic cancers"/talks briefly about "changes in neuropathy"/treatments etc

" Research Gaps Remain

The panel found that there is consistent evidence that exercise training can lead to improvements in aerobic fitness, muscular strength, quality of life, and fatigue in breast, prostate, and hematologic cancer patients and survivors, but that the data for colon and gynecologic cancers are still too limited to lead to conclusions.

Multiple research gaps remain in this field, the panel notes. These include a need for greater specificity with regard to the dose-response effects of specific modes of exercise training on specific end points and within a broader range of populations, such as survivors of colon and gynecologic cancers.

They also urge fitness trainers who work with cancer survivors to learn as much as possible about the specifics of the cancer diagnosis and treatment to make informed safe choices with regard to exercise testing and prescription.

Cancer diagnosis and treatment effects numerous body systems that are required for and affected by exercise training, they conclude, and "because cancer treatments are increasingly customized according to specific tumor characteristics, fitness professionals may benefit from contacting the medical treatment team for more precise information regarding the treatments received.""