Exercise program improves quality of life for patients with metastatic breast cancer

In In The News by Barbara Jacoby

By: Matthew Shinkle

From: healio.com

Key takeaways:

  • Results showed improved quality of life and reduced fatigue after the exercise program.
  • More research is needed to design a safe exercise program for those with unstable bone metastases.

SAN ANTONIO — Patients with metastatic breast cancer who take part in a supervised, structured exercise program during palliative treatment may experience improved quality of life, according to study results.

Individuals who participated in an exercise program reported higher health-related quality-of-life scores and less overall physical fatigue than those in a control group, findings presented at San Antonio Breast Cancer Symposium showed. Those who participated in the exercise program also exhibited less pain and dyspnea.

What surprised us was how clear our results were,” Anne M. May, PhD, professor of clinical epidemiology of cancer survivorship at University Medical Center Utrecht, the Netherlands, told Healio. “All researchers in our consortium are experienced researchers doing exercise studies in the curative setting, so here we found better results than we had expected.

“Clinicians and nurses should recommend exercise to patients in this setting — at least those with stable bone metastases … and I think patients should ask for it,” May added. “There is still more research to be done in unstable bone metastases.”

Background and methods

Evidence-based international guidelines — such as those published by ASCO in Journal of Clinical Oncology — recommend exercise for patients with breast cancer receiving adjuvant treatment to help reduce cancer- and treatment-related adverse events.

However, limited evidence exists to support the potential effectiveness of exercise for patients with metastatic breast cancer.

May and colleagues conducted the multinational, randomized controlled PREFERABLE-EFFECT trial to assess the effects of a 9-month supervised exercise program among individuals with metastatic breast cancer.

The analysis included 357 adults with stage IV breast cancer and life expectancy of at least 6 months.

Researchers randomly assigned 178 adults (median age, 54.9 years; 99.4% female; 65.2% with bone metastases) to the exercise intervention group. In the first 6 months, the intervention consisted of twice-weekly 1-hour supervised exercise sessions. In the final 3 months, researchers replaced one supervised session with an unsupervised session, supplemented by an exercise mobile application.

The other 179 adults (median age, 55.9 years; 99.4% female; 69.8% with bone metastases) in the control group received usual care and general physical activity advice.

Investigators used the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-30) to assess health-related quality of life. They used the EORTC-FA12 questionnaire to evaluate multidimensional physical fatigue.

Changes in cancer-related physical fatigue and health-related quality of life served as the study’s primary endpoints. Secondary endpoints included pain, breast cancer-specific symptoms, anxiety, depression, polyneuropathy and sleep.

Researchers analyzed intervention effects by comparing changes from baseline to 3, 6 and 9 months. Achieving the study’s primary endpoint required statistically significant improvement in either one or both primary outcome objectives.

Results and next steps

After 6 months of data accumulation, patients who participated in the exercise intervention reported statistically significant improvement in physical fatigue (mean difference: 5.3; 95% CI, 10 to 0.6) and health-related quality of life (mean difference, 4.8; 95% CI, 2.2-7.4) compared with the control group.

The benefits persisted after 9 months with regard to both physical fatigue (mean difference, 5.6; 95% CI, 10.9 to 0.4) and health-related quality of life (mean difference, 4.3; 95% CI, 1.4-7.3).

Two serious adverse events — one wrist fracture and one sacral stress fracture — occurred in the intervention group. Neither were deemed related to bone metastases.

The intervention had no effects on emotional functioning or emotional fatigue, according to investigators.

The results demonstrate the positive benefits of a structured exercise program for patients with metastatic breast cancer and support implementation of this type of intervention for similar populations moving forward, May said.

Further research is needed to understand the long-term benefits of such a program, as well as additional studies to evaluate potential benefits for patients with unstable bone metastases, she added.

“First steps will be looking into whether exercise improves prognosis or the survival of these patients, and we would like to know more about mechanisms that underlie these effects,” May told Healio.

Investigators have blood samples from study participants and will evaluate inflammation markers, May said.

Researchers also will further evaluate the effectiveness and safety of this type of intervention for patients with unstable bone metastases, May said.

“I think they can benefit, too, but we need more research into how to tweak the exercise program so that it’s safe for them,” she said.

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