Cost-effectiveness of an exercise programme for patients undergoing adjuvant chemotherapy

May, A.M. et al. (2017) BMJ Open. 7:e012187

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Image source: Sancho McCann – Flickr // CC BY 2.0

Objective: Meta-analyses show that exercise interventions during cancer treatment reduce cancer-related fatigue. However, little is known about the cost-effectiveness of such interventions. Here we aim to assess the cost-effectiveness of the 18-week physical activity during cancer treatment (PACT) intervention for patients with breast and colon cancer. The PACT trial showed beneficial effects for fatigue and physical fitness.

 

Results: For colon cancer, the cost-effectiveness analysis showed beneficial effects of the exercise intervention with incremental costs savings of €4321 and QALY improvements of 0.03. 100% of bootstrap simulations indicated that the intervention is dominant (ie, cheaper and more effective). For breast cancer, the results did not indicate that the exercise intervention was cost-effective. Incremental costs were €2912, and the incremental effect was 0.01 QALY. At a Dutch threshold value of €20 000 per QALY, the probability that the intervention is cost-effective was 2%.

Conclusions: Our results suggest that the 18-week exercise programme was cost-effective for colon cancer, but not for breast cancer.

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Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue

Mustian, K.M. et al. JAMA Oncology | Published online: 2 March 2017

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Question: Which of the 4 most commonly recommended treatments for cancer-related-fatigue—exercise, psychological, the combination of exercise and psychological, and pharmaceutical—is the most effective?

Findings: This meta-analysis of 113 unique studies (11 525 unique participants) found that exercise and psychological interventions and the combination of both reduce cancer-related fatigue during and after cancer treatment. Reduction was not due to time, attention, or education. In contrast, pharmaceutical interventions do not improve cancer-related fatigue to the same magnitude.

Meaning: Clinicians should prescribe exercise and/or psychological interventions as first-line treatments for cancer-related fatigue.

Read the abstract here

Quality of life with those with advanced cancer improved through walking

Walking for just 30 minutes three times per week could improve the quality of life for those with advanced cancer, a new study has found | ScienceDaily

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Researchers from the University of Surrey collaborated with those form the Florence Nightingale Faculty of Nursing & Midwifery at King’s College London to explore the impact of walking on the quality of life and symptom severity in patients with advanced cancer.

Despite growing evidence of significant health benefits of exercise to cancer patients, physical activity commonly declines considerably during treatment and remains low afterwards. Initiatives in place to promote physical activity for those suffering with cancer are normally supervised and require travel to specialist facilities, placing an additional burden on patients.

Read the full overview here

Read the full article here

Physical Activity Associated With Fewer Cancers

Jenks, S. (2016) JNCI: Jnl of National Cancer Institute. Volume 108, Issue 8

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Even moderate leisure-time physical activity may protect against 13 cancers, according to a massive observational study that appeared May 16 in JAMA Internal Medicine (doi:10.1001/jamainternmed.2016.1548).

But which type of exercise brings the most benefit is not yet clear, researchers say, nor is exercise alone likely to account for its association with a lower cancer risk in colon, breast, and endometrial cancers, among others.

“Physical activity is not a stand-alone, magic bullet,” said William McCarthy, Ph.D., adjunct professor in the department of health services in the Fielding School of Public Health at the University of California, Los Angeles. “The biggest bang [in risk reduction] comes when exercise is coupled with a Mediterranean-style diet and not smoking.”

Still, McCarthy said, the recent joint study by researchers at the National Cancer Institute and the American Cancer Society highlights exercise’s importance to cancer risk and overall health, despite what he described as years of skepticism in the scientific community. “It’s a shot in the arm for those of us doing exercise studies for years,” he said.

Researchers at both organizations analyzed pooled data for the self-reported leisure-time physical activities of 1.44 million people in 12 U.S. and European studies conducted between 1982 and 2004. Analyzing data from those combined studies gave investigators greater statistical power than a single study.

Read the original article abstract here

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Patient-reported outcomes, body composition, and nutrition status in patients with head and neck cancer: Results from an exploratory randomized controlled exercise trial

Capozzi, L. et al. Cancer. Article first published online: 1 February 2016

Background: Patients with head and neck cancer experience loss of weight and muscle mass, decreased functioning, malnutrition, depression, and declines in quality of life during and after treatment. The purpose of this exploratory randomized study was to determine the optimal timing for the initiation of a lifestyle and progressive resistance exercise training intervention (during or after radiation therapy), as determined by intervention adherence and by comparing between-group outcomes across 24 weeks.

Methods: Sixty patients with head and neck cancer were randomized to engage in a 12-week lifestyle intervention and progressive resistance-training program either during radiation treatment or immediately after completion. The primary outcome of body composition—specifically, lean body mass, body mass index, and body fat—as well as secondary outcomes of fitness, quality of life, depression, and nutrition status were evaluated.

Results: The progressive resistance-training intervention carried out during treatment did not significantly influence the primary outcome of body composition, despite a significant increase in weekly physical activity reported by the intervention group. A small-to-medium intervention effect was noted for some secondary outcomes, including fitness, quality of life, and nutrition status. Regardless of whether patients received the immediate or delayed progressive resistance-training intervention, the analysis revealed a main effect of time on body composition, fitness, quality of life, depression, and nutritional scores.

Conclusions: Although the intervention during treatment did not reduce the loss of lean body mass, delaying the exercise program until after treatment completion was associated with improved intervention adherence, a finding with important clinical implications

View the abstract here

Is preoperative physical activity related to post-surgery recovery? A cohort study of patients with breast cancer

Nilsson, H. et al. BMJ Open: 2016;6:e007997

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Objective The aim of our study is to assess the association between preoperative level of activity and recovery after breast cancer surgery measured as hospital stay, length of sick leave and self-assessed physical and mental recovery.

Design A prospective cohort study.

Setting Patients included were those scheduled to undergo breast cancer surgery, between February and November 2013, at two participating hospitals in the Western Region of Sweden.

Participants Patients planned for breast cancer surgery filled out a questionnaire before, as well as at 3 and 6 weeks after the operation. The preoperative level of activity was self-assessed and categorised into four categories by the participants using the 4-level Saltin-Grimby Physical Activity Level Scale (SGPALS).

Main outcome measure Our main outcome was postoperative recovery measured as length of sick leave, in-hospital stay and self-assessed physical and mental recovery.

Results 220 patients were included. Preoperatively, 14% (31/220) of participants assessed themselves to be physically inactive, 61% (135/220) to exert some light physical activity (PA) and 20% (43/220) to be more active (level 3+4). Patients operated with mastectomy versus partial mastectomy and axillary lymph node dissection versus sentinel node biopsy were less likely to have a short hospital stay, relative risk (RR) 0.88 (0.78 to 1.00) and 0.82 (0.70 to 0.96). More active participants (level 3 or 4) had an 85% increased chance of feeling physically recovered at 3 weeks after the operation, RR 1.85 (1.20 to 2.85). No difference was seen after 6 weeks.

Conclusions The above study shows that a higher preoperative level of PA is associated with a faster physical recovery as reported by the patients 3 weeks post breast cancer surgery. After 6 weeks, most patients felt physically recovered, diminishing the association above. No difference was seen in length of sick leave or self-assessed mental recovery between inactive or more active patients.

Exercise could work as treatment for prostate cancer

Cancer Research UK

The PANTERA study, led by Sheffield Hallam University, will focus on 50 men who have the disease, but whose cancer has not spread.

Half of the men in the study will carry out two-and-a-half hours of aerobic exercise every week for 12 months – initially with the support of a qualified trainer and then with free access to local gyms. The other half will be given information about the benefits of exercise for cancer patients but will have no supervised sessions.

Prostate cancer that has not spread is sometimes treated with surgery or radiotherapy. But this can have side-effects so many men opt for active surveillance instead, which involves monitoring the disease. All the men in the PANTERA study are and will remain on active surveillance – and they will also be closely monitored as part of the study itself.

 

Read the full press release via Cancer Research UK