Incorporating physical activity or exercise into cancer treatment can significantly improve symptom management, quality of life and fitness during and after treatment, French researchers concluded in two presentations at the ESMO 201
More than 3,500 cancer patients already participate in exercise programs every year at more than 80 cancer centers in France. The cost per patient amounts to about 400 €, rising Thierry Bouillet, Medical Oncologist, Ile de France, American Hospital of Paris, Neuilly Sur Seine, France, and author of one of the new studies. Classes are conducted by coaches with specialized knowledge of cancer and their treatment, which can tailor training programs to individual needs.
"We found that patients have the most benefit if they exercise two or three times a week for at least one hour the six months of their chemo or radiotherapy and then for another six months, making physical activity a part of their life will, "said Bouillet.
"With 20 years of experience, we have also seen patients find it easier to train in on-site classes and feel safer than giving them training information and leaving them alone or taking courses outside the hospital with trainers Bouillet added
In one of the French studies presented at ESMO, 60-minute strength exercises and aerobic exercise twice a week significantly reduced the pain and fatigue levels in 3 and 6 months in 114 patients with cancer treatment, 83% for breast cancer and 21% with metastases. The fatigue values dropped from 3.3 at the beginning of the study to 2.8 (p
There was also significant reductions in body fat, while lean body mass remained stable. In the whole group the fat mass decreased from 33.9% at baseline to 33.2% after 3 months (p
"Patients are often tired and have begun to lose muscle before being diagnosed with cancer, so it is important to exercise as soon as possible after the first consultation, which we should consider as an emergency treatment for their first symptoms and later, to help with the side effects of the treatment, "said Bouillet.
In a second study presented at ESMO in 2018, researchers not only reported on the value of exercise for cancer patients, but also showed that it is possible to identify patients with the greatest risk of poor quality of life during treatment so they can get extra help.
In the study of 2525 patients with stage I-III breast cancer receiving adjuvant chemotherapy, those who took 75 minutes vigorously or 150 minutes of moderate exercise a week had significantly better overall quality than those inactive after six and twelve months after treatment ( Table 1). They also had significantly better physical well-being and less fatigue, pain and respiratory distress. Powerful exercises included activities such as aerobics dancing, heavy gardening or fast swimming, while moderate training included brisk walking, water aerobics or volleyball.
"Around 60% of patients were physically active before and after chemotherapy, and despite their quality of life, they were negatively affected by chemotherapy, consistently achieving better results on a variety of physical, emotional, and symptom scales than those who were inactive." explained Dr. Antonio Di Meglio, study author and medical oncologist at the Institut Gustave Roussy, Villejuif, France.  The study found that patients who had mastectomy or additional illnesses, smoked or had a low income, were particularly at risk of poor quality of life after breast cancer chemotherapy, but also benefited from the exercise.
"Using a novel approach, we demonstrated that it is possible to identify breast cancer patients whose quality of life is most affected by chemotherapy, so that we can now target these patients directly for dedicated interventions, including those aimed at: increase physical activity to levels recommended by the WHO, "added Di Meglio.
Dr. Gabe Sonke, a medicine oncologist at the Dutch Cancer Institute, Amsterdam, Netherlands, underlined the importance of the French studies showing the value of physiotherapy in clinical practice, as has been observed in clinical trials, and through current ESMO recommendations for exercise as part of the standard care of all Cancer survivors is supported.
"The findings from the new studies in patients with metastatic breast cancer are particularly timely, as a large study is being launched by the international PREFERABLE consortium to further explore the value of exercise in this group of patients," he said.
Sonke pointed out that these and other studies endeavor to confirm early signs that programs for physical activity may improve compliance with chemotherapy and radiotherapy, and thus improve patient outcomes, making insurance companies more encouraged to pay for exercise initiatives.
"Insurers may ask why they should pay for training for patients with cancer if they do not pay for it in the general population, but if we can show that there is improved treatment adherence and an added survival benefit for cancer patients this strengthen our payment claim, "said Sonke.
He also wants more patients to be routinely invited to participate in exercise programs, including those who do not normally exercise: "We know that patients who are already active enter these exercise programs, but those who are not active, are missed, especially those with low income and less healthy lifestyles, and the new results must encourage us to focus on being more inclusive so that all patients can benefit from exercise to improve the quality of life during chemotherapy, "he concluded.
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