exercise and cancer outcomes assoc prof sandi hayes qut, ihbi, school of public health
TRANSCRIPT
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Exercise and Cancer Outcomes
Assoc Prof Sandi Hayes
QUT, IHBI, School of Public Health
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CRICOS No. 00213J
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Reduced Functional
status
Gastro-intestinal
side effects
depression
neuropathy
fatigue
depression
arthralgia
sleeping difficulties
poor body image
changes in BC
Quality and quantity of survival
Survivorship concerns
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Function, quality of life and survival
Fatigue
depression
Functional status
CIPNArthralgias
Bone outcomes
CV late effects
Survivorship concerns: common, do not sit in isolation and persist
Schmitz et al; Cancer, 2012, 118(8):S2217-2225
(n=160) Post-diagnosis
6m 12m 18m 6y
0 symptoms 60 (37.5) 80 (50.0) 92 (57.5) 68 (42.5)
1 symptom 43 (26.9) 38 (23.8) 28 (17.5) 41 (25.6)
2 symptoms 26 (16.3) 22 (13.8) 21 (13.1) 27 (16.9)
3+ symptoms 31 (19.4) 20 (12.5) 19 (12.0) 24 (15.0)
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No cancer(%)
< 5 year cancer
survivor (%)
5+ year cancer survivor (%)
A: Any physical restriction 13 31 31
B: Any limitation in physical performance
21 53 54
Survivorship concerns: associated with cancer and its treatment
Ness et al, AEP, 2006, 16:197
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Limitations in physical performance and participation restrictions:
• Impacts all aspects of quality of life• Associated with increased health care costs• May influence survival
Individual Impact Public health Impact
So what?
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Concerns following cancer
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• improves the function of all of our physiological systems• being physically active =
– Reduces risk of specific cancers by up to 60%– Reduces risk of heart disease and hypertension by 40%– Reduces risk of stroke by 27%– Reduces risk of type II diabetes by 58%– Is twice as effective in treating type II diabetes than insulin– Decreases depression as effectively as prozac or
behavioural therapy• Physical inactivity = greater risk of dying than smoking, obesity,
hypertension, high cholesterol
Relevance of exercise?
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Exercise and cancer outcomes
Preservation or improvements:
Reductions:
• Muscle mass, strength, power• Cardiorespiratory fitness• Physical function• Physical activity levels• Range of motion• Immune function• Chemotherapy completion rates• Body image, self esteem and mood
• Number of symptoms and side- effects reported, such as nausea, fatigue and pain• Intensity of symptoms reported• Duration of hospitalisation• Psychological and emotional stress• Depression and anxiety
Hayes S, et al. (2009). J Sci Med Sport;12:428-34 ; Schmitz KH, et al. (2005). Cancer Epi & Biomarkers ;14.1588-95.
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Cardiovascular disease
Osteoporosis
Diabetes
Hypertension
Other cancers
Improves cancer survival: 4-18%
Exercise and survival following cancer
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Exercise prescription guidelines
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Feasibility and clinical concerns
• Participation in exercise post-diagnosis is feasible
• Clinical concerns:– Immunosuppressive effect of exercise– Potential for exacerbating treatment-
related side effects such as fatigue, lymphoedema, nausea, pain
– Reduced exercise tolerance in cancer survivors
• Exercise is considered to be safe• Adverse effects have been rare and mild
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State of play
Majority enter cancer diagnosis insufficiently active
Majority stop exercising or experience declines in physical activity levels during treatment
Majority never regain pre-cancer physical activity levels
Cancer diagnosis
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Limits to our knowledge
• Evidence heavily derived from studying women with breast cancer
• Small samples with response bias– Representativeness?– Conservative estimate of effect
• Lack of understanding of mechanisms– Focus on specific outcomes in isolation
• Cost-effectiveness• Survival
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Exercise and Gynaecological Cancer
Significant scope for advancing knowledge
Name: ECHO Trial
Design: a phase III, RCT evaluating the effects of an exercise intervention during chemotherapy for ovarian cancer
Outcomes: physical wellbeing, chemotherapy-related side effects and adherence, physical function, QoL, progression-free survival, health resource use.
Team: Hayes, Friedlander, Obermair, Mileshkin, Janda, Gordon, Barnes, Beesley, Sommeijer, Martyn
App#: 1063509
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Greatest challenge in exercise intervention trials is recruitment:
Need for clinician support