A structured exercise program in patients with cancer receiving chemotherapy led to a reduction in self-reported cognitive impairment vs those receiving chemotherapy who were not on an exercise plan, according to findings from a nationwide, randomized phase III trial published in JNCCN—Journal of the National Comprehensive Cancer Network.
Benefits of the exercise program—called Exercise for Cancer Patients (EXCAP)—on cognitive function were more significant among patients receiving chemotherapy in 2-week cycles vs those receiving chemotherapy in 3- to 4-week cycles.
“This means that a safe, simple exercise program could be an important part of supportive care for people going through chemotherapy,” stated co-lead author Karen M. Mustian, PhD, MPH, of the Wilmot Cancer Institute, University of Rochester Medical Center. “Cancer care providers should consider incorporating structured, home-based exercise prescriptions, such as walking and resistance band exercises, into routine chemotherapy care. Providers should educate patients on these benefits, monitor cognitive and fatigue symptoms throughout treatment, and, as part of optimal supportive care, refer patients to exercise oncology specialists when needed, to tailor prescriptions for individual capabilities.”
Background and Study Methods
Exercise-induced immunocompetence may lead to improvements in mental fatigue and cancer-related cognitive impairments, which are experienced by up to 75% of patients with cancer during treatment.
Researchers conducted a first-of-its-kind, nationwide, multicenter, randomized phase III study of 687 patients with cancer who were undergoing chemotherapy across 20 community oncology practices within the National Cancer Institute Community Oncology Research Program Research Base. All participating patients were enrolled between 2009 and 2014 and were receiving chemotherapy for the first time; patients did not have any distant metastases, and the majority of patients were women, had undergone surgery, and/or had breast cancer.
Patients who were randomly assigned to receive a prescription for the EXCAP plan were given instructions for individualized walking and resistance band–based exercise; all instructions were given in a teach-back method so that trainers could ensure solid technique. The patients were also advised to keep records of their daily steps and of their time spent doing such exercises. Blood samples were also collected to track markers of inflammation.
Key Findings
Patients who were receiving 2-week cycles of chemotherapy and who were randomly assigned to the structured exercise plan demonstrated significantly reduced cognitive decline overall (mean difference = 7.0; P = .04), including a reduction in their perceived cognitive impairment (mean difference = 4.1; P= .05) and mental fatigue (mean difference = 4.1; P= .05) compared to patients not placed on the exercise plan. Throughout receipt of chemotherapy, these patients maintained their daily walking regimen, while 53% of patients not assigned to the exercise plan reduced their walking.
All EXCAP participants benefitted from the plan and reported less mental fatigue (–0.7; P = .02), regardless of the number of their chemotherapy cycles.
Suppressed inflammatory responses were associated with cancer-related cognitive impairments in all patients receiving chemotherapy (0.2; P < .01).
“It was striking to find that without a structured exercise plan, patients receiving chemotherapy often reduce their daily walking by half and experience notable increases in problems with thinking, memory, and mental fatigue,” added co-lead author Po-Ju Lin, PhD, MPH, RD, also of the Wilmot Cancer Institute, University of Rochester Medical Center. “Nonpharmacologic interventions, such as exercise, cognitive training, and mindfulness, are important for managing cognitive impairment during chemotherapy because they are safe, accessible, and can often be delivered at low cost or even at home, making them easier for patients to use, compared with expensive or clinic-based treatments.”
The study authors suggested that the 2-week chemotherapy cycles may be a "sweet spot" for allowing patients to recover enough to continue exercising, unlike patients on 3- to 4-week treatment cycles.
DISCLOSURE: For full disclosures of the study authors, visit jnccn.org.
