Effects of Exercise during Adjuvant Chemotherapy on Breast Cancer Outcomes

Observational studies suggest that physical activity after a breast cancer diagnosis is associated with improved cancer outcomes; however, no randomized data are available. Here, we report an exploratory follow-up of cancer outcomes from the Supervised Trial of Aerobic versus Resistance Training (ST...

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Bibliographic Details
Published in:Medicine and science in sports and exercise 2014-09, Vol.46 (9), p.1744-1751
Main Authors: COURNEYA, KERRY S, SEGAL, ROANNE J, MCKENZIE, DONALD C, DONG, HUIRU, GELMON, KAREN, FRIEDENREICH, CHRISTINE M, YASUI, YUTAKA, REID, ROBERT D, CRAWFORD, JENNIFER J, MACKEY, JOHN R
Format: Article
Language:English
Subjects:
Antineoplastic Agents - therapeutic use
Biological and medical sciences
Breast Neoplasms - complications
Breast Neoplasms - drug therapy
Breast Neoplasms - pathology
Bridged-Ring Compounds - therapeutic use
Chemotherapy, Adjuvant
Combined Modality Therapy - methods
Disease-Free Survival
Exercise Therapy - methods
Female
Follow-Up Studies
Fundamental and applied biological sciences. Psychology
Gynecology. Andrology. Obstetrics
Human physiology applied to population studies and life conditions. Human ecophysiology
Humans
Mammary gland diseases
Medical sciences
Middle Aged
Multiple tumors. Solid tumors. Tumors in childhood (general aspects)
Neoplasm Staging
Obesity - complications
Receptors, Estrogen - analysis
Resistance Training
Survival Rate
Taxoids - therapeutic use
Treatment Outcome
Tumors
Vertebrates: body movement. Posture. Locomotion. Flight. Swimming. Physical exercise. Rest. Sports
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Summary:Observational studies suggest that physical activity after a breast cancer diagnosis is associated with improved cancer outcomes; however, no randomized data are available. Here, we report an exploratory follow-up of cancer outcomes from the Supervised Trial of Aerobic versus Resistance Training (START). METHODSThe START was a Canadian multicenter trial that randomized 242 breast cancer patients between 2003 and 2005 to usual care (n = 82), supervised aerobic (n = 78), or resistance (n = 82) exercise during chemotherapy. The primary end point for this exploratory analysis was disease-free survival (DFS). Secondary end points were overall survival, distant DFS, and recurrence-free interval. The two exercise arms were combined for analysis (n = 160), and selected subgroups were explored. RESULTSAfter a median follow-up of 89 months, there were 25/160 (15.6%) DFS events in the exercise groups and 18/82 (22.0%) in the control group. Eight-year DFS was 82.7% for the exercise groups compared with 75.6% for the control group (HR, 0.68; 95% confidence interval (CI), 0.37–1.24; log-rank, P = 0.21). Slightly stronger effects were observed for overall survival (HR, 0.60; 95% CI, 0.27–1.33; log-rank, P = 0.21), distant DFS (HR, 0.62; 95% CI, 0.32–1.19; log-rank, P = 0.15), and recurrence-free interval (HR, 0.58; 95% CI, 0.30–1.11; Gray test, P = 0.095). Subgroup analyses suggested potentially stronger exercise effects on DFS for women who were overweight/obese (HR, 0.59; 95% CI, 0.27–1.27), had stage II/III cancer (HR, 0.61; 95% CI, 0.31–1.20), estrogen receptor-positive tumors (HR, 0.58; 95% CI, 0.26–1.29), human epidermal growth factor receptor 2-positive tumors (HR, 0.21; 95% CI, 0.04–1.02), received taxane-based chemotherapies (HR, 0.46; 95% CI, 0.19–1.15), and ≥85% of their planned chemotherapy (HR, 0.50; 95% CI, 0.25–1.01). CONCLUSIONSThis exploratory follow-up of the START provides the first randomized data to suggest that adding exercise to standard chemotherapy may improve breast cancer outcomes. A definitive phase III trial is warranted.
ISSN:0195-9131
1530-0315
DOI:10.1249/MSS.0000000000000297