Impact of Exercise on Chemotherapy Tolerance and Survival in Early-Stage Breast Cancer: A Nonrandomized Controlled Trial

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  • 1 University of Alberta, Edmonton, Alberta, Canada;
  • | 2 Now: University of Toronto, Toronto, Canada;
  • | 3 British Columbia Cancer, Vancouver, British Columbia, Canada;
  • | 4 Australian Catholic University, Mary Mackillop Institute for Health Research, Melbourne, Victoria, Australia; and
  • | 5 University of British Columbia, Vancouver, British Columbia, Canada.
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Background: Available preliminary evidence is conflicting on whether exercise can positively influence antineoplastic treatment tolerance and in turn improve survival. Patients and Methods: This study compared chemotherapy treatment tolerance and survival among women receiving adjuvant chemotherapy for early-stage breast cancer who participated in a single-arm trial of supervised aerobic and resistance exercise programming versus a historical cohort that did not receive structured exercise programming. Results: The exercise group (EX; n=73) and control group (CTR; n=85) participants were matched on age and treatment and balanced on medical history, cancer diagnosis, and body mass index. Attendance in the EX group was 64% ± 27% of 3 offered sessions per week. For all chemotherapy agents combined, the relative risk (RR) of a chemotherapy dose reduction (RR, 0.78; 95% CI, 0.54–1.11) or delay (RR, 1.05; 95% CI, 0.62–1.80) did not differ between groups. However, the EX group had reduced relative and absolute risks of a dose reduction in doxorubicin by 60% and 18%, respectively. For all agents combined, there were no differences between groups in risk of anemia, neutropenia, or weight gain. In the EX group, dose reductions due to neutropenia (P=.027), other infections (P=.049), and fatigue (P=.037) were less common, whereas mucositis was more common (P=.023), compared with the CTR group. The EX group had reduced relative and absolute risks of weight gain on the docetaxel + cyclophosphamide regimen by 38% and 30%, respectively. After a median follow-up of 70 months (range, 54–84 months), there was no difference between the EX and CTR groups in disease-free survival events (n=8 [11%] vs n=9 [11%], respectively; log-rank test, P=.78) or overall survival events (n=5 [7%] vs n=6 [7%], respectively; log-rank test, P=.974). Conclusions: Overall, exercise programming during adjuvant chemotherapy does not appear to impact treatment tolerance or survival in women receiving common modern regimens of adjuvant chemotherapy for early-stage breast cancer. However, exercise may provide selective benefits, depending on the treatment regimen received.

Submitted March 16, 2020; accepted for publication June 3, 2020.

Author contributions: Study concept: Kirkham, Gelmon Van Patten, McKenzie, Campbell. Funding acquisition: Van Patten, Campbell. Data acquisition: Kirkham, Gelmon, Van Patten, Bland, Wollmann, Landry, Campbell. Provided patients: Gelmon. Data analysis and interpretation: Kirkham. Manuscript preparation: Kirkham, Campbell.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This work was supported by funding from the BC Cancer Agency (Campbell) and the Canadian Institutes of Health Research (Kirkham).

Correspondence: Kristin L. Campbell, PhD, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. Email: kristin.campbell@ubc.ca
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