Groundbreaking Study Highlights Benefits of Structured Exercise
A recent phase III study reveals that a structured exercise program lasting three years, initiated immediately after adjuvant chemotherapy, is associated with improved disease-free and overall survival rates among patients diagnosed with stage III and high-risk stage II colon cancer. These findings, which will be presented at the upcoming 2025 ASCO Annual Meeting (Abstract LBA3510), underscore the vital role that physical activity can play in cancer recovery.
The Colorectal Cancer Landscape
According to the World Health Organization, colorectal cancer represents the third most frequently diagnosed cancer globally, contributing to roughly 10% of all cancer cases. In the United States alone, it is anticipated that 154,270 new colorectal cancer cases will emerge this year, with nearly 53,000 fatalities attributed to the disease.
Expert Insights
Lead author Dr. Christopher Booth, MD, FRCPC, from Queen’s University in Kingston, Canada, expressed the significance of this study, stating, "As oncologists, one of the most common questions we hear from patients is, ‘What else can I do to improve my outcome?’ This study offers a clear answer: an exercise program with a personal trainer not only reduces the risk of cancer recurrence but also enhances overall well-being and longevity."
Study Overview
The primary objective of this research was to establish whether an increase in recreational physical activity following adjuvant therapy could lead to significant improvements in disease-free survival among patients with advanced colon cancer. The study enrolled 889 patients, randomly assigning them to either a structured exercise program (n = 445) or a health education materials group (n = 444) across 55 sites in six different countries from 2009 to 2024.
Participants in the structured exercise program engaged with a consultant who utilized behavior-change techniques to guide their exercise interventions over three years. The trend was to raise recreational physical activity levels by at least 10 MET-hours weekly from baseline in the initial six months, and maintain that level throughout the study. MET, or metabolic equivalent, measures energy expenditure related to physical activity.
The study's primary endpoint was disease-free survival, measured through a stratified log-rank test on an intention-to-treat basis, while secondary endpoints included overall survival and patient-reported outcomes utilizing the SF-36 physical function scale.
Demographics and Results
The participant demographic showed a median age of 61 years, with an equal representation of genders (51% female) and a predominance (90%) of stage III cases. Notably, both groups exhibited improved physical function, but those in the structured exercise program experienced substantially greater enhancements.
Key Findings Include:
- With a median follow-up duration of 7.9 years, 224 disease-free events were recorded, with 93 from the exercise group and 131 from the health education group.
- The study reported 107 deaths among participants, with lower fatalities in the exercise program (41) compared to the education group (66).
- Five-year disease-free survival rates were 80% in the exercise arm vs. 74% in the health education arm (HR = 0.72; P = .017).
- The eight-year overall survival was also more favorable in the exercise group at 90% compared to 83% in the other group (HR = 0.63; P = .022).
- Substantial improvements in physical functioning were observed within the first six months, sustaining increases for 24 months (mean change scores: 7.42 vs 1.10; P < .001).
During safety assessments, 19% of participants in the structured exercise program reported any grade of musculoskeletal adverse events, compared to 12% in the health education group, with only a small percentage of events related to the exercise regimen itself.
Implications for Future Care
The study authors assert, "In patients with stage III and high-risk stage II colon cancer, a three-year structured exercise program initiated shortly after completion of adjuvant chemotherapy profoundly improves disease-free survival, overall survival, and patient-reported physical functioning. Therefore, health systems are encouraged to integrate structured exercise programs as part of the standard care for these patients."
Moreover, Dr. Pamela Kunz, MD, from Yale School of Medicine, and an ASCO Expert in gastrointestinal cancers, emphasized the groundbreaking nature of the study, stating, "This is the first randomized phase III trial to show that post-treatment exercise is both feasible and effective in enhancing disease-free survival. Integrating exercise into patient recovery plans should be a standard practice moving forward."
Financial Disclosures
The study received funding from the Canadian Cancer Society, the National Health and Medical Research Council, Cancer Research UK, and the University of Sydney Cancer Research Fund.
Bias Analysis
Key Questions About This Article
