Physical Fitness and Chemotherapy Tolerance in Patients with Early-Stage Breast Cancer
Groen, Wim G; Naaktgeboren, Willeke R; van Harten, Wim H; van Vulpen, Jonna K; Kool, Nathalie; Sonke, Gabe S; van der Wall, Elsken; Velthuis, Miranda J; Aaronson, Neil K; May, Anne M; Stuiver, Martijn M
(2022) Medicine and Science in Sports and Exercise, volume 54, issue 4, pp. 537 - 542
(Article)
Abstract
INTRODUCTION: An optimal relative dose intensity (RDI) of adjuvant chemotherapy is associated with better survival in patients with breast cancer. Little is known about the role of physical fitness in attaining an adequate RDI in patients with early-stage breast cancer. We investigated the association between pretreatment physical fitness and RDI
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in this population. METHODS: We pooled individual patient data from two randomized exercise trials that studied exercise programs in early breast cancer: the Physical Exercise During Adjuvant Chemotherapy Effectiveness Study (n = 230) and the Physical Activity during Chemotherapy Treatment (n = 204) study. Logistic regression models were used to evaluate the association between pretreatment fitness and achieving an optimal RDI (≥85%). In addition, we added an interaction term to the model to explore the potential moderating effect of participating in an exercise program. RESULTS: Data were available for 419 patients (mean age at diagnosis, 50.0 ± 8.6 yr). In the total sample, lower pretreatment physical fitness was associated with significantly lower odds of achieving ≥85% RDI: age-adjusted odds ratio (OR) of 0.66 (95% confidence interval (CI), 0.46-0.94). In patients allocated to the supervised exercise intervention during chemotherapy (n = 173), the association between pretreatment physical fitness and RDI was almost completely mitigated (OR, 0.95 (95% CI, 0.54-1.56)), whereas it was more pronounced in patients who received care as usual (n = 172; OR, 0.31 (95% CI, 0.13-0.63); Pinteraction = 0.022). CONCLUSIONS: Early-stage breast cancer patients with relatively lower levels of pretreatment physical fitness have lower odds of achieving an optimal dose of chemotherapy. Given that physical fitness is modifiable and our results suggest that following a moderate-to-high intensity exercise training during chemotherapy could improve treatment completion, clinicians should not refrain from referring patients to supportive exercise programs because of low fitness.
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Keywords: breast cancer, chemotherapy, clinical cancer research, physical fitness, Physical Therapy, Sports Therapy and Rehabilitation, Orthopedics and Sports Medicine, Journal Article
ISSN: 0195-9131
Publisher: Lippincott Williams and Wilkins
Note: Funding Information: The PACES study was supported by the Alpe d’Huzes/Dutch Cancer Society (Grant No. ALPE-2009-4299), the CZ Fund, Zilveren Kruis Achmea, and the Comprehensive Cancer Centre of the Netherlands. The PACT study was supported by The Netherlands Organisation for Health Research and Development (ZonMw; project number: 171002202), the Dutch Cancer Society (project number: UU 2009–4473), and the Dutch Pink Ribbon Foundation (2011/Woo2.C100). The results of the present study do not constitute endorsement by the American College of Sports Medicine, and we declare that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Publisher Copyright: © Lippincott Williams & Wilkins.
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