Exercise Oncology

Question 1

Exercise is useful in 4 phases of cancer after diagnosis

Answer 1

Pretreatment, Treatment, Survivorship, and End of Life

Question 2

Goals of exercise during pretreatment

Answer 2

Delay/prevent treatment, qualify for treatment, improve treatment effectiveness, reduce side effects, improve outcomes.

Question 3

Goals for exercise during treatment

Answer 3

Improve treatment effectiveness, reduce treatment side effects, improve treatment completion, hasten recovery.

Question 4

Most common treatment with prehab

Answer 4

Surgery

Question 5

Goals of exercise post-treatment

Answer 5

Recover from treatment side effects, restore function, improve survival, deal with long-term side effects, reduce recurrence risk.

Question 6

Goals of exercise during palliation

Answer 6

Manage symptoms, maintain functionality, slow progression, improve QoL.

Question 7

Cancer variables can be…

Answer 7

Exercise outcomes (Exercise effects cancer variable)
Moderators of exercise outcomes (enhance/negate usual outcomes of exercise)
Exercise determinants (Cancer variable determines if you exercise, how, etc)
Moderators of exercise determinants (Change the relation of age, gender, SES, etc to exercise)

Question 8

Disease variables

Answer 8

Stage, grade, type of cancer, treatment response.

Question 9

What are the pros and cons of AS?

Answer 9

The pros: Avoid the potential side effects of treatment, maintain quality of life, and save costs.

The cons: Small risk of metastasis, 30-50% of patients eventually get invasive treatment, and fear of progression.

Question 10

What were the findings of the ERASE trial?

Answer 10

Found that HIIT training during AS: Improves physical fitness, delays progression of PCa, reduces PCa cell growth, and reduce PCa-specific anxiety.

Question 11

Generally, EX during cancer treatment improves/manages:

Answer 11

physical fitness
body composition
some symptoms (fatigue)
some aspects of QoL

Question 12

Most exercise during treatment research has involved which two cancer and treatments?

Answer 12

Breast cancer + chemotherapy, and Prostate cancer + ADT (hormone therapy)

Question 13

3 effects pathways for EX during treatment.

Answer 13

Direct pathways, treatment completion, and treatment efficacy.

Question 14

Mechanisms of improved treatment tolerance (completion)

Answer 14

+LBM (chemo metabolism)
+physical function
+Neutrophil counts (infection resistance)
-side effects (avoid severe toxicities)

Question 15

Mechanisms of improved treatment efficacy

Answer 15

+angiogenesis (more chemo drugs delivered to the tumor, and oxygenates the tumor for radiation therapy)
+intratumoral blood profusion
-intratumoral hypoxia
+intratumoral immune cell infiltration

Question 16

How do EX, chemo drugs, and tumors interact?

Answer 16

Some tumors appear to grow faster, slower, or the same with EX compared to no EX. Exercise and chemo drugs appear to have synergistic effects.

Question 17

What was the START trial?

Answer 17

The START trial examined the effects of resistance or aerobic exercise on versus UC in BC patients on adjuvant chemotherapy.

Question 18

What were the major START trial findings?

Answer 18

AET increased VO2. RET improved strength (effect was greater in non-taxanes) and significantly improved LBM (node positive). Both RET and AET significantly decreased the amount of fat gained during treatment (node positive). RET significantly improved relative dose intensity.

Question 19

HELP trial

Answer 19

Compared AET to UC in lymphoma patients. Primary endpoint QoL. QoL improved in both chemo and off treatment groups. Improvements were greatest with poor baseline health and unmarried. Had a significant effect in improving sleep quality in those who already experienced poor sleep.

Question 20

EXERT Trial

Answer 20

Compared exercise vs UC during neoadjuvant chemoradiotherapy. Found EX is feasible and safe, may not improve fitness, may exacerbate symptoms and worsen QoL, may not improve treatment or completion rates, but may improve treatment response!

Question 21

Overall results of EX during survivorship

Answer 21

Similar outcomes to during treatment but with stronger effects.

Question 22

What is the goal of precision medicine?

Answer 22

The goal of precision medicine is to provide treatments only to those who will benefit, and avoid providing them to those who will not, while avoiding the side effects and costs of providing treatment to those who would not benefit.

Question 23

Overall, cancer patients doing the most exercise have a ___ % reduction in mortality compared to those doing the least.

Answer 23

37%

Question 24

What is the significant finding of tumor biomarker p27 and EX in colorectal cancer patients.

Answer 24

Those who did EX and expressed p27 had a statistically significant reduction in mortality of 68%.

Question 25

Significant finding of tumor size in breast cancer and EX effect on survivability.

Answer 25

When tumor size was <2cm, survivability was better (statistically significant). If tumor size was larger there appeared to be no effect of EX.