Exercise During Chemotherapy Improves Cardiovascular Function in Women with Breast Cancer

March 2019 Vol 10, No 3

Categories:

Breast Cancer

A 12-month supervised exercise program improved cardiovascular function in women undergoing adjuvant chemotherapy for breast cancer—including anthracyclines and taxanes—while cardiovascular function decreased among controls who did not exercise according to the program guidelines. These results from the randomized EBBA-II trial were presented at the 2018 San Antonio Breast Cancer Symposium.

“All subgroups in the exercise intervention group benefited from physical activity during breast cancer treatment. Our study supports incorporating supervised clinical exercise programs into breast cancer treatment guidelines. All patients with breast cancer receiving chemotherapy should be offered tailored exercise programs based on assessed pretreatment level of function,” stated lead author Inger Thune, MD, PhD, Oslo University Hospital, Norway.

The success of this program depended partly on the oncologists’ buy-in on the importance of exercise, Dr Thune explained.

“The treating oncologist encouraged participation in this program and checked up on patients each month to see how they were doing,” she said.

“For such a program to be successful, clinicians have to support the importance of exercise. I speak to all my patients about exercise ahead of surgery. So do my colleagues. Patients should know that their cardiovascular function during treatment will affect their physical function later in life. Cardiovascular function is a marker of susceptibility to comorbidity during survivorship,” Dr Thune emphasized.

Adherence to the exercise intervention was over 90%, perhaps because the oncologists supported the program.

Study Description

To enroll in the trial, patients were screened and assessed by trained nurses for cardiovascular capacity using maximal oxygen uptake (VO2 max) to assess aerobic capacity as a surrogate marker for cardiovascular function. The treating physician telephoned patients to invite them to participate in the trial, and 545 decided to enroll. Participants were aged 18 to 75 years and had stage I or II ductal carcinoma in situ or lobular carcinoma in situ, no known severe comorbidity, and were capable of participating in exercise. They also had no history of previous cancer.

Three weeks after surgery, patients were randomized to the exercise intervention or standard of care. The exercise intervention entailed a 12-month, supervised, group-based program of strength and endurance exercise tailored to each patient’s physical capacity. Participants in the exercise intervention did moderate- to high-intensity stretching and weight-bearing exercises outdoors for 60 minutes twice a week and 120 minutes of exercise at home for a total of 240 minutes every week. The control group received standard of care with no limit or restrictions on physical activity.

“Exercises were modified according to the patient’s situation,” Dr Thune said. “For example, if you had a mastectomy, you couldn’t do certain stretching exercise during the first few months.”

Mean age was 55 years. Fifty-five percent of patients in both arms were treated with chemotherapy; 53% received anthracyclines, and 39% received taxanes. About 58% had endocrine therapy. There was a slight imbalance between study arms for radiation: 76.8% of patients in the exercise group and 84.7% in the control arm received radiation. Median body mass index was 25.6.

Patients were assessed for cardiovascular function before surgery, then at 6 and 12 months after randomization.

“VO2 max was similar and quite high in both groups at baseline,” Dr Thune said.

At 12 months, the exercise group went back to baseline levels of VO2 max with a 0.3% increase, while controls had an 8.9% decrease.

Among women who did not receive chemotherapy, VO2 max at 12 months increased by 1.6% in the exercise group but decreased by 2.7% in controls.

Looking at women treated with chemotherapy, at 6 months there was a 9% decrease in VO2 max in the exercise group and a 14.3% decrease among controls. At 12 months there was a 0.8% increase among exercise group patients and a 6.4% decrease among controls.

A similar pattern in VO2 max was observed in patients treated with taxanes at 6 months and 12 months.

The number of adverse events was “incredibly low,” Dr Thune said. “I was worried that they might faint on the treadmill, but they didn’t.”

“Whether you were treated only with surgery or you got chemotherapy as well, all patients had a good effect from the intervention,” Dr Thune stated.

Commenting on the positive results of this study, Kent Osborne, MD, director of the Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine, Houston, TX, said: “I think exercise is extremely impor­tant. I encourage all my patients to get exercise. It is also important for the family not to act like the patient is sick and encourage physical activity. Data show that exercise improves survival.”

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