Delivering exercise to rectal cancer patients during neoadjuvant chemotherapy: Safe, feasible, and poised for evaluation

15 Aug 2018 2:05 PM | Brandon Davenport (Administrator)

Digest Commentator: Stephanie Saunders, MA student, Jennifer Brunet PhD

Edited by: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto

Medical advancement in cancer treatments have led to improved surgical outcomes and survival in locally advanced rectal cancer patients. In particular, neoadjuvant chemoradiation therapy (NACRT), followed by surgical resection, has become the standard regimen for rectal cancer patients, as it improves local control of cancer. Although this leads to enhanced prognosis, NACRT is associated with a host of adverse side effects that negatively impact patients’ wellbeing. Whereas many researchers have reported that exercise is an effective strategy to mitigate these negative treatment side effects in a range of cancers (e.g., breast, prostate, colon), few of these studies have been performed in patients with rectal cancer, and, to date, no studies have looked at the influence of exercise on NACRT side effects.

The current study examined study feasibility and safety of an aerobic exercise intervention in 18 patients diagnosed with rectal cancer during and immediately after NACRT. Forty-five participants were screened for eligibility by their medical oncologist at the time of their first radiation consultation. The study coordinator followed-up with 32 patients who were deemed eligible to participate, and scheduled initial exercise assessment for 18 interested participants.

Morielli and colleagues (2016) had participants engage in a supervised aerobic exercise program, consisting of warm up and cool down, and a tailored session on a variety of aerobic modalities (e.g., treadmill, upright bike, recumbent bike, elliptical, and rower). The program ran three times per week throughout their NACRT treatment (6 weeks). Upon completion of their NACRT treatment, participants were given an unsupervised aerobic exercise program, cumulating in 150 minutes per week, for 6-8 weeks until their surgical resection.

The authors found a high study eligibility (32/45,71%), high recruitment rate (18/32, 56%), and high retention rate (14/18, 78%), all of which are comparable to rates of other Phase 1 exercise intervention studies in other commonly studied cancers (e.g., breast and lymphoma). Additionally, secondary findings suggest that while health-related fitness outcomes (i.e., cardiorespiratory fitness level, psychosocial functioning, quality of life) declined during NACRT, they recovered afterwards to baseline levels, and in some cases improved beyond pre-NACRT levels. These results provide early evidence that exercise training among eligible patients with rectal cancer undergoing NACRT is both safe and feasible. In addition, exercise may have potential protective health effects during NACRT, as health-related fitness outcomes increased upon completion of treatment of NACRT prior to surgery. As this was a feasibility study without a control group, more research is needed to determine the effectiveness of the intervention and the effect of exercise on health outcomes.

What I liked about this article: The current literature has shown that exercise is beneficial to a range of cancer populations; however its effects on patients with rectal cancer are understudied. Morielli and colleagues’ (2016) article is among the first to provide an indication of the role exercise can play in ameliorating negative side effects of NACRT in patients with rectal cancer. Further, as the authors have shown eligibility and recruitment rates over 50%, patients with rectal cancer are both highly interested, and able, to participate in exercise training opportunities. As a result of this study, researchers have an exciting opportunity to further explore the relationship between exercise and NACRT side effects, as well as investigate the benefits of exercise training in a population that has shown interest in participating in exercise-based studies.

Journal website:

Morielli, A. R., Usmani, N., Boulé, N. G., Tankel, K., Severin, D., Nijjar, T., … & Courneya, K. S. (2016). A phase I study examining the feasibility and safety of an aerobic exercise intervention in patients with rectal cancer during and after neoadjuvant chemoradiotherapy. Oncology Nursing Forum, 43(3), 352-362.

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