Exercise after chemo is key to surviving colon cancer, the study studies

Exercise after chemo is key to surviving colon cancer, the study studies

An international study shows that cancer survivors getting exercise after chemotherapy can increase their chances of beating colon cancer, making it a game changer for long-term survival.

Study:Structured training after adjuvant chemotherapy for colon cancer. Photo credit: SimplyLove/Shutterstock.com

A current one New England Journal of Medicine The study conducted a randomized phase 3 trial to assess how structured exercise programs after adjuvant chemotherapy influence longer disease-free survival in colorectal cancer patients.

Colon cancer: conventional treatment and relapse

Colorectal cancer, also known as colorectal cancer, is the third most common type of cancer worldwide and has high mortality rates. Typically, patients with stage III or high-risk stage II colon cancer are recommended surgery and adjuvant chemotherapy.

Shortly after surgery, these patients are treated with capecitabine and oxaliplatin (Capox), 5-fluorouracil and oxaliplatin (FOLFOX), or monotherapy fluoropyrimidine for three to six months. In addition to side effects, this treatment strategy has a high relapse rate. Therefore, new interventions are urgently needed to improve the quality of life and survival rate of these patients.

Preclinical studies have shown the beneficial effects of exercise on reducing cancer growth. Observational studies have also shown that colorectal cancer patients who engage in recreational physical activity after treatment have a lower risk of cancer recurrence and death.

However, previous evidence from observational studies has failed to prove a definitive causal relationship due to limitations in study design. Further research is important to understand how exercise improves colorectal cancer outcomes after surgery and adjuvant chemotherapy.

About the study

The Canadian Cancer Trials Group (CCTG) has launched the Co.21 Colon Health and Lifelong Training Change (Challenge) study to compare the effects of health operating materials (health education) or these materials in combination with a structured exercise program (training) over three years in patients with colorectal cancer who have completed adjuvant chemotherapy.

All participants completed resection of stage III or high-risk stage II adenocarcinoma of the colon, followed by adjuvant chemotherapy. These patients exercised less than 150 minutes per week of moderate to mild intensity exercise at baseline.

Eastern Cooperative Oncology Group (ECOG) used a 5-point approach to assess the level of disability. Higher numbers on this scale indicated greater disability. All eligible patients could complete at least 6-minute walk tests or two levels of submaximal treadmill testing.

Patients were randomly assigned to health education and exercise groups in a 1:1 ratio. Patients assigned to the health education group received materials related to physical activity and healthy eating. In contrast, those in the exercise group received the same materials and an exercise guide for colorectal cancer survivors. Participants in the exercise group also received three years of guidance from a certified physical activity counselor.

The support program was divided into three phases based on the timeline and defined support. During the first six months of the program (Phase 1), participants in the exercise groups participated in 12 mandatory in-person behavioral support sessions scheduled every two weeks, 12 mandatory supervised exercise sessions, and an additional 12 supervised exercise sessions during the alternate weeks.

During the second six months of the program (Phase 2), patients attended in person or remotely every two weeks, as well as one supervised exercise session when visited in person.

During the final two years of the study (Phase 3), patients were required to attend 24 mandatory monthly in-person or remote behavioral support sessions, combined with a supervised exercise session if the patient was visited in person.

The training program aimed to increase aerobic exercise exercise through at least ten metabolic equivalent tasks (MET) in the first two quarters. The goal was then to maintain or further increase this over the remaining 2.5 years.

Study results

Between 2009 and 2024, 889 patients were recruited from 55 sites in Canada and Australia. In this study, 445 patients were randomly assigned to the exercise group and 444 were assigned to the health education group. The average age of the patients was 61 years; 90% of the cohort had stage III disease and 61% had received FOLFOX treatment.

During Phase 1, adherence to the intervention and changes in physical activity adherence were estimated at 83% for the 12 mandatory behavioral support sessions, 79% for the 12 mandatory supervised exercise sessions, and 20% for the 12 recommended supervised exercise sessions.

During Phase 2, adherence fell to 68% for the 12 mandatory behavioral support sessions and 54% for the 12 recommended supervised training sessions. Phase 3 adherence rates were 63% for the 24 mandatory behavioral support sessions and 44% for the 24 recommended supervised training sessions.

A regression model showed that patients in the exercise group maintained greater improvements than those in the health education group throughout the three-year intervention. These improvements were consistent with moderate to vigorous physical activity, maximal oxygen consumption, and 6 minutes of walking distance.

The difference in leisure-time and major-to-major recreational physical activity between groups ranged from 5.2 to 7.4 MET hours per week. Predicted maximum oxygen consumption improved from 1.3 to 2.

7 ml/kg/min and the difference between groups in 6-minute walking distance between 13 and 30 meters. Minimal differences between groups were observed for body weight or waist circumference.

At a median follow-up of 7.9 years, 93 and 131 patients in the exercise group and the health education group experienced recurrent disease, a new primary cancer, or death. This corresponded to a hazard ratio for disease recurrence, new primary cancer, or death of 0.72, favoring the exercise group.

Notably, five-year disease-free survival was significantly longer in the exercise group (80.3%) compared to the health education group (73.9%). The exercise group also improved overall survival, with a hazard ratio for death of 0.63. The 8-year overall survival was 90.3% in the exercise group and 83.2% in the health education group.

In addition, patients in the exercise group showed more improvement on the physical functioning subscale than those in the health education group. After six months, improvement in the SF-36 physical functioning subscale was 7.1 points for the exercise group and 1.3 points for the health education group. These improvements continued for three years.

The safety analysis showed that 82.0% of patients in the exercise group and 76.4% in the health education group experienced at least one adverse event of any class.

Musculoskeletal adverse events occurred in 18.5% of patients in the exercise group and 11.5% in the health education group. Only 10% of musculoskeletal events in the exercise group were related to the exercise intervention. Three or more adverse events occurred in 15.4% of the exercise group and 9.1% of the health education group.

Study limitations include slow recruitment, selection bias toward higher-functioning patients, and a lower-than-expected event rate. The exercise group also received more social contact through behavioral support, which may have had some influence.

Furthermore, self-reported physical activity is subject to recall bias. The study did not evaluate whether exercising before or during chemotherapy would produce similar or greater benefits. The exercise program initiated shortly after adjuvant chemotherapy resulted in significantly longer disease-free survival in colon cancer patients.

The results also support improved overall survival and physical function, with increased musculoskeletal adverse events.

Diploma

Structured exercise programs started soon after chemotherapy significantly improved disease-free and overall survival in colorectal cancer patients compared to patients who received standard health education alone.

This provides a powerful, evidence-based strategy for colorectal cancer survival and highlights the need to invest in structured behavioral support programs to understand the full benefits.

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