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Physical activity is linked to longer survival in
advanced colorectal cancer
P
hysically active patients
with metastatic colorectal
cancer may fare better than
those who are less active. This
conclusion is based on results
of a federally funded Alliance
for Clinical Trials in Oncology,
Cancer and Leukemia Group B
phase III trial of first-line chemo-
therapy for metastatic colorectal
cancer.
Brendan John Guercio, MD, of
Brigham & Women’s Hospital,
Boston, explained that in this
large clinical trial, patients who
reported engaging in physical
activity equivalent to 30 or more
minutes of moderate exercise
daily when they started chemo-
therapy experienced a 19%
reduction in mortality and 16%
reduction in cancer progression.
This outcome is the first evi-
dence of such a link in patients
with colorectal cancer involving
distant metastases. Prior studies
have consistently shown a link
between regular exercise and
improved outcomes in patients
with earlier-stage colorectal
cancer.
Dr Guercio said, “These findings
suggest that it doesn’t take a lot
of physical activity to improve
outcomes. While exercise is by
no means a substitute for chemo-
therapy, patients can experience
a wide range of benefits from as
little as 30 minutes of exercise
a day.”
The analysis included 1231
patients. When they began
receiving chemotherapy, patients
self-reported their physical activ-
ity through a questionnaire.
Based on their responses, the
researchers determined the
level of physical activity for each
patient using a standard meas-
ure, the metabolic equivalent
task-hours per week, which
assesses energy expended dur-
ing physical activity.
Patients who were most phys-
ically active engaged in 18 or
more metabolic equivalent task
hours per week, equivalent to 30
or more minutes daily of mod-
erate physical activity, such as
walking, cleaning, or gardening.
The least physically active group
engaged in fewer than 3 meta-
bolic equivalent task hours per
week, equivalent to 30 minutes
of physical activity per week.
Researchers adjusted for factors
that may have affected patients’
ability to participate in physi-
cal activity, such as age, general
health, body weight change,
other chronic illnesses, and type
of cancer therapy received.
Overall, patients who spent more
time in physical activity experi-
enced reduced rates of cancer
progression and death. In a sec-
ondary exploratory analysis, more
time spent in nonvigorous phys-
ical activity, such as walking
or lawn mowing, was linked to
improved survival.
Patients who spent at least 5 h
per week engaged in nonvigor-
ous activity experienced a 25%
reduction in mortality. No asso-
ciation was observed, however,
between vigorous physical activ-
ity, such as running and playing
sports, and cancer outcomes.
Randomised controlled trials and
more prospective clinical stud-
ies are needed to confirm the
associations between physical
activity and outcomes in meta-
static colorectal cancer.
An ongoing randomised clinical
trial is comparing patients who
exercise during treatment vs
those who do not. The trial may
prove that physical activity leads
to longer survival in patients with
metastatic colorectal cancer.
PracticeUpdate Editorial Team
© ASCO/Todd Buchanan 2017
ASCO GI 2017
23
VOL. 2 • NO. 2 • 2017