Exercise ‘prescription’ helps patients beat cancer return
Going back to basics might help some patients live longer or respond to therapy, data shows.
When facing down a cancer diagnosis, patients often ask: what can I do to help my own odds?
The answer, data increasingly shows, is to go back to the basics: exercise and a good diet.
A structured exercise program with a trainer helped colorectal cancer patients lower their risks of death and cancer recurrence after treatment, according to a study released at the weekend at the American Society of Clinical Oncology’s annual conference in Chicago and published in the New England Journal of Medicine.
The study spanned more than a decade and is the first to answer conclusively in a controlled trial whether physical activity can improve cancer-related survival, the study’s authors said. Patients in the program had a 37 per cent lower risk of death after eight years, compared with patients who only received educational information on exercise.
“That is on par with the best treatments out there,” said Peter Campbell, a cancer epidemiologist at Montefiore Einstein Comprehensive Cancer Centre in New York, who wasn’t involved in the trial. “If this were a therapeutic, people would leave the building to go order this drug for their patients on Monday morning.”
A separate study released at the conference found that eating a diet heavier in foods that research shows can increase inflammation was linked to worse survival overall in colorectal cancer patients compared with those who consumed less-inflammatory foods. Other researchers are presenting data on how higher-fibre diets could improve melanoma patients’ response to immune-boosting drugs.
Knowing that more movement and a healthy diet are good for a person’s health seems obvious, but growing evidence is finding that they could also boost some cancer patients’ lifespans or responses to therapy. Helping improve patients’ quality of life has taken on increasing urgency in recent years, as patients are surviving longer with a range of cancers.
Testing healthy habits with the same rigour as researchers would test a drug might persuade health systems and insurers to help patients stick with lifestyle changes, according to doctors.
“That’s really challenging for someone to maintain on their own without a nutritionist and coaching,” said Dr Sara Char, an oncology fellow at Dana-Farber Cancer Institute in Boston who was part of the analysis on diet in colorectal cancer patients. “If we have a study that shows a lifestyle intervention works, then it is a much easier case to make to invest in those resources for our patients.”
Dr Char and her team are set to present the full analysis in which they looked back on an earlier clinical trial for stage-3 colorectal cancer that collected data on the eating habits of more than 1600 patients. The original trial didn’t find a difference in outcomes between the treatment options being tested.
Chronic inflammation, meanwhile, is a risk factor for colon cancer, spurring the new analysis to see if there were differences in outcomes based on patients’ diets. It found that eating an inflammation-linked diet heavier in processed meats, refined grains and sugary beverages was linked to worse survival from any cause, compared with a diet higher in leafy greens and drinks including coffee or tea. There wasn’t, however, a significant difference in rates of cancer relapse or deaths from cancer specifically, the researchers found.
In the exercise trial published at the weekend, some 890 patients across six countries who had either stage-3 or high-risk stage-2 colorectal cancer were enrolled after getting surgery and chemotherapy. Half received educational materials that promoted physical activity and healthy nutrition. The others were set up with a certified exercise consultant, with the goal of adding 2½ hours of some form of moderately intense exercise a week and sustaining that for three years.
Patients who underwent the structured program had a 28 per cent lower risk of their cancer coming back or developing a new cancer, the trial found. At eight years, 90 per cent of the patients in the exercise program were alive, compared with 83 per cent of the other patients. The program prevented one death for every 14 people who joined it, the researchers said.
“We saw the data, and we didn’t sleep for like three days,” said Dr Christopher Booth, the study’s co-chair and an oncologist at Kingston Health Sciences Centre and Queen’s University in Ontario. “It was just so remarkable, the biological effect of exercise.”
For Terri Swain-Collins, 61, making time to exercise felt nearly impossible, stretched between her X-ray technologist job in Ontario and her family. When she was diagnosed with colorectal cancer and started the trial in 2022, a personal coach encouraged her to fit in time during work or after dinner, just to walk, and met with her regularly.
“That accountability of having that person to partner with is a big part of it,” Ms Swain-Collins said. Without that, she likely would have given up, she said.
Ms Swain-Collins started increasing her steps, and it got easier. A 45-minute walk three times a week became regular, and she bought a stationary bike to use in the colder months. Her time in the trial ended in February, and Ms Swain-Collins said she has still kept the same pace in the months since.
Another trial set to be presented in Chicago recruited 43 melanoma patients who were starting immunotherapy and shipped higher-fibre or lower-fibre meals to their homes for up to 10 weeks. Some 77 per cent of patients on the high-fibre diet responded to their immune-boosting treatment, compared with 29 per cent in the control group.
“It’s not a magic diet or a trendy diet. It is essentially saying eat vegetables and fruit and whole grains and cut out processed food,” said Dr Jennifer McQuade, a melanoma specialist at the University of Texas MD Anderson Cancer Centre and a senior researcher on the trial.
Dr McQuade said the group is planning on doing a larger, late-stage trial to confirm the results and is testing sending out only the fibre-rich foods paired with nutrition counselling, to make the idea more doable on a bigger scale. Meanwhile, she tells her patients that the higher-fibre diet is good for them overall, even if she doesn’t know for sure that it will influence their cancers.
Dr McQuade added this advice: especially with the stress that comes with cancer treatment, the occasional sweet or dessert can still be on the menu.
The Wall Street Journal
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