Physical Activity May Be Equally Crucial as Medications in Preventing Colon Cancer Recurrence
locks in on colorectal cancer, the third most prevalent form of cancer globally, and a leading reason behind cancer-related deaths.
Interestingly, recent research spearheaded by Canadian scientists proposes that a well-planned exercise program post surgery and chemotherapy for colon cancer significantly decreases patients’ chances of cancer recurrence by a staggering 28%, when compared to those given merely health tips.
The study, published in the revered The New England Journal of Medicine (NEJM), further revealed that structured exercise resulted in a 37% drop in the risk of death from any cause.
Experts have expressed that the findings seem to indicate exercise might be superior to medication in the battle against colon cancer recurrence.
David Sebag-Montefiore, an Audrey and Stanley Burton Professor of Clinical Oncology and Health Research at the University of Leeds, expresses optimism for future cancer patients with his comments: "This is fantastic news for people with bowel cancer and offers benefits beyond the well-known side effects of our other treatments."
Fitness regimens vs health advice for cancer prevention
The researchers recruited 889 participants mostly from Canada and Australia, but also a handful from the United States, U.K., and France for this study, which was part of the comprehensive Colon Health and Lifelong Exercise Change (CHALLENGE) trial.
All participants, falling between 19 and 84 years old (median age of 61) and having undergone surgery for stage 3 or high-risk stage 2 colon cancer followed by adjuvant chemotherapy to prevent cancer recurrence, were a part of the study. The overwhelming majority of participants were overweight or obese, with none exercising more than 150 minutes per week prior to the trial.
Researchers randomly assigned all participants to one of the two groups.
The exercise group, consisting of 445 individuals, collaborated with a certified physical activity consultant for 3 years. Initially, consultants saw them every week, followed by fortnightly meetings for the next 6 months, and monthly appointments for the subsequent 2 years.
Participants were free to choose the type, frequency, and intensity of aerobic exercise, the primary goal being to achieve the equivalent of three to four brisk 45-60 minute walks per week.
The health-education group (comprising 444 individuals) received general health-education materials promoting physical activity and healthy nutrition in addition to standard surveillance care.
Exercise for cancer prevention: Reduced recurrence, enhanced survival
After a median follow-up of 7.9 years, 93 individuals from the exercise group and 131 from the health-education group had experienced cancer recurrence, a new primary cancer, or had passed away. In total, 107 passed away from any cause – 41 from the exercise group, 66 from the health-education group.
Individuals from the exercise group did not lose weight but did see an improvement in physical functioning and significantly longer disease-free survival, with an annual incidence of recurrence, new primary cancer, or death of 3.7%, compared with 5.4% in the health-education group.
Strikingly, 80.3% of patients from the exercise group were disease-free after 5 years, compared with 73.9% of the health-education group.
Kerry S. Courneya, the study’s lead author, expressed that the most significant results were the overall improvement in survival.
Exercise: A potential cancer prevention powerhouse
Julie Gralow, the Chief Medical Officer of the American Society of Clinical Oncology (ASCO), who was not associated with the trial, stated that the findings suggest exercise might be "better than a drug" for cancer patient outcomes because it lacks the accompanying side effects typically associated with medication.
It's crucial to note that Gralow did not advocate for excluding drugs in favor of exercise; her intention was to compare the magnitude of benefit that comes from standard therapies with the benefits offered by exercise in terms of decreasing recurrence rates and deaths while taking toxicity into account.
She further mentioned that while there are drugs that are effective in helping prevent recurrence for patients with specific colon cancer mutations, "exercise's positive impact on colon cancer patients is not limited to these specific mutations.”
Courneya reinforced the benefits of their structured exercise program: “The adverse effects of exercise are almost entirely favorable (better fitness, stronger muscles, less fatigue, fewer depressive symptoms, decreased risk of cardiovascular disease, etc.). I believe exercise continues to exert an effect on new primary cancers and possibly other causes of death. Participants in the exercise program were still engaging in greater exercise than the health education group at years 4 and 5."
A structured exercise program can also save money as it tends to cost significantly less than medication.
"The physical activity intervention was perhaps between 3,000 and 5,000 Canadian dollars, while it is not uncommon for certain cancer drugs to cost 10s of thousands and even reach 100,000," Courneya adds.
The necessity of support: Overcoming barriers to exercise
Vicky Coyle, the U.K.'s lead researcher for the trial and Clinical Professor at Queen's University Belfast, Northern Ireland, feels it's essential to work closely with policymakers and healthcare providers to integrate exercise into treatment plans for relevant patients.
Joe Henson, PhD, Associate Professor in Lifestyle Medicine at the University of Leicester who oversaw exercise sessions in Leicester, U.K. for the trial, insists that support plays a crucial role in overcoming barriers to regular exercise.
"Despite its proven benefits, many people face obstacles in adopting regular exercise. This study highlights the importance of making exercise advice a routine part of cancer care and offering patients personalized assistance."
Although she advocates for exercise within her own patients, Gralow points out the challenges associated with implementing exercise programs such as these in a clinical setting: "I question whether most clinics have the staff to accommodate the frequency of visits (especially since prior observational data indicates that several other cancer types, including common ones like breast and prostate cancer, benefit from exercise). I also wonder whether all, or even most, patients are willing to visit the clinic as often as required."
"Therefore," she says, "we must find alternative ways to support our patients in incorporating exercise into their lives that don't require regular clinic visits but do provide support and encouragement, while also ensuring that we, as clinicians, consistently recommend exercise to our patients."
- The CHALLENGE trial, part of a comprehensive study, focused on colorectal cancer, a leading cause of cancer-related deaths globally.
- The study, published in the New England Journal of Medicine, revealed that structured exercise post surgery and chemotherapy led to a 28% decrease in cancer recurrence and a 37% drop in the risk of death from any cause.
- David Sebag-Montefiore commented on the findings, expressing excitement for future cancer patients as the exercise program offers benefits beyond the side effects of other treatments.
- The researchers recruited participants from various countries, assigning them to either an exercise group or a health-education group, with the exercise group showing improved physical functioning and significantly longer disease-free survival.
- Julie Gralow, from the American Society of Clinical Oncology, suggested that exercise might be "better than a drug" for cancer patient outcomes due to its lack of side effects typically associated with medication.
- Vicky Coyle emphasized the importance of working closely with policymakers and healthcare providers to integrate exercise into treatment plans for relevant patients, highlighting the need for personalized assistance to overcome barriers to regular exercise.
