Effects of exercise during and after neoadjuvant chemoradiation on symptom burden and quality of life in rectal cancer patients: a phase II randomized controlled trial

Andria R Morielli; Normand G Boulé; Nawaid Usmani; Keith Tankel; Kurian Joseph; Diane Severin; Alysa Fairchild; Tirath Nijjar; Kerry S Courneya

doi:10.1007/s11764-021-01149-w

Effects of exercise during and after neoadjuvant chemoradiation on symptom burden and quality of life in rectal cancer patients: a phase II randomized controlled trial

J Cancer Surviv. 2023 Aug;17(4):1171-1183. doi: 10.1007/s11764-021-01149-w. Epub 2021 Nov 29.

Authors

Andria R Morielli¹, Normand G Boulé¹, Nawaid Usmani², Keith Tankel², Kurian Joseph², Diane Severin², Alysa Fairchild², Tirath Nijjar², Kerry S Courneya³

Affiliations

¹ Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada.
² Department of Oncology, University of Alberta and Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada.
³ Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada. kerry.courneya@ualberta.ca.

PMID: 34841461
DOI: 10.1007/s11764-021-01149-w

Abstract

Purpose: We previously demonstrated that exercise during and after neoadjuvant chemoradiation (NACRT) for rectal cancer may improve the rate of pathologic complete/near complete response. Here, we report the effects of exercise on symptom management and quality of life (QoL).

Methods: Rectal cancer patients (N = 36) were randomized to a supervised high-intensity interval training program during NACRT followed by unsupervised continuous exercise after NACRT or usual care. Patient-reported outcomes were assessed at baseline, post-NACRT, and presurgery including symptom burden (M.D. Anderson Symptom Inventory) and QoL (European Organisation for Research and Treatment of Cancer QLQ- C30 and -CR29).

Results: During NACRT, exercise significantly worsened stool frequency (adjusted between-group difference, 25.8; 95% CI, 4.0 to 47.6; p = 0.022), role functioning (adjusted between-group difference, -21.3; 95% CI, -41.5 to -1.1; p = 0.039), emotional functioning (adjusted between-group difference, -11.7; 95% CI, -22.0 to -1.4; p = 0.028), and cognitive functioning (adjusted between-group difference, -11.6; 95% CI, -19.2 to -4.0; p = 0.004) compared to usual care. After NACRT, exercise significantly worsened diarrhea (adjusted between-group difference, 1.2; 95% CI, 0.1 to 2.3; p = 0.030) and embarrassment (adjusted between-group difference, 19.7; 95% CI, 7.4 to 32.1; p = 0.003) compared to usual care.

Conclusions: Exercise exacerbated some symptoms and worsened QoL during NACRT; however, most negative effects dissipated after NACRT. Larger trials are necessary to confirm these findings.

Implications for cancer survivors: If the clinical benefit of exercise is confirmed, then the modest symptom exacerbation during NACRT may be considered tolerable. However, in the absence of any clinical benefit, exercise may be contraindicated in this clinical setting.

Keywords: Chemotherapy; Exercise; Quality of life; Radiotherapy; Rectal neoplasms.

Publication types

Randomized Controlled Trial
Clinical Trial, Phase II
Research Support, Non-U.S. Gov't

MeSH terms

Cancer Survivors*
Exercise
Humans
Neoadjuvant Therapy / adverse effects
Quality of Life
Rectal Neoplasms* / pathology
Rectal Neoplasms* / therapy