Regular exercise should be part of cancer care for all patients

The inclusion of exercise or sport in the treatment of cancer can significantly improve the management of symptoms, quality of life and fitness during and after treatment, have concluded two presentations that will be presented to the ESMO Congress 2018 Munich. Even in patients at high risk of poor quality of life, exercise can make a difference.

More than 3,500 cancer patients are already participating each year in exercise programs in more than 80 cancer treatment centers in France, at a cost of around € 400 per patient. This number continues to increase, explained Dr. Thierry Bouillet, doctor oncologist, Ile de France. , American Hospital of Paris, Neuilly Sur Seine, France, and author of one of the new studies. The courses are facilitated by trainers specializing in the treatment of cancer and its treatment, able to adapt the programs of exercise to individual needs.

"We found that patients benefited the most if they exercised two or three times a week for at least one hour during the six months of their chemotherapy or radiation therapy, and then for another six months, so that physical activity becomes an integral part of their lives, "said Bouillet.

"Building on our 20-year experience, we also found that patients found it easier to exercise in on-site classes and felt safer than if we provided them with information about how to do it. exercise and allow them to do it themselves or go to courses outside the hospital with trainers who do not know the special needs of cancer patients, "added Bouillet.

In one of the French studies presented at ESMO, 60-minute bi-weekly strength training sessions and aerobic exercises significantly reduced pain and fatigue scores at 3 and 6 months. in 114 patients on cancer treatment, 83% for breast cancer and 21% with metastatic disease. Fatigue scores went from 3.3 initially to 2.8 (p

There were also significant reductions in body fat, while lean body mass remained stable. In the group as a whole, body fat decreased from 33.9% in the beginning to 33.2% at 3 months (p

"Patients are often tired and have started to lose muscle before their cancer is diagnosed, so it is essential to start the exercise as soon as possible after the first consultation, we should consider it as a" treatment. " "Emergency" for their first symptoms and later help with the side effects of treatment, "said Bouillet.

In a second study presented at ESM 2018, researchers not only emphasized the benefit of exercise for cancer patients, but also demonstrated that it was possible to Identify patients with the highest risk of poor quality of life during treatment so that they can benefit from additional help. .

In the study of 2525 patients with stage I-III breast cancer and undergoing adjuvant chemotherapy, those taking 75 minutes of vigorous exercise or 150 minutes of moderate exercise by week had a significantly better overall quality of life at 6 and 12 months after treatment than the rest. inactive (Table 1). They also benefited from significantly improved physical well-being and reduced fatigue, shortness of breath and breathlessness. Vigorous exercises included activities such as aerobic dance, intensive gardening or fast swimming, while moderate exercises included brisk walking, water aerobics or volleyball.

"About 60% of patients were physically active before and after chemotherapy and, although their chemotherapy had a negative impact on their quality of life, their score was consistently better on various physical, emotional and symptomatic scales than those who were inactive," explained Dr. Antonio Di Meglio, author of the study and medical oncologist, Gustave Roussy Institute, Villejuif, France.

The study showed that patients who had a mastectomy or other illnesses, smoking or low-income were particularly at risk of losing their quality of life after chemotherapy for breast cancer, but also benefited from # 39; exercise.

"Using a new approach, we have shown that it is possible to identify breast cancer patients whose quality of life would be most affected by chemotherapy, so we can now target these patients to specific interventions, including those aimed at increasing physical activity to levels recommended by WHO, "added Di Meglio.

In front of ESMO, Dr. Gabe Sonke, medical oncologist, Dutch Cancer Institute, Amsterdam, Netherlands, stressed the importance of French studies to demonstrate the benefit of physical therapy in practice daily clinic, previously seen in clinical trials and supported by the current ESMO. recommendations for exercise as part of standard care for all cancer survivors.

"The information from the new studies on patients with metastatic breast cancer is particularly timely, as a large study of the international PREFERABLE consortium is underway to further explore the value of exercise in this group of patients", did he declare.

Sonke pointed out that this study and others are striving to confirm the early signs that physical activity programs could improve the observance of chemotherapy and radiation therapy and thereby improve outcomes. of treatment, so that insurance companies are more encouraged to pay for initiatives in the area of ​​exercise.

"Insurers can ask why they should pay for the exercise of cancer patients when they do not do so in the general population, but if we can show that there is an improvement in treatment compliance and benefit additional survival for cancer patients, strengthen our arguments for payment, "said Sonke.

He also wants more and more patients to be regularly invited to participate in exercise programs, including those who do not practice physical activity: "We know that already active patients participate in these exercise programs, but those who are not excluded, especially those with low incomes and less healthy lifestyles, should be encouraged to focus on how to be more inclusive so that all patients can benefit exercise by improving the quality of life during chemotherapy, "he concluded.

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