Exercise during chemotherapy reduces tumour growth

Cancer patients who followed a course of exercise ahead of surgery saw their tumours start to shrink  compared to patients who followed the standard care pathway, according to a ground-breaking study in the UK.

The trial, funded by the Guy’s & St Thomas’ charity, which examined the role of exercise pre-habilitation during oesophageal cancer treatment, provides the first evidence that a structured exercise intervention promotes tumour regression during pre-operative chemotherapy.

Patients on the exercise trial also experienced a strengthening of the immune system, a partial reverse of chemo-related deconditioning and improved muscle mass leading to an improvement in quality of life during treatment.

Scientists involved in the study, which is published in the British Journal of Sports Medicine this week, said it was an extremely encouraging moment to observe an improved response to chemotherapy in cancer patients.

'Quality of life'

“Chemotherapy plays a key role in cancer treatment but can result in a number of unwanted side effects which have a direct impact on patients’ quality of life. It is incredibly encouraging to see the positive impact of exercise during treatment on chemotherapy response as well as reducing some of the negative side-effects leading to an improvement in quality of life,” explained Greg Whyte OBE, professor of sport and exercise sciences at Liverpool John Moores University.

In the trial, the team compared two groups of oesophageal cancer patients undergoing chemotherapy prior to surgery. Twenty-one patients were assigned to a structured prehabilitation exercise intervention for 16 weeks, while a second group of 19 patients followed standard care without structured exercise.

The exercise was based on a ‘moderate intensity’ programme in line with World Health Organisation and UK Chief Medical Officer guidelines for physical activity for health including 150 minutes of moderate intensity aerobic exercise (i.e., walking) and two strength sessions per week.

Radiological, biochemical and body composition analyses were performed at multiple time points prior to, during and following chemotherapy, prior to surgery, and following surgery, to measure radiological and pathological markers of disease regression.

Better immunity

The results showed that the ‘exercise’ group demonstrated higher rates of tumour regression and downstaging, as well as improved immune function, reduced inflammation, and a reduction in chemotherapy-related reductions in muscle mass and physical deconditioning.

Prehabilitation is increasingly recognised as an important part of supporting cancer patients during treatment and there are a growing number of centres in the UK offering exercise prehabilitation and rehabilitation as part of standard cancer care.

Although this particular study included oesophageal cancer patients, the team say the data is potentially relevant to any cancer patient undergoing chemotherapy.

'Exciting'

Andrew Davies, Consultant Surgeon at Guy’s and St Thomas’ NHS Foundation Trust and lead author of the study, described the results as “exciting” and more far-reaching than the oesophageal cancer patients enrolled in the study. He said: “This is the first time a relationship between exercise and chemotherapy response has been shown in a human trial and opens up the possibility of benefitting patients with other types of cancer and those in palliative as well as curative settings. The argument for exercise now being a standard part of our treatment strategy for cancer becomes even stronger.”