Physical activity in gynecologic cancer survivors

Most survivors of gynecologic cancer are sedentary at diagnosis but have the potential to increase their level of exercise, which could improve quality of life. Findings from a new study by Australian researchers suggest that physical activity should be incorporated into cancer care during and beyond treatment.

Published in The International Journal of Gynecological Cancer,¹ the analysis is of a prospective, longitudinal, cohort study designed to look at physical activity levels from before and up to 2 years after gynecological cancer surgery, with or without adjuvant therapy.

The authors also explored the relationship between physical activity patterns and quality of life and characteristics of physical activity trajectories after gynecological cancer.

The cohort consisted of 408 women, mean age 60. Of them, 235 had endometrial cancer, 114 ovarian cancer, and 59 other types of gynecologic cancer. Eighty percent of the participants were postmenopausal and 75% were either overweight or obese.

Compared with other gynecological cancers, higher proportions of women with ovarian cancer were diagnosed with stage III or higher disease and higher proportions of overweight and obese women were diagnosed with endometrial cancer.

Baseline data were collected from the women at the pre-operative visit and during hospital follow-up visits, at 6 weeks, and 3, 6, 9, 12, 15, 18, 21, and 24 months after surgery.

The participants completed the Active Australia Survey, a validated tool that estimates time spent during the previous week walking and engaging in moderate and vigorous physical activity.

Minutes reported are weighted by the ratio of energy expended from physical activity compared with sitting quietly (MET value). Quality of life (QoL) was assessed with the Functional Assessment of Cancer Therapy–General Survey, a validated 27-item questionnaire about well-being in physical, social/family, emotional, and functional domains and total quality of life.

All participants completed the baseline assessment and retention rates were 86% at 6 weeks, 84% at 12 months, and 78% at 24 months. Up to 68% of women who provided baseline physical activity data were sedentary (<0.67 MET-hours/week) or participated in low levels (0.67 to 10 MET-hours/week) of weekly physical activity.

From baseline to 24 months after diagnosis, mean total physical activity increased to > 15 MET-hours/week (P < 0.002) and increases in moderate and vigorous exercise (P < 0.02) contributed to these changes.

Between baseline and 6 to 12 months after diagnosis, a twofold increase in MET-hours/week was seen, largely ascribed to more walking.

Regarding QoL, it was significantly different (P < 0.05) between groups at baseline, and highest in exercise enthusiasts and lowest in the physically inactive (95% confidence interval 0.54 to 31.2). For the other three follow-up periods, the exercise enthusiasts also reported the highest QoL, but the differences were not statistically significant.

The exercise enthusiasts were more likely to be diagnosed with ovarian cancer, have stage III disease, have had lymph node removal, and/or receive chemotherapy as their only form of adjuvant treatment.

The authors’ trajectory analysis showed that the increases in walking and moderate and vigorous physical activity were due to high and increasing levels of physical activity in a small group. Almost 70% of the women were sedentary or insufficiently active at diagnosis and by 24 months after diagnosis, fewer than one-third met physical activity requirements.

Their findings, the authors said, “contribute to a compelling and growing evidence demonstrating the potential for improving cancer survivorship by incorporating physical activity intervention into standard [gynecological cancer] care.”

In short, more activity is good for everyone and can go hand in hand with mental status and hence QoL metrics.

Reference

1. Fleming S, Jones T, Janda M, Vagenas D, Ward L, Reul-Hirche H, et al. Physical activity trajectories following gynecological cancer: results from a prospective, longitudinal cohort study. Int J Gynecol Cancer. 2020;0:1-7. doi: 10.1136/ijgc-2020-001543