TY - JOUR
T1 - Physical Fitness and Chemotherapy Tolerance in Patients with Early-Stage Breast Cancer
AU - Groen, Wim G.
AU - Naaktgeboren, Willeke R.
AU - Van Harten, Wim H.
AU - Van Vulpen, Jonna K.
AU - Kool, Nathalie
AU - Sonke, Gabe S.
AU - Van Der Wall, Elsken
AU - Velthuis, Miranda J.
AU - Aaronson, Neil K.
AU - May, Anne M.
AU - Stuiver, Martijn M.
N1 - Funding Information:
The PACES study was supported by the Alpe d’Huzes/Dutch Cancer Society (Grant No. ALPE-2009-4299), the CZ Fund, Zilveren Kruis Achmea, and the Comprehensive Cancer Centre of the Netherlands. The PACT study was supported by The Netherlands Organisation for Health Research and Development (ZonMw; project number: 171002202), the Dutch Cancer Society (project number: UU 2009–4473), and the Dutch Pink Ribbon Foundation (2011/Woo2.C100). The results of the present study do not constitute endorsement by the American College of Sports Medicine, and we declare that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation.
Publisher Copyright:
© Lippincott Williams & Wilkins.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - Introduction An optimal relative dose intensity (RDI) of adjuvant chemotherapy is associated with better survival in patients with breast cancer. Little is known about the role of physical fitness in attaining an adequate RDI in patients with early-stage breast cancer. We investigated the association between pretreatment physical fitness and RDI in this population. Methods We pooled individual patient data from two randomized exercise trials that studied exercise programs in early breast cancer: the Physical Exercise During Adjuvant Chemotherapy Effectiveness Study (n = 230) and the Physical Activity during Chemotherapy Treatment (n = 204) study. Logistic regression models were used to evaluate the association between pretreatment fitness and achieving an optimal RDI (≥85%). In addition, we added an interaction term to the model to explore the potential moderating effect of participating in an exercise program. Results Data were available for 419 patients (mean age at diagnosis, 50.0 ± 8.6 yr). In the total sample, lower pretreatment physical fitness was associated with significantly lower odds of achieving ≥85% RDI: age-adjusted odds ratio (OR) of 0.66 (95% confidence interval (CI), 0.46-0.94). In patients allocated to the supervised exercise intervention during chemotherapy (n = 173), the association between pretreatment physical fitness and RDI was almost completely mitigated (OR, 0.95 (95% CI, 0.54-1.56)), whereas it was more pronounced in patients who received care as usual (n = 172; OR, 0.31 (95% CI, 0.13-0.63); Pinteraction = 0.022). Conclusions Early-stage breast cancer patients with relatively lower levels of pretreatment physical fitness have lower odds of achieving an optimal dose of chemotherapy. Given that physical fitness is modifiable and our results suggest that following a moderate-to-high intensity exercise training during chemotherapy could improve treatment completion, clinicians should not refrain from referring patients to supportive exercise programs because of low fitness.
AB - Introduction An optimal relative dose intensity (RDI) of adjuvant chemotherapy is associated with better survival in patients with breast cancer. Little is known about the role of physical fitness in attaining an adequate RDI in patients with early-stage breast cancer. We investigated the association between pretreatment physical fitness and RDI in this population. Methods We pooled individual patient data from two randomized exercise trials that studied exercise programs in early breast cancer: the Physical Exercise During Adjuvant Chemotherapy Effectiveness Study (n = 230) and the Physical Activity during Chemotherapy Treatment (n = 204) study. Logistic regression models were used to evaluate the association between pretreatment fitness and achieving an optimal RDI (≥85%). In addition, we added an interaction term to the model to explore the potential moderating effect of participating in an exercise program. Results Data were available for 419 patients (mean age at diagnosis, 50.0 ± 8.6 yr). In the total sample, lower pretreatment physical fitness was associated with significantly lower odds of achieving ≥85% RDI: age-adjusted odds ratio (OR) of 0.66 (95% confidence interval (CI), 0.46-0.94). In patients allocated to the supervised exercise intervention during chemotherapy (n = 173), the association between pretreatment physical fitness and RDI was almost completely mitigated (OR, 0.95 (95% CI, 0.54-1.56)), whereas it was more pronounced in patients who received care as usual (n = 172; OR, 0.31 (95% CI, 0.13-0.63); Pinteraction = 0.022). Conclusions Early-stage breast cancer patients with relatively lower levels of pretreatment physical fitness have lower odds of achieving an optimal dose of chemotherapy. Given that physical fitness is modifiable and our results suggest that following a moderate-to-high intensity exercise training during chemotherapy could improve treatment completion, clinicians should not refrain from referring patients to supportive exercise programs because of low fitness.
KW - BREAST CANCER
KW - CHEMOTHERAPY
KW - CLINICAL CANCER RESEARCH
KW - PHYSICAL FITNESS
UR - http://www.scopus.com/inward/record.url?scp=85126490201&partnerID=8YFLogxK
U2 - 10.1249/MSS.0000000000002828
DO - 10.1249/MSS.0000000000002828
M3 - Article
C2 - 34961754
AN - SCOPUS:85126490201
VL - 54
SP - 537
EP - 542
JO - Medicine and science in sports and exercise
JF - Medicine and science in sports and exercise
SN - 0195-9131
IS - 4
ER -