Active Patients May Have Better Metastatic Colorectal Cancer Outcomes

colorectal cancer: colorectal cancerSAN FRANCISCO—Patients with metastasized colorectal cancer enrolled in a phase III chemotherapy trial had better survival and lower progression rates if they engaged in a half hour of moderate physical activity each day, according to an analysis of subjects conducted by the Alliance for Clinical Trials in Oncology. The investigators found a 19 percent reduction in mortality from any cause and a 16 percent reduction in cancer progression among patients who reported 30 or more minutes of moderate physical activity daily at the time they began chemotherapy. Spending 5 or more hours per day was associated with a 25 percent reduction in mortality. The link between physical activity and better outcomes has been repeatedly reported in studies involving patients with less advanced colorectal cancer, but this is the first time it has been shown in metastasized disease, explained Brendan J. Guercio, MD, in a press briefing during the ASCO 2017 Gastrointestinal Cancers Symposium (Abstract 659). The findings challenge the opinion that little is to be gained from exercise in metastatic colorectal cancer because the prognosis is so poor, he noted. Guercio was a medical student at Dana-Farber at the time the research was completed and is now a resident at Brigham and Women's Hospital in Boston. Jeffrey A. Meyerhardt, MD, Clinical Director of Dana-Farber's Gastrointestinal Cancer Center, is the study group chair and senior author. The researchers reported that greater walking duration and longer daily non-vigorous physical activity were associated with reduced risk of all-cause mortality, but no association was observed between walking pace or more vigorous exercise and better outcomes. “These findings suggest that it doesn't take a lot of physical activity to improve outcomes,” said Guercio. “While exercise is by no means a substitute for chemotherapy, patients can experience a wide range of benefits from as little as 30 minutes of exercise a day.” Methods, Results Guercio and his colleagues based their findings on self-reported daily exercise in 1,231 patients participating in the NCI-sponsored phase III CALGB 80405 trial for metastasized colorectal cancer. Each participant completed a questionnaire at the time they began chemotherapy that included their daily physical activity. The investigators then estimated total metabolic equivalent task (MET) hours per week to evaluate physical activity levels. The primary endpoint was overall survival while the secondary endpoint was progression-free survival. To minimize the effects of poor and rapidly declining health, patients were excluded if they experienced disease progression or died within 60 days of assessment. The data also was adjusted for known prognostic factors, comorbidity, weight loss over the previous 6 months, age, general health, other chronic illnesses, and type of cancer therapy received. Patients who were most physically active engaged in 18 or more MET hours per week, equal to at least 30 minutes of moderate activity each day, such as walking, cleaning, or gardening. The least physically active patients engaged in fewer than 3 MET hours per week. No association was observed between more vigorous physical activity and cancer outcomes. Overall, patients who spent more time being physically active had reduced rates of cancer progression and death. In a secondary exploratory analysis, more time spent in non-vigorous physical activity, such as walking or lawn mowing, was linked to improved survival. “This is important because a lot of colon cancer patients seek answers from their physician on whether lifestyle changes can impact outcomes,” said Guercio. The biggest question, given the observational nature of the study, is whether or not confounding health factors played a role, Guercio explained. “In other words, the question is: does physical activity make people healthier, or are individuals who are sicker than others just exercising less?” “Randomized controlled trials and more prospective clinical studies are needed to confirm the associations between physical activity and outcomes in metastatic colorectal cancer,” Guercio noted. An ongoing randomized clinical trial is comparing patients who exercise during treatment and those who do not, and could provide additional data that physical activity leads to longer survival. Guercio added, “Patients should be encouraged by this. While the findings have to be replicated...moderate exercise is not likely to harm these patients and may yield other benefits.” Commentary Nancy Baxter, MD, PhD, of St. Michael's Hospital and the University of Toronto, who moderated the press conference, commented on the findings. “This study shows that even a small amount of exercise may make a big difference. I think this is something we can definitely recommend to our patients. This is an important addition to our armamentarium,” she said. “Physical activity can be difficult for patients with advanced colorectal cancer, but this study shows that even a small amount of exercise may make a big difference. It's important to help our patients find ways to incorporate moderate exercise into their daily lives—regardless of the stage of their disease.” Peter Campbell, PhD, Strategic Director of digestive system cancer research at the American Cancer Society, also noted the data are in-line with prior studies in colorectal cancer patients. “We've previously reported on a cohort of patients with non-metastatic colorectal cancer, and increased physical activity seems to be associated with improved survival among these patients,” he told Oncology Times. “The main limitation to all of these data, however, is that the datasets are simply observational. That is, patients were not randomly assigned to an activity group or to a sedentary group.” Kurt Samson is a contributing writer.

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