KMCRIC

Effects of exercise during adjuvant chemotherapy on breast cancer outcomes.

Courneya KS, Segal RJ, McKenzie DC, Dong H, Gelmon K, Friedenreich CM, Yasui Y, Reid RD, Crawford JJ, Mackey JR.

Med Sci Sports Exerc.

2014

46(9)

1744-51.

10.1249/MSS.0000000000000297.

24633595

http://www.ncbi.nlm.nih.gov/pubmed/24633595

Antineoplastic Agents/therapeutic use
Breast Neoplasms/complications
Breast Neoplasms/drug therapy*
Breast Neoplasms/pathology
Bridged Compounds/therapeutic use
Chemotherapy, Adjuvant
Combined Modality Therapy/methods
Disease-Free Survival
Exercise Therapy/methods*
Female
Follow-Up Studies
Humans
Middle Aged
Neoplasm Staging
Obesity/complications
Receptors, Estrogen/analysis
Resistance Training*
Survival Rate
Taxoids/therapeutic use
Treatment Outcome

PHYSICAL ACTIVITY; DISEASE-FREE SURVIVAL; RANDOMIZED CONTROLLED TRIAL; RECURRENCE; SURVIVAL

신체 활동; 무병 생존율; 무작위배정 비교 임상시험; 회귀; 생존

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Observational studies suggest that physical activity after a breast cancer diagnosis is associated with improved cancer outcomes; however, no randomized data are available. Here, we report an exploratory follow-up of cancer outcomes from the Supervised Trial of Aerobic versus Resistance Training (START).

METHODS:
The START was a Canadian multicenter trial that randomized 242 breast cancer patients between 2003 and 2005 to usual care (n = 82), supervised aerobic (n = 78), or resistance (n = 82) exercise during chemotherapy. The primary end point for this exploratory analysis was disease-free survival (DFS). Secondary end points were overall survival, distant DFS, and recurrence-free interval. The two exercise arms were combined for analysis (n = 160), and selected subgroups were explored.

RESULTS:
After a median follow-up of 89 months, there were 25/160 (15.6%) DFS events in the exercise groups and 18/82 (22.0%) in the control group. Eight-year DFS was 82.7% for the exercise groups compared with 75.6% for the control group (HR, 0.68; 95% confidence interval (CI), 0.37-1.24; log-rank, P = 0.21). Slightly stronger effects were observed for overall survival (HR, 0.60; 95% CI, 0.27-1.33; log-rank, P = 0.21), distant DFS (HR, 0.62; 95% CI, 0.32-1.19; log-rank, P = 0.15), and recurrence-free interval (HR, 0.58; 95% CI, 0.30-1.11; Gray test, P = 0.095). Subgroup analyses suggested potentially stronger exercise effects on DFS for women who were overweight/obese (HR, 0.59; 95% CI, 0.27-1.27), had stage II/III cancer (HR, 0.61; 95% CI, 0.31-1.20), estrogen receptor-positive tumors (HR, 0.58; 95% CI, 0.26-1.29), human epidermal growth factor receptor 2-positive tumors (HR, 0.21; 95% CI, 0.04-1.02), received taxane-based chemotherapies (HR, 0.46; 95% CI, 0.19-1.15), and ≥85% of their planned chemotherapy (HR, 0.50; 95% CI, 0.25-1.01).

CONCLUSIONS:
This exploratory follow-up of the START provides the first randomized data to suggest that adding exercise to standard chemotherapy may improve breast cancer outcomes. A definitive phase III trial is warranted.

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