Exercise and Cancer Survivorship

John Saxton · Amanda Daley Editors

Exercise and Cancer Survivorship Impact on Health Outcomes and Quality of Life

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Editors Professor John Saxton School of Allied Health Professions Faculty of Health Queen’s Building University of East Anglia Norwich NR4 7TJ [email protected]

Dr. Amanda Daley Primary Care Clinical Sciences School of Health and Population Sciences College of Medical and Dental Sciences University of Birmingham Birmingham, B15 2TT [email protected]

ISBN 978-1-4419-1172-8 e-ISBN 978-1-4419-1173-5 DOI 10.1007/978-1-4419-1173-5 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2009940579 © Springer Science+Business Media, LLC 2010 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com)

Foreword

The volume of evidence for the health benefits of PA has grown exponentially in the last 20 years (Department of Health, 2004; United States Department of Health and Human Services, 2008). These benefits include reduced risk of a range of diseases, including CV disease, obesity, diabetes and mental conditions such as dementia and depression. Increasingly, PA is also indicating its effectiveness in therapy. The role of PA in the prevention and treatment of cancers has only recently come to the forefront. The WCRF Report (2007) clearly established that PA reduces the risk of a range of cancers, with the evidence for the prevention of colon and breast cancer being most convincing. Less public health attention has been paid to the worth of PA in therapy and recovery from cancer. PA has lots of potential in this setting. There are intuitive and plausible biomedical mechanisms by which exercise might improve prognosis for survival. Additionally, the many established psychological benefits that exercise is able to bring may be particularly potent for cancer recoverers. It has the potential to energise, improve physical function and mood and its positive action may bring hope and optimism to an otherwise difficult challenge. A steady stream of studies and systematic reviews is indicating that these benefits can be realised and a comprehensive exposition of key issues is now overdue. John Saxton and Amanda Daley, through this book, have achieved just this. Both have been heavily involved in research in PA as therapy for cancer for over a decade. They have drawn upon their experiences to identify cogent topics around the evidence and potential for PA in cancer recovery. To help them in this mission they have engaged experts from leading teams from around the world who have applied their experiences to a research or practical question. The result is a volume that provides fascinating insight into the complexities that make up this area of work. Different effects are likely for different cancers. Exercise dose response may be different for outcomes that can be as diverse as improved chance of survival to better QoL. Then, as always, there is the matter of creating conditions that will engage the patients themselves and facilitate their success. Above all, this book has brought to light the

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importance of PA as a therapeutic medium for cancer and established the need for more investment in systematic and sequential research. Enjoy. University of Bristol June 2009

Ken Fox

Contents

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . John Saxton and Amanda Daley 2 Exercise and Cancer-Related Fatigue Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Margaret L. McNeely and Kerry S. Courneya 3 Exercise as an Intervention During Breast Cancer Treatment . . . Martina Markes 4 Exercise After Treatment for Breast Cancer: Effects on Quality of Life . . . . . . . . . . . . . . . . . . . . . . . . . . . Helen Crank and Amanda Daley 5 The Importance of Controlling Body Weight After a Diagnosis of Breast Cancer: The Role of Diet and Exercise in Breast Cancer Patient Management . . . . . . . . . . . . . . . Michelle Harvie 6 The Biological Mechanisms by Which Physical Activity Might Have an Impact on Outcome/Prognosis After a Breast Cancer Diagnosis . . . . . . . . . . . . . . . . . . . . . . . Melinda L. Irwin 7 Exercise After Prostate Cancer Diagnosis . . . . . . . . . . . . . . Daniel Santa Mina, Paul Ritvo, Roanne Segal, N. Culos-Reed, and Shabbir M.H. Alibhai 8 Exercise for Prevention and Treatment of Prostate Cancer: Cellular Mechanisms . . . . . . . . . . . . . . . . . . . . R. James Barnard and William J. Aronson 9 Physical Activity Before and After Diagnosis of Colorectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . David J. Harriss, N. Tim Cable, Keith George, Thomas Reilly, Andrew G. Renehan, and Najib Haboubi

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10 Exercise-Based Rehabilitation in Patients with Lung Cancer . . . Martijn A. Spruit, Khaled Mansour, Emiel F.M. Wouters, and Monique M. Hochstenbag

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11 Exercise and Cancer Mortality . . . . . . . . . . . . . . . . . . . . John Saxton

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12 Ready to Change Lifestyle? The Feasibility of Exercise Interventions in Cancer Patients . . . . . . . . . . . . Clare Stevinson

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13 Cardiorespiratory Exercise Testing in Adult Cancer Patients . . . Lee W. Jones

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Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Contributors

Shabbir M.H. Alibhai Division of Clinical Decision Making and Healthcare, Toronto General Research Institute, Toronto General Hospital, Ontario, Canada M5G 2C4, [email protected] William J. Aronson Department of Urology, David Geffin School of Medicine, University of California, Los Angeles, CA 90095-1606, USA, [email protected] R. James Barnard Department of Physiological Science, David Geffin School of Medicine, University of California, Los Angeles, CA 90095-1606, USA, [email protected] N. Tim Cable Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK, [email protected] Kerry S. Courneya Department of Physical Therapy, University of Alberta; Department of Oncology, Cross Cancer Institute, Edmonton, AB T6G 1Z2, Canada, [email protected] Helen Crank Faculty of Health and Wellbeing, Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, S10 2BP, UK, [email protected] N. Culos-Reed Department of Kinesiology, Dalhousie University, Halifax, Nova Scotia, Canada, [email protected] Amanda Daley Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK, [email protected] Keith George Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK Najib Haboubi Department of Pathology, Trafford General Hospital NHS Trust, Manchester, UK, [email protected] David J. Harriss Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK, [email protected]

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Michelle Harvie University Hospital South Manchester, Manchester, M23 9LT, UK, [email protected] Monique M. Hochstenbag Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands, [email protected] Melinda L. Irwin Epidemiology and Public Health, Yale School of Public Health, New Haven, CT 06520-8034, USA, [email protected] Lee W. Jones Duke University Medical Center, Durham, North Carolina, NC 27710, USA, [email protected] Khaled Mansour Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands, [email protected] Martina Markes German Institute for Health Research gGmbH, D-08645 Bad Elster, Germany, [email protected] Margaret L. McNeely Department of Physical Therapy, University of Alberta; Department of Oncology, Cross Cancer Institute, Edmonton, AB T6G 1Z2, Canada, [email protected] Thomas Reilly Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK Andrew G. Renehan Department of Surgery, Christie Hospital NHS Trust, Manchester, UK, [email protected] Paul Ritvo Population Studies and Surveillance, Cancer Care Ontario, University Avenue, Toronto, Ontario, Canada M5G 2L7, [email protected] Daniel Santa Mina Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada, [email protected] John Saxton School of Allied Health Professions, Faculty of Health, Queen’s Building, University of East Anglia, Norwich, NR4 7TJ, UK, [email protected] Roanne Segal Ottawa Hospital Regional Cancer Center, University of Ottawa Heart Institute, Ottawa, Ontario, Canada, [email protected] Martijn A. Spruit Department of Research, Development and Education of the Centre for Integrated Rehabilitation of Organ failure (CIRO), Horn, The Netherlands, [email protected] Clare Stevinson Macmillan Research Unit, School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester, M13 9PL, UK, [email protected]

Contributors

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Emiel F.M. Wouters Department of Research, Development and Education of the Centre for Integrated Rehabilitation of Organ failure (CIRO), Horn, The Netherlands; Department of Respiratory Medicine of the Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands, [email protected]

List of Abbreviations

ACS ADT AICR AS AT ATAC BCN BFI BMD BMI BPH BT CALGB C-CLEAR CI CMF CONSORT COPD CPET CRF CRP CRUK CT CV CWLS DEXA or DXA DRE EBR EM EORTC ES FACT-C FACT-F

American Cancer Society Androgen deprivation therapy American Institute for Cancer Research Active surveillance Anaerobic threshold Arimidex or Tamoxifen alone or in combination Breast care nurse Brief fatigue inventory Bone mineral density Body mass index Benign prostatic hyperplasia Brachytherapy Cancer and leukemia group B Colorectal cancer, lifestyle, exercise and research Confidence intervals Cyclophosphamide, methotrexate, fluorouracil Consolidated standards of reporting trials Chronic obstructive pulmonary disease Cardiopulmonary exercise test Cancer-related fatigue C-reactive protein Cancer Research UK Computerised tomography Cardiovascular Collaborative women’s longevity study Dual energy x-ray absorptiometry Digital rectal examinations External beam radiation Expectant management European Organization for Research and Treatment of Cancer Effect size Functional assessment of cancer therapy – colorectal Functional assessment of cancer therapy – fatigue scale xiii

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FACT-G FACT-L FACT-P FBS FEC FFM FQ GTT Hb HEAL HIF HR HSCT IGF IGFBP IL-1ra IL-6 Ki-ras LEAD LNCaP MAPK MCCS MET MFI MFSI MHR MMPs MRI NCI NIDDM NIHR NMES NSAIDs NSCLC OR PA PCa PCNA PFS PI-3 K POSH PSA QoL RCT

List of Abbreviations

Functional assessment of cancer therapy – general Functional assessment of cancer therapy – lung Functional assessment of cancer therapy – prostate Fetal bovine serum Fluorouracil, epirubicin, cyclophosphamide Fat-free mass Fatigue questionnaire Gastrointestinal transit-time Hemoglobin Health, eating, activity and lifestyle Hypoxia-inducible factor Hazard ratio Hematopoietic stem cell transplantation Insulin-like growth factor Insulin-like growth factor binding protein Interleukin-1 receptor antagonist Interleukin-6 Kirsten-ras Leading the way in exercise and diet Lymph node-derived PCa cell proliferation Mitogen-activated protein kinase Melbourne collaborative cohort study Metabolic equivalent task Multi-dimensional fatigue inventory Multi-dimensional fatigue symptom inventory Maximum heart rate Matrix metalloproteases Magnetic resonance imaging National Cancer Institute Non insulin-dependent diabetes mellitus National Institute for Health Research Neuromuscular electrical stimulation Non-steroidal anti-inflammatory drugs Non-small cell lung cancer Odds ratio Physical activity Prostate cancer Proliferating cell nuclear antigen Piper fatigue scale Phosphatidylinositol 3-kinase Prospective study of outcomes in sporadic versus hereditary breast cancer Prostate-specific antigen Quality of life Randomized controlled trial

List of Abbreviations

REE RER RP RPE RR RT SCFS SCLC SEER SHERBERT SMD TLR4 TNF-α TNM TPB TURP ˙ 2max VO ˙ 2peak VO WCRF WHELS WINS WMD WTBS YES

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Resting energy expenditure Respiratory exchange ratio Radical prostatectomy Rate of perceived exertion Relative risk Radiotherapy Schwartz cancer fatigue scale Small cell lung cancer Surveillance epidemiology and end results Sheffield exercise and breast randomised trial Standardized mean difference (effect size) Toll-like receptor 4 Tumor necrosis factor-α Tumor, node, metastasis Theory of planned behavior Transurethral resection of the prostate Maximal oxygen consumption Symptom-limited maximal oxygen consumption World Cancer Research Fund Women’s healthy eating and living study Women’s intervention nutrition study Weighted mean difference Weight training for breast cancer survivors Yale exercise and survivorship

Chapter 1

Introduction John Saxton and Amanda Daley

Abstract The global burden of cancer has more than doubled during the last 30 years and with the continued growth and aging of the world’s population, it is expected to double again by 2020. While 5-year survival rates for some cancers remain very poor, an increasing number of people in economically developed societies are now surviving for at least 5 years after being diagnosed with some of the most common cancers. This means that the quality of cancer survival has become an important issue in the management of cancer patients. The cancer experience is widely acknowledged as a life-changing event and can be the trigger for reviewing personal health behaviours and making major lifestyle changes. For some cancers, a growing body of observational evidence suggests that a physically active lifestyle can be beneficial in terms of primary prevention and cancer mortality. Prospective intervention studies have also shown that regular exercise participation during and after cancer treatment is associated with higher levels of physical functioning and CV fitness, reduced feelings of fatigue and improved health-related QoL. Nevertheless, the specific benefits of habitual exercise are likely to vary as a function of cancer type and disease stage, treatment approach and current lifestyle of the patient. The aim of this book is to present the most up-to-date synthesis of scientific evidence gleaned from observational and intervention studies that have investigated the health benefits to cancer patients of engaging in a physically active lifestyle.

1.1 The Burden of Cancer Cancer is an ‘umbrella term’ for a group of over 200 different diseases, in which cells of the body grow and divide in an uncontrolled way. This uncontrolled cellular growth often invades and destroys neighbouring tissues and can metastasize (via J. Saxton (B) School of Allied Health Professions, Faculty of Health, Queen’s Building University of East Anglia, Norwich, NR4, 7TJ, UK e-mail: [email protected]

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J. Saxton and A. Daley

the blood or lymphatic system) to other sites within the body. Although the disease affects people of all ages, the risk of developing most types of cancer increases with age. The recently published World Cancer Report showed that the global burden of cancer has more than doubled during the last 30 years and with the continued growth and aging of the world’s population, it is expected to double again by 2020 [1]. Worldwide, there were 12.4 million new cancer diagnoses in 2008, 7.6 million cancer deaths and 25 million people living with cancer [1]. Cancer is classified according to the tissue in which it originates. Carcinomas are cancers of the skin or tissues that line or cover the internal organs and include cancers of the lung, colon, prostate, breast and cervix. Sarcomas are cancers arising in bone, cartilage, fat, muscle, blood vessels and other connective and supportive tissues. Leukaemia is cancer that begins in the blood-forming tissues (e.g. bone marrow) and lymphoma (including multiple myeloma) originates in cells of the immune system [2]. Globally, lung cancer is the most commonly diagnosed cancer and cause of cancer-related death in men, whereas in women, breast cancer is the most common form of the disease and cancer-related death [1]. In both North American and European men, however, prostate, lung and colorectal cancers are the most commonly diagnosed forms of the disease, accounting for 56 and 50% of all incident cases, respectively. In North American women, breast, lung and colorectal cancers are the most commonly diagnosed, together accounting for 54% of all incident cases, in comparison to breast, colorectal and uterus cancers in European women (52% of all incident cases). Cancer mortality rates for North America and Europe are presented in Fig. 1.1, which illustrates that lung, colorectal, prostate (men) and breast (women) cancers are the leading causes of cancer-related death.

North American men

European men Lung 31%

Lung 27%

Colorectal 10%

Colorectal 11%

Prostate 9%

Prostate 9%

Pancreas 6%

Stomach 7%

Others 44%

North American women

Others 46%

European women Lung 26%

Breast 18%

Breast 15%

Colorectal 13%

Colorectal 10%

Lung 11%

Pancreas 6%

Uterus 6%

Others 43%

Others 52%

Fig. 1.1 Cancer mortality rates for North America and Europe. Sources: ACS, Facts & Figures 2006; Atlanta: ACS, 2006. Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P (2007). Estimates of cancer incidence and mortality is Europe in 2006. Annals of Oncology 18, 581–592

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Cancer survival statistics are based on the proportion of cancer patients who are still alive 5 years after diagnosis. Survival rates for some cancers (e.g. lung, liver, esophageal and pancreatic) are very poor and do not differ much between economically developed and developing nations [3]. These cancers are difficult to detect early and effective treatments are lacking. However, survival rates for cancers which can be detected early (perhaps through screening programs) and for which there are more effective treatments, differ considerably between poor and wealthy countries [3]. For Example, a global study of cancer survival statistics published in 2008 showed that the 5-year relative survival for breast cancer in women ranged from ≥80% in North America, Sweden, Japan, Finland and Australia to