Effects and moderators of exercise on quality of life and physical function in patients with cancer: An individual patient data meta-analysis of 34 RCTs

Laurien M Buffart,Lene Thorsen,Erica L James,Alex Mcconnachie,Paul B Jacobsen,Dennis R Taaffe,Jennifer Wenzel,Martine M Goedendorp,Neil K Aaronson,Willem Van Mechelen,Kathryn H Schmitz,Hans Knoop,Karin Potthoff,Kathleen A Griffith,Camille E Short,Wim H Van Harten,Kerri M Winters-Stone,Melinda L Irwin,Karen Steindorf,Marc Van Beurden,Ilse Mesters,Daniel A Galvão,Robert U Newton,Miranda J Velthuis,Gabe S Sonke,Joeri Kalter,Nanette Mutrie,Anne M May,Gill Arbane,Kerry S Courneya,Johannes Brug,Maike G Sweegers,Rachel Garrod,Martin Bohus,Ellen Van Weert,Joachim Wiskemann,Frans Nollet,Martina E Schmidt,Martijn M Stuiver,Hester S A Oldenburg ,Sandra C Hayes ,Ronald C Plotnikoff ,Amanda Daley ,Alejandro Lucía ,Schulz Kh ,Mai J M Chinapaw ,Marie José Kersten ,Irma M Verdonck‐De Leeuw

doi:10.1016/j.ctrv.2016.11.010

Abstract

This individual patient data meta-analysis aimed to evaluate the effects of exercise on quality of life (QoL) and physical function (PF) in patients with cancer, and to identify moderator effects of demographic (age, sex, marital status, education), clinical (body mass index, cancer type, presence of metastasis), intervention-related (intervention timing, delivery mode and duration, and type of control group), and exercise-related (exercise frequency, intensity, type, time) characteristics.Relevant published and unpublished studies were identified in September 2012 via PubMed, EMBASE, PsycINFO, and CINAHL, reference checking and personal communications. Principle investigators of all 69 eligible trials were requested to share IPD from their study. IPD from 34 randomised controlled trials (n=4519 patients) that evaluated the effects of exercise compared to a usual care, wait-list or attention control group on QoL and PF in adult patients with cancer were retrieved and pooled. Linear mixed-effect models were used to evaluate the effects of the exercise on post-intervention outcome values (z-score) adjusting for baseline values. Moderator effects were studies by testing interactions.Exercise significantly improved QoL (β=0.15, 95%CI=0.10;0.20) and PF (β=0.18, 95%CI=0.13;0.23). The effects were not moderated by demographic, clinical or exercise characteristics. Effects on QoL (βdifference_in_effect=0.13, 95%CI=0.03;0.22) and PF (βdifference_in_effect=0.10, 95%CI=0.01;0.20) were significantly larger for supervised than unsupervised interventions.In conclusion, exercise, and particularly supervised exercise, effectively improves QoL and PF in patients with cancer with different demographic and clinical characteristics during and following treatment. Although effect sizes are small, there is consistent empirical evidence to support implementation of exercise as part of cancer care.

Highlights

As a consequence of the increased number of cancer diagnoses, and concomitant mortality reductions for most types of cancer [1,2,3], many patients live with physical and psychosocial problems associated with the disease and its treatment that may compromise their quality of life (QoL)
Predicting OptimaL Cancer RehabIlitation and Supportive care (POLARIS) included randomised controlled trials (RCT) that evaluated the effects of exercise interventions and/or psychosocial interventions on QoL compared to a wait-list, usual care or attention control group in adult patients with cancer
We found no significant differences in effects on QoL (p = 0.25) and physical function (PF) (p = 0.25) between RCTs of which individual patient data (IPD) were shared and those of which were not (Table 3)

Summary

Introduction

As a consequence of the increased number of cancer diagnoses, and concomitant mortality reductions for most types of cancer [1,2,3], many patients live with physical and psychosocial problems associated with the disease and its treatment that may compromise their quality of life (QoL). A number of RCTs showed that demographic, clinical, and personal factors, such as age, marital status, disease stage and type of treatment, moderate the effects of exercise in patients with cancer [11,12,13,14,15]. These single studies are generally underpowered to analyse moderators of intervention effects and conduct subsequent stratified analysis. Meta-analyses based on aggregate data are limited to using summary data, such as the mean age of the patients or the proportion of men in a study, and they are unable to investigate intervention-covariate interactions at the level of the patient [16,17]

Methods

Results

Conclusion