Abstract
PurposeTo evaluate the long-term effectiveness and cost-effectiveness of a supervised 18-week high-intensity exercise program compared with usual care in patients treated with autologous stem cell transplantation.MethodsOne hundred nine patients were randomly assigned to the exercise intervention (n = 54) or the usual care control group (n = 55). Data on cardiorespiratory fitness (VO2peak), handgrip strength, general fatigue, and health-related quality of life (quality-adjusted life years [QALYs]) were collected at baseline (T0), after completion of the exercise intervention or at a similar time point in the control group (T1) and 12 months later (T2). Cost questionnaires were used to assess societal costs. Long-term effectiveness (at T2) was evaluated using linear mixed model analyses. For the economic evaluation, missing data were imputed using multiple imputation, and data were analyzed using linear mixed models.ResultsAt T2, no statistically significant differences were found between the intervention and control group for VO2peak (0.12; 95%CI − 1.89; 2.14 ml/min/kg), handgrip strength (− 1.08; 95%CI− 2.47; 2.31), and general fatigue (− 0.69; 95%CI − 2.52; 1.14). During 12-months follow-up, no significant between-group differences in QALYs and societal costs were found (QALYs − 0.07; 95%CI − 0.17; 0.04; costs 529; 95%CI − 3205;4452). Intervention costs were €1340 per patient. For all outcomes, the probability of the intervention being cost-effective was low at reasonable values of willingness-to-pay.ConclusionWe found no evidence for the exercise intervention being effective on physical fitness and fatigue, nor cost-effective from a societal perspective.Trial registrationThe study was prospectively registered on 27 May 2010 at the Netherlands Trial Register (NTR2341).Implications for Cancer SurvivorsThe current exercise intervention should not be recommended to patients recently treated with autologous stem cell transplantation.
Highlights
Cancer and cancer treatment may have a negative impact on physical fitness, fatigue, and quality of life, which may be counteracted by exercise interventions
A recent study has shown that the effects of exercise interventions following cancer treatment for solid tumors on physical fitness and health-related quality of life (HRQoL) can be sustained at 1 year, while the intervention effects on fatigue disappeared [12]
To cover this research gap, the present study aimed to evaluate the long-term effectiveness and costeffectiveness of the exercise intervention versus usual care for physical fitness, fatigue, and HRQoL in patients treated with autologous stem cell transplantation
Summary
Cancer and cancer treatment may have a negative impact on physical fitness, fatigue, and quality of life, which may be counteracted by exercise interventions. Several systematic reviews reported favorable effects of exercise interventions on cardiorespiratory fitness [4, 9, 28], muscle strength [9, 28], fatigue [4, 9], and health-related quality of life (HRQoL) [3, 30] in patients with cancer during and following cancer treatment. In various countries, this has resulted in the development of exercise guidelines for patients with cancer [2]. To the best of our knowledge, effects of exercise interventions in patients who received a stem cell transplantation on these outcomes at long-term (≥ 1 year) are unknown
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