Abstract
ABSTRACTIntroductionAn optimal relative dose intensity (RDI) of adjuvant chemotherapy is associated with better survival in patients with breast cancer. Little is known about the role of physical fitness in attaining an adequate RDI in patients with early-stage breast cancer. We investigated the association between pretreatment physical fitness and RDI in this population.MethodsWe pooled individual patient data from two randomized exercise trials that studied exercise programs in early breast cancer: the Physical Exercise During Adjuvant Chemotherapy Effectiveness Study (n = 230) and the Physical Activity during Chemotherapy Treatment (n = 204) study. Logistic regression models were used to evaluate the association between pretreatment fitness and achieving an optimal RDI (≥85%). In addition, we added an interaction term to the model to explore the potential moderating effect of participating in an exercise program.ResultsData were available for 419 patients (mean age at diagnosis, 50.0 ± 8.6 yr). In the total sample, lower pretreatment physical fitness was associated with significantly lower odds of achieving ≥85% RDI: age-adjusted odds ratio (OR) of 0.66 (95% confidence interval (CI), 0.46–0.94). In patients allocated to the supervised exercise intervention during chemotherapy (n = 173), the association between pretreatment physical fitness and RDI was almost completely mitigated (OR, 0.95 (95% CI, 0.54–1.56)), whereas it was more pronounced in patients who received care as usual (n = 172; OR, 0.31 (95% CI, 0.13–0.63); Pinteraction = 0.022).ConclusionsEarly-stage breast cancer patients with relatively lower levels of pretreatment physical fitness have lower odds of achieving an optimal dose of chemotherapy. Given that physical fitness is modifiable and our results suggest that following a moderate-to-high intensity exercise training during chemotherapy could improve treatment completion, clinicians should not refrain from referring patients to supportive exercise programs because of low fitness.
Highlights
An optimal relative dose intensity (RDI) of adjuvant chemotherapy is associated with better survival in patients with breast cancer
E A total of 434 breast cancer patients participated in Physical Activity during Chemotherapy Treatment (PACT) or PACES, of whom 22 were excluded from the current analysis due to the absence of sufficient information on chemotherapy
We found that breast cancer patients with lower pre-treatment physical fitness had a lower likelihood of completing chemotherapy as planned
Summary
An optimal relative dose intensity (RDI) of adjuvant chemotherapy is associated with better survival in patients with breast cancer. Little is known about the role of physical fitness in attaining an adequate RDI in patients with early stage breast cancer. We investigated the association between pre-treatment physical fitness and RDI in this population. D regression models were used to evaluate the association between pre-treatment fitness and achieving an optimal RDI (≥85%). 5-year breast cancer survival rates have continued to improve and are currently higher than 90% in the Netherlands for early stage breast cancer [1]. Improvement in chemotherapy is considered as one of the key elements that have contributed to this increased survival rate[2]. In a study of more than 10,000 breast cancer patients treated
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