Exercise can markedly improve the quality of life for patients with metastatic breast cancer
Patients with metastatic breast cancer often experience cancer- and treatment-related side effects that can impair daily life activities and health-related quality of life (HRQoL). Results of the PREFERABLE-EFFECT trial demonstrate that metastatic breast cancer patients who took part in a nine-month structured exercise program reported significantly less fatigue and an improved quality of life compared to those patients who did not undergo the exercise program.
Recent evidence-based international guidelines (ASCO, ACSM) recommend exercise during adjuvant treatment for patients with breast cancer. In fact, exercise it leads to improvements in cardiorespiratory fitness, strength, fatigue and other patient-reported outcomes. However, evidence of the effectiveness of exercise in patients with metastatic breast cancer (mBC) remains scarce. In this respect, the PREFERABLE-EFFECT study (NCT04120298) assessed the effects of a nine-month supervised exercise program in patients with mBC on fatigue, health-related quality of life (HRQoL), and other cancer- and treatment-related side effects.
Study design
PREFERABLE-EFFECT is a multinational, randomised, controlled trial that enrolled patients with mBC from five European countries (Germany, Poland, Spain, Sweden, The Netherlands) and Australia. All patients had a diagnosis of stage IV breast cancer, an ECOG performance status of ≤2 and a life expectancy of at least six months. Participants were randomly assigned to usual care or an individualised, structured exercise program consisting of aerobic, resistance, and balance training. During the first six months, patients participated twice weekly in a supervised exercise session of one hour. In the last three months, one supervised session was replaced by an unsupervised session, supplemented by an exercise App. All participants received general physical activity advice (physical activity ≥ 30 min/day) and an activity tracker. Primary outcomes of the study were physical fatigue (subscale of the EORTC QLQ-FA12) and HRQoL (summary score of the EORTC QLQ-C30). Both were assessed at baseline and after 3, 6, and 9 months.
Results
Out of the 357 patients with mBC that were enrolled in the study, 178 were randomised to the exercise intervention while the remaining 179 received usual care. The median age of the patients was 55.4 years, most patients received first- or second-line treatment at study enrolment (74.8%) and most patients had bone metastases (73.9%). At three, six, and nine months, respectively, the average HR-QoL score for patients assigned to the exercise intervention was 3.9, 4.8, and 4.3 points higher than for patients in the control arm. Additionally, patients who participated in the exercise intervention had EORTC-FA12 scores that were 3.4, 5.3, and 5.6 points lower (indicating decreased fatigue) at three, six, and nine months, respectively. Both differences at the 6-month time point (primary endpoint) were statistically significant.
At six months, patients assigned to the exercise intervention also reported significantly better scores on important EORTC-QLQ-30 subscales, including a 5.5-point increase in social functioning, a 7.1-point decrease in pain, and a 7.6-point decrease in shortness of breath. In the steep ramp test, patients in the exercise arm reached an average maximum resistance that was 24.3 Watts (13%) higher than for patients in the control arm. Two serious adverse events were reported; one wrist fracture and one sacral stress fracture, neither was related to bone metastases.
Conclusion
A supervised resistance and aerobic exercise intervention resulted in beneficial effects on fatigue, HRQoL and other clinically relevant outcomes of patients with mBC. Therefore, supervised exercise as part of supportive care regimens during palliative treatment should be recommended.
Reference
May A, et al. Effects of a structured and individualized exercise program on fatigue and health-related quality of life in patients with metastatic breast cancer: the multinational randomized controlled PREFERABLE-EFFECT study. Presented at SABCS 2023; Abstract GS02-10.
