Exercise program could improve cancer treatment outcomes

A moderate exercise programme could improve the success of chemotherapy treatment in oesophageal cancer patients, according to results from a study at Guy’s and St Thomas’ NHS Foundation Trust.

The research, which involved 40 oesophageal cancer patients, shows that exercise can be safely included as part of cancer treatment. It was published in the British Journal of Sports Medicine.

Moderate exercise was also shown to reduce some of the negative effects of chemotherapy on fitness, meaning that it could help to make chemotherapy an option for more patients. The authors say the results indicate a larger study is needed to confirm the findings.

Chemotherapy is a standard treatment for a range of cancers, including oesophageal cancer, which affects the oesophagus, sometimes called the gullet or food pipe. It can have negative side effects for patients including tiredness, sickness and risk of infection. Because of this, clinicians weigh up the positive and negative effects for each patient before using this treatment.

The trial looked at the impact of ‘prehabilitation’ exercise – a guided exercise programme in which patients received regular training sessions before and during their chemotherapy treatment. They were also provided with instructions on how to continue the exercise programme at home.

The patients were compared with a group of patients who had a similar age and clinical status before the chemotherapy. The team looked at tumour samples, CT scans and immune markers from the patients. They found that those who had taken part in the exercise programme showed a better response to the chemotherapy, with their tumours shrinking more, and being more likely to be ‘down-graded’ – assessed as being less advanced.

The study was led by Mr Andrew Davies, consultant in upper gastro-intestinal surgery at Guy’s and St Thomas’. He said: “This is a small study, but a promising one, as it shows how a moderate exercise programme could help to improve the success of chemotherapy treatment. We want to confirm this effect in further studies, but conceivably this may benefit patients with other types of cancer and be a cost-effective way to improve the effectiveness of treatment.”

Alan Holman, 70, was a participant in the study which was funded by Guy’s and St Thomas’ Charity. Alan was diagnosed with oesophageal cancer in December 2016, soon after he retired from his role as Facilities Manager at a shopping mall.

He took part in guided exercise sessions once a week, and did exercises at home around once a week. The sessions took place while he was having chemotherapy, and in the run up to an operation in May 2017. He then had sessions closer to his home in Forest Hill, and is still leading an active life since he finished his treatment.

Alan said: “Once I started the chemotherapy, it was tiring, but doing an hour with the trainer, you come out feeling better. It definitely helped to get me back to my pre-op weight, and got me through the chemotherapy.

“I’m not one for sitting in doors all day. When I was working I had a very active job, and was walking a lot every day. Now I try to get to the gym once a week, and get out for a walk at least once every day.”

The authors cautioned that the study had limitations. It was a relatively small study, and rather than being randomly assigned to either the exercise or the control group, patients were allocated based on whether they lived in the region where the exercise sessions took place. This was because the team felt that requiring patients to travel long distances would be too much of a burden. The team were careful to check for any effect this may have had on the study population, and adjusted their analysis accordingly.