A pilot study of exercise intervention during chemotherapy in patients with metastatic cancer

Abstract

Background: Skeletal muscle loss is a central component of cancer cachexia syndrome and is a poor prognostic factor in patients with cancer. We investigated prevalence of sarcopenia and the feasibility of exercise intervention in patients with newly diagnosed advanced solid cancer. Methods: Between July 2017 and February 2018, consecutive patients with newly diagnosed advanced solid cancer were enrolled to our prospective cohort. Sarcopenia was defined as the third lumbar vertebra (L3) muscle index of less than 552cm2/m2for men and of less than 39 cm2/m2for women using computed tomography scan. Patients were recruited to participate in a 12-week, combined resistance and aerobic exercise program consisted of supervised, hospital-based (2x/week) and home-based training (3x/week), during the first-line palliative chemotherapy. The primary endpoint was feasibility and safety of the exercise intervention. Skeletal muscle mass by bioelectrical impedance analysis (BIA) and patients' quality of life questionnaires were measured at pre- and post- exercise intervention and compared. Results: Among 76 patients enrolled in the prospective cohort, sarcopenia was present in 58 (76.3%) patients (94.3% in men, 34.8% in women). Nineteen patients was enrolled in the exercise program, however 5 patients withdrew consent before commencement. Reasons for withdrawal were health concern (n = 2), distance to the hospital (n = 1) and unspecified (n = 2). The completion rate of the 12-week exercise program was 78.6% (11/14). Disease progression (n = 2) was the main reason for early discontinuation. The adherence rate of the supervised exercise session was 78.1% (207/265) and there was no adverse event associated with the exercise training. Among participants in the exercise program, there was no significant change in skeletal muscle index from baseline to post-intervention (mean, 9.4±1.3kg/m2vs 9.4±1.2kg/m2, p = 0.982). FACIT-fatigue scale was non-significantly improved after the exercise intervention (mean, 35.2±10.4 vs 38.2±9.8, p = 0.635). Conclusions: Exercise interventions appear to be feasible and safe in patients with advanced solid cancer and might have a role of preventing skeletal muscle loss without fatigue exacerbation during palliative chemotherapy.