Arya Ritu, Siamakpour-Reihani Sharareh, Palta Manisha, Massa Lisa, Broadwater Gloria, Blitzblau Rachel C, Horton Janet K
Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
Pract Radiat Oncol. 2015 Jul-Aug;5(4):e275-81. doi: 10.1016/j.prro.2015.01.003. Epub 2015 Feb 26.
Radiation therapy is associated with acute treatment-related complications that can lead to decreased quality of life (QOL). Exercise has been shown in other cancer treatment settings to improve negative outcomes. We conducted a prospective pilot study to explore the association between exercise, patient-reported outcomes, and acute radiation therapy toxicities.
Women receiving curative breast radiation therapy were enrolled. Each patient completed an exercise behavior/QOL survey before or during the first week of treatment and again during the last week of treatment. Exercise behavior was quantified with the Godin Leisure Time Exercise Questionnaire (metabolic equivalent [MET] hours per week). Measurements to evaluate upper extremity lymphedema and shoulder range of motion were completed. Skin toxicity was assessed weekly. Patient-reported outcomes were measured using standardized questionnaires.
Forty-five patients were enrolled. Mean patient age was 54 (range, 28-73) years. Mean METs in the exercise cohort (≥9 METs/wk) was 21 per week (range, 11-38, n = 14); 3 per week (range, 0-8, n = 25) in the nonexercise cohort (<9 METs/wk). Women in the exercise cohort showed improvements in treatment-induced quality of life and fatigue (not significant) despite more extensive surgical, medical, and radiation treatment. No differences in treatment-related toxicities, pain, or sleep scores were noted. Lymphedema was mild (<3 cm) in the entire patient cohort.
The vast majority of current exercise oncology literature implicates physical activity as an independent predictor of QOL in cancer patients. Our study noted similar trends, but they were not statistically significant. This may be due to our finding that patient-reported outcomes with radiation therapy are relatively high compared with other treatment modalities and remain stable throughout treatment. Thus, it may be that radiation therapy has a limited impact on QOL in breast cancer patients. Exercise may be best used as a targeted therapy in patients at high risk for poor QOL or radiation-related toxicities at baseline.
放射治疗会引发与治疗相关的急性并发症，进而导致生活质量（QOL）下降。在其他癌症治疗环境中，运动已被证明可改善不良预后。我们开展了一项前瞻性试点研究，以探讨运动、患者报告的结局与急性放射治疗毒性之间的关联。
纳入接受根治性乳腺癌放射治疗的女性患者。每位患者在治疗的第一周之前或期间以及治疗的最后一周再次完成一份运动行为/生活质量调查问卷。运动行为通过戈丁休闲时间运动问卷（每周代谢当量[MET]小时数）进行量化。完成评估上肢淋巴水肿和肩部活动范围的测量。每周评估皮肤毒性。使用标准化问卷测量患者报告的结局。
共纳入45例患者。患者平均年龄为54岁（范围28 - 73岁）。运动组（≥9 METs/周）的平均METs为每周21（范围11 - 38，n = 14）；非运动组（<9 METs/周）为每周3（范围0 - 8，n = 25）。尽管接受了更广泛的手术、药物和放射治疗，但运动组女性在治疗引起的生活质量和疲劳方面有改善（不显著）。未观察到与治疗相关的毒性、疼痛或睡眠评分存在差异。整个患者队列中的淋巴水肿均为轻度（<3 cm）。
当前绝大多数运动肿瘤学文献表明身体活动是癌症患者生活质量的独立预测因素。我们的研究也发现了类似趋势，但未达到统计学显著水平。这可能是因为我们发现与其他治疗方式相比，放射治疗患者报告的结局相对较高，且在整个治疗过程中保持稳定。因此，放射治疗对乳腺癌患者生活质量的影响可能有限。运动可能最适合作为基线时生活质量差或有放射相关毒性高风险患者的靶向治疗。
