化疗期间运动：是敌是友？
Exercise during chemotherapy: Friend or foe?
机构信息
Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA.
Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
出版信息
Cancer Med. 2023 May;12(9):10715-10724. doi: 10.1002/cam4.5831. Epub 2023 Apr 19.
BACKGROUND
A higher chemotherapy completion rate is associated with better outcomes including treatment efficacy and overall survival. Exercise may have the potential to improve relative dose intensity (RDI) by reducing the frequency and severity of chemotherapy-related toxicities. We examined the association between exercise adherence and RDI and possible clinical- and health-related fitness predictors of RDI.
METHODS
Chemotherapy records were extracted from the electronic medical record for patients enrolled in the ENACT trial (n = 105). Chemotherapy completion was assessed using average RDI. A threshold of 85% was established for "high" versus "low" RDI. Logistic regression analyses were used to estimate the associations between the clinical- and health-related fitness predictors of RDI.
RESULTS
Patients with breast cancer (BC) had a significantly higher average RDI (89.8% ± 17.6%) compared with gastrointestinal cancer (GI) (76.8% ± 20.9%, p = 0.004) and pancreatic cancer (PC) (65.2% ± 20.1%, p < 0.001). Only 25% of BC patents required a dose reduction compared to 56.3% of GI and 86.4% of PC patients. Cancer site was significantly associated with RDI. Compared with BC, patients with GI (β = -0.12, p = 0.03) and PC (β = -0.22, p = 0.006) achieved significantly lower RDI. Every 2.72 unit increase in overall exercise adherence led to a significant 7% decrease in RDI (p = 0.001) in GI patients. Metastatic GI patients had a 15% RDI increase for every 2.72 unit increase in exercise adherence (p = 0.04).
CONCLUSION
Exercise is a supportive therapy that has potential to enhance chemotherapy tolerance and completion. The relationship between exercise adherence and RDI is influenced by factor such as cancer site and treatment type. Special attention must be paid to how exercise is prescribed to ensure that exercise adherence does not negatively affect RDI. Cancer site, exercise dosage, and multimodal interventions to address toxicities are key areas identified for future research.
背景
更高的化疗完成率与更好的结果相关，包括治疗效果和总生存率。运动可能通过降低化疗相关毒性的频率和严重程度来提高相对剂量强度（RDI）。我们研究了运动依从性与 RDI 之间的关系，以及 RDI 的可能临床和健康相关体能预测因素。
方法
从 ENACT 试验（n=105）的电子病历中提取化疗记录。使用平均 RDI 评估化疗完成情况。建立了 85%的阈值用于“高”与“低”RDI。使用逻辑回归分析来估计 RDI 的临床和健康相关体能预测因素之间的关联。
结果
乳腺癌（BC）患者的平均 RDI（89.8%±17.6%）明显高于胃肠道癌（GI）（76.8%±20.9%，p=0.004）和胰腺癌（PC）（65.2%±20.1%，p<0.001）。只有 25%的 BC 患者需要减少剂量，而 GI 患者为 56.3%，PC 患者为 86.4%。癌症部位与 RDI 显著相关。与 BC 相比，GI（β=-0.12，p=0.03）和 PC（β=-0.22，p=0.006）患者的 RDI 明显较低。整体运动依从性每增加 2.72 个单位，GI 患者的 RDI 就会显著降低 7%（p=0.001）。运动依从性每增加 2.72 个单位，转移性 GI 患者的 RDI 就会增加 15%（p=0.04）。
结论
运动是一种支持性治疗方法，具有增强化疗耐受性和完成度的潜力。运动依从性与 RDI 之间的关系受到癌症部位和治疗类型等因素的影响。必须特别注意如何规定运动，以确保运动依从性不会对 RDI 产生负面影响。癌症部位、运动剂量以及解决毒性的多模式干预是未来研究的关键领域。
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