Binyam David, Naaktgeboren Willeke R, Groen Wim G, Aaronson Neil K, Hiensch Anouk E, van Harten Wim H, Stuiver Martijn M, May Anne M
Julius Center, University Medical Center Utrecht, Universiteitsweg 100, 3584CG, Utrecht, The Netherlands.
Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
J Cancer Surviv. 2024 Aug 5. doi: 10.1007/s11764-024-01640-0.
Numerous randomized controlled trials (RCTs) have shown beneficial exercise effects on fatigue, anxiety and depression and health-related quality of life (HRQoL) in breast cancer (BC) patients during and shortly after treatment. Here, we investigated the long-term effects of exercise during chemotherapy for BC on these outcomes.
We invited participants of two highly comparable RCTs that investigated the effects of exercise (EX) (versus usual care (UC)) during chemotherapy in patients with non-metastatic BC (N = 357) to participate in an 8-year follow-up. In both trials, fatigue, anxiety and depression and HRQoL were assessed using the same questionnaires, at multiple timepoints. Linear mixed-effect models were used to compare study arms over time.
In total, 156 participants (EX = 82; UC = 74) completed the follow-up questionnaires. EX reported comparable general (between-group difference 0.73, 95% confidence interval (- 0.35; 1.80), ES = 0.18) and physical fatigue (0.55 (- 0.55; 1.65), ES = 0.13), small but statistically significantly higher levels of anxiety (1.24 (0.47 to 2.00), ES = 0.39) and depression (1.10 (0.34; 1.85), ES = 0.38), significantly lower global HRQoL (- 5.99 (- 10.65; - 1.32), ES = 0.34) and comparable summary HRQoL (- 1.90 (- 4.70; 0.89), ES = 0.16) compared to UC.
No long-term beneficial effects of exercise during chemotherapy on BC patients' fatigue, anxiety, depression or HRQoL were observed. The less favourable outcomes for mood and HRQoL that were observed 8 years after participation in an exercise intervention may be explained by selective loss-to-follow-up.
The results highlight the need to incorporate strategies that promote physical activity maintenance after participation in an exercise programme to also counteract long-term detrimental side effects of cancer treatment.
众多随机对照试验（RCT）表明，运动对乳腺癌（BC）患者在治疗期间及治疗后不久的疲劳、焦虑、抑郁及健康相关生活质量（HRQoL）具有有益影响。在此，我们调查了BC化疗期间运动对这些结局的长期影响。
我们邀请了两项高度可比的RCT的参与者，这两项试验研究了运动（EX）（与常规护理（UC）相比）对非转移性BC患者（N = 357）化疗期间的影响，以参与为期8年的随访。在两项试验中，均使用相同问卷在多个时间点评估疲劳、焦虑、抑郁及HRQoL。使用线性混合效应模型比较各研究组随时间的变化。
共有156名参与者（EX = 82；UC = 74）完成了随访问卷。与UC相比，EX组报告的总体疲劳（组间差异0.73，95%置信区间（-0.35；1.80），效应量（ES）= 0.18）和身体疲劳（0.55（-0.55；1.65），ES = 0.13）相当，焦虑水平略高但具有统计学显著性（1.24（0.47至2.00），ES = 0.39），抑郁水平略高（1.10（0.34；1.85），ES = 0.38），总体HRQoL显著更低（-5.99（-10.65；-1.32），ES = 0.34），综合HRQoL相当（-1.90（-4.70；0.89），ES = 0.16）。
未观察到化疗期间运动对BC患者的疲劳、焦虑、抑郁或HRQoL有长期有益影响。参与运动干预8年后观察到的情绪和HRQoL方面不太有利的结局可能是由于选择性失访所致。
结果强调需要纳入促进运动计划参与后维持身体活动的策略，以抵消癌症治疗的长期有害副作用。
