Courneya Kerry S, McNeely Margaret L, Booth Christopher M, Friedenreich Christine M
Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB, Canada.
Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
Front Oncol. 2024 Sep 23;14:1432899. doi: 10.3389/fonc.2024.1432899. eCollection 2024.
Exercise plays many important roles across the entire cancer continuum that have been described in previous frameworks. These frameworks, however, have generally provided a simplified description of the roles of exercise postdiagnosis. The modern cancer treatment landscape has become complex and often consists of multiple lines of multimodal treatments combined concurrently and/or sequentially and delivered over many months or years. This complexity requires a more multifaceted and targeted approach to the study of exercise after a cancer diagnosis. Here, we propose a new integrated framework-Exercise Across the Postdiagnosis Cancer Continuum (EPiCC)-that highlights the distinct roles of exercise for disease treatment and supportive care from diagnosis until death. We also propose new terminology to clarify the distinct roles of exercise that emerge in the context of the modern cancer treatment landscape. The EPiCC Framework is structured around multiple sequential cancer treatments that highlight six distinct cancer treatment-related time periods for exercise-before treatments, during treatments, between treatments, immediately after successful treatments, during longer term survivorship after successful treatments, and during end of life after unsuccessful treatments. The EPiCC Framework proposes that the specific roles of exercise as a disease treatment and supportive care intervention will vary depending on its positioning within different cancer treatment combinations. As a cancer treatment, exercise may serve as a "priming therapy", primary therapy, neoadjuvant therapy, induction therapy, "bridging therapy", adjuvant therapy, consolidation therapy, maintenance therapy, and/or salvage therapy. As a supportive care intervention, exercise may serve as prehabilitation, intrahabilitation, interhabilitation, rehabilitation, "perihabilitation", health promotion/disease prevention, and/or palliation. To date, exercise has been studied during all of the cancer treatment-related time periods but only in relation to some cancer treatments and combinations. Moreover, fewer studies have examined exercise across multiple cancer treatment-related time periods within any cancer treatment combination. Future research is needed to study exercise as a disease treatment and supportive care intervention within and across the distinct cancer treatment-related time periods contained within different cancer treatment combinations. The aim of the EPiCC Framework is to stimulate a more targeted, integrated, and clinically-informed approach to the study of exercise after a cancer diagnosis.
运动在整个癌症病程中发挥着许多重要作用，这在以往的框架中已有描述。然而，这些框架通常对诊断后运动的作用进行了简化描述。现代癌症治疗格局变得复杂，通常包括多种多模式治疗方法，这些方法同时和/或相继联合使用，疗程长达数月或数年。这种复杂性要求采用更具多面性和针对性的方法来研究癌症诊断后的运动。在此，我们提出一个新的综合框架——癌症诊断后连续阶段运动框架（EPiCC），该框架突出了运动在从诊断到死亡的疾病治疗和支持性护理中的不同作用。我们还提出了新的术语，以阐明在现代癌症治疗格局背景下运动所发挥的不同作用。EPiCC框架围绕多个连续的癌症治疗构建，突出了与运动相关的六个不同的癌症治疗时间段——治疗前、治疗期间、治疗间隔期、成功治疗后即刻、成功治疗后的长期生存期间以及未成功治疗后的生命末期。EPiCC框架提出，运动作为一种疾病治疗和支持性护理干预的具体作用将因其在不同癌症治疗组合中的定位而异。作为一种癌症治疗方法，运动可作为“启动疗法”、主要疗法、新辅助疗法、诱导疗法、“桥接疗法”、辅助疗法、巩固疗法、维持疗法和/或挽救疗法。作为一种支持性护理干预措施，运动可作为预康复、康复中、康复间、康复、“围康复”、健康促进/疾病预防和/或姑息治疗。迄今为止，在所有与癌症治疗相关的时间段都对运动进行了研究，但仅涉及某些癌症治疗方法和组合。此外，较少有研究在任何癌症治疗组合中跨多个与癌症治疗相关的时间段研究运动。未来需要开展研究，以在不同癌症治疗组合所包含的不同与癌症治疗相关的时间段内以及跨这些时间段，研究运动作为一种疾病治疗和支持性护理干预措施（的效果）。EPiCC框架的目的是激发一种更具针对性、综合性且基于临床知识的方法来研究癌症诊断后的运动。
