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Effects of exercise during and after neoadjuvant chemoradiation on symptom burden and quality of life in rectal cancer patients: a phase II randomized controlled trial

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Abstract

Purpose

We previously demonstrated that exercise during and after neoadjuvant chemoradiation (NACRT) for rectal cancer may improve the rate of pathologic complete/near complete response. Here, we report the effects of exercise on symptom management and quality of life (QoL).

Methods

Rectal cancer patients (N = 36) were randomized to a supervised high-intensity interval training program during NACRT followed by unsupervised continuous exercise after NACRT or usual care. Patient-reported outcomes were assessed at baseline, post-NACRT, and presurgery including symptom burden (M.D. Anderson Symptom Inventory) and QoL (European Organisation for Research and Treatment of Cancer QLQ- C30 and -CR29).

Results

During NACRT, exercise significantly worsened stool frequency (adjusted between-group difference, 25.8; 95% CI, 4.0 to 47.6; p = 0.022), role functioning (adjusted between-group difference, -21.3; 95% CI, -41.5 to -1.1; p = 0.039), emotional functioning (adjusted between-group difference, -11.7; 95% CI, -22.0 to -1.4; p = 0.028), and cognitive functioning (adjusted between-group difference, -11.6; 95% CI, -19.2 to -4.0; p = 0.004) compared to usual care. After NACRT, exercise significantly worsened diarrhea (adjusted between-group difference, 1.2; 95% CI, 0.1 to 2.3; p = 0.030) and embarrassment (adjusted between-group difference, 19.7; 95% CI, 7.4 to 32.1; p = 0.003) compared to usual care.

Conclusions

Exercise exacerbated some symptoms and worsened QoL during NACRT; however, most negative effects dissipated after NACRT. Larger trials are necessary to confirm these findings.

Implications for Cancer Survivors

If the clinical benefit of exercise is confirmed, then the modest symptom exacerbation during NACRT may be considered tolerable. However, in the absence of any clinical benefit, exercise may be contraindicated in this clinical setting.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

Code availability

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Acknowledgements

The authors would like to thank Spencer Allen, Ki-Yong An, Morgan Corbett, Diane Cook, Dong-Woo Kang, Stephanie Wharton, and Terri Wood for their assistance with exercise testing and supervision. We also thank the participants for their time and commitment to the trial.

Funding

This work was supported by the Canadian Cancer Society (grant number 704680). ARM was supported by the Frederick Banting and Charles Best Canada Graduate Scholarships (CGS-D) through the Canadian Institutes of Health Research. KSC is supported by the Canada Research Chairs Program.

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Authors and Affiliations

  1. Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada

    Andria R. Morielli, Normand G. Boulé & Kerry S. Courneya

  2. Department of Oncology, University of Alberta and Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada

    Nawaid Usmani, Keith Tankel, Kurian Joseph, Diane Severin, Alysa Fairchild & Tirath Nijjar

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  1. Andria R. Morielli
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Contributions

ARM, NU, NGB, and KSC made important contributions to the conception and design of the study. ARM, NU, NGB, and KSC made important contributions to the acquisition, analysis, or interpretation of the data. ARM, NU, KT, KJ, DS, AF, and TN made important contributions to patient screening and recruitment. ARM drafted the manuscript. All authors critically reviewed the manuscript and approved the final version.

Corresponding author

Correspondence to Kerry S. Courneya.

Ethics declarations

Ethics approval

This trial was approved by the Health Research Ethics Board of Alberta-Cancer Committee (No. 26200).

Consent to participate

Written informed consent was obtained from all participants. This trial was conducted in accordance with the Declaration of Helsinki.

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Not applicable.

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The authors declare no competing interests.

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Morielli, A.R., Boulé, N.G., Usmani, N. et al. Effects of exercise during and after neoadjuvant chemoradiation on symptom burden and quality of life in rectal cancer patients: a phase II randomized controlled trial. J Cancer Surviv 17, 1171–1183 (2023). https://doi.org/10.1007/s11764-021-01149-w

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