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Exercise reduces mortality among childhood cancer survivors
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Vigorous exercise lowered mortality risk among childhood cancer survivors, according to findings presented at the ASCO Annual Meeting and published in JAMA Oncology.
“In the general population, adherence to healthy lifestyle behaviors including regular exercise is associated with substantial reductions in cardiovascular disease mortality and mortality from any cause,” Jessica M. Scott, PhD, principal investigator at the Lee Jones Lab of Memorial Sloan Kettering Cancer Center, and colleagues wrote. “Exercise also reduces the primary incidence of several forms of cancer and the risk of recurrence following a diagnosis of certain adult-onset cancers (eg, breast, colon, prostate). Whether these findings extend to adult survivors of childhood cancer with excess risk of mortality is not known.”
Scott and colleagues performed a multicenter cohort analysis of 15,450 adults (men, 52.8%; median age at interview, 25.9 years) enrolled in the Childhood Cancer Survivor Study, all of whom were diagnosed at age younger than 21 years between 1970 and 1999. The researchers used multivariable piecewise exponential regression analysis to evaluate associations between self-reported vigorous exercise and cause-specific mortality.
During a median follow-up of 9.6 years, 1,063 deaths occurred. Of these, 120 were a result of recurrence or progression of primary cancer, 811 were “health related,” and 132 were from external or unknown causes.
At 15 years, cumulative incidence of all-cause mortality was 11.7% (95% CI, 10.6-12.8) among patients who exercised at zero metabolic-equivalent task hours per week, compared with 8.6% (95% CI, 7.4-9.7) among those who exercised at 3 to 6 metabolic-equivalent task hours per week, 7.4% (95% CI, 6.2-8.6) among those who exercised at 9 to 12 metabolic-equivalent task hours per week and 8% among those who exercised at 15 to 21 metabolic-equivalent task hours per week.
After adjusting for chronic conditions and treatment exposures, researchers found an inverse association with mortality across all exercise quartiles (P = .02).
Among a subset of 5,869 survivors, increased exercise (mean, 7.9 metabolic-equivalent task hours per week) appeared associated with a 40% decrease in all-cause mortality rate over the course of 8 years compared with maintenance of low exercise levels.
“Our findings indicate that regular vigorous exercise, as well as an increase in exercise, is associated with significant reductions in the risk of mortality in adult survivors of childhood cancer,” Scott and colleagues wrote. “These findings may be of importance for the large and rapidly growing global population of adult survivors of childhood cancer at substantially higher risk [for] mortality due to multiple competing risks.” – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Anne H. Blaes, MD
It is important for all of us as providers to help our patients continue to move. We have known exercise is beneficial for the heart. This study confirms that it actually improves OS for our youngest patients treated for cancer. Although exercise is important in all phases of cancer, it is especially important in survivorship. It is important we ask our patients about exercise and encourage them to keep moving. If they have barriers to doing this, we need to work as a team with physiatrists, cancer rehabilitation and physical therapy to help make this more feasible.
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