Physical activity after surgery for stage III colon cancer may prevent disease recurrence
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Key takeaways:
- Postoperative physical therapy appeared associated with a significant DFS benefit.
- The findings indicate that physical exercise should be initiated as soon as the patient is cleared by their surgeon.
For patients who undergo surgery for stage III colon cancer, physical activity appears to prevent — rather than merely delay — recurrence of the disease, according to a study published in British Journal of Sports Medicine.
The death of his father at age 48 years due to colon cancer inspired study lead author Justin C. Brown, PhD, director of the cancer metabolism program and assistant professor at Louisiana State University’s Pennington Biomedical Research Center, to conduct this research.
“I have committed the rest of my life to doing this,” Brown told Healio. “This is just the beginning. We have multiple randomized clinical trials; some have just concluded and some are just starting. The National Cancer Institute has been unwavering in their support of this type of research because it answers fundamental questions that can improve patient care and help us figure out how these simple lifestyle choices can stop cancer in its tracks.”
Brown spoke with Healio about his study’s encouraging findings and their potential to improve outcomes and quality of life for patients with colon cancer.
Healio: What prompted you to conduct this study?
Brown: We have previously shown that patients with surgically resected stage III colon cancer who were more physically active during and after postoperative chemotherapy have improved DFS. One of the things we were interested in figuring out is what sounds like a simple question: does physical activity prevent cancer recurrence, or does it simply delay the amount of time that is required before the cancer comes back? That is important because if you know the answer to that question, it may give you clues into the biology of how physical activity may impact cancer recurrence. It can also inform cancer care because it may help to understand when physical activity is most beneficial for patients who want to reduce their risk for recurrence.
Healio: How did you conduct the study?
Brown: This was an observational study nested within a large therapeutic trial. In the large therapeutic trial, patients were randomly assigned to receive either the anti-inflammatory drug celecoxib (Celebrex, Viatris) or placebo, and some received either 3 months of chemotherapy or 6 months of chemotherapy. We embedded questionnaires about physical activity in this trial, allowing us to use the data efficiently and rigorously to describe the potential benefits of physical activity in this population.
Healio: What did you find?
Brown: We found that when done during postoperative chemotherapy, physical activity seems to prevent recurrence in at least a subset of patients. We found no evidence that physical activity delays recurrence. That prevention of recurrence translates into an OS benefit.
The largest benefit of physical activity occurred when it was done early in the postoperative setting. What that means is that patients who are motivated to use physical activity as a tool to improve their long-term prognosis should start being physically active as soon as they recover from surgery. The sooner they start, the sooner they can derive the potential DFS benefit. This is important because it gives us clues biologically as to what physical activity might be doing to prevent recurrence. We think physical activity may eradicate residual cancer cells left over after surgery. This study is important for clinical care because for physicians, we now have an answer when asked how soon patients should begin being physically active. The answer is now, as soon as your surgeon clears you to resume your activities of daily living. Patients should start low and progress slow with a physical activity program.
Healio: How has the death of your father to cancer influenced your research?
Brown: My father was a patient who would otherwise have been eligible for this type of study. He asked his oncologist, “What can I do to survive this?” His oncologist at the time said, “Come to your treatment appointments, and go home and get your affairs in order.” That was what we knew at the time. Now, we have good evidence that the decisions and actions patients take outside of the cancer center have a tremendous impact on how they feel, how they function and, most importantly, how they survive. Physical activity is one of those things that patients can do.
I think in the 20-plus years since my father died, the tide has changed dramatically in terms of helping patients understand how the choices they make in daily life can impact their long-term disease outcomes. My lifelong commitment is to try to generate evidence so that patients like my father know what they can do to have the best possible chance after a cancer diagnosis.
For more information:
Justin C. Brown, PhD, can be reached at Pennington Biomedical Research Center, 2328 Irene Drive, Baton Rouge, LA 70808; email: justin.brown@pbrc.edu.
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