Exercise improves quality of life in people with metastatic breast cancer | SABCS 2023

Background

Last year the American Society of Clinical Oncology released a guideline recommending exercise during cancer treatment when the goal of the treatment is cure. This recommendation was based on multiple studies linking exercise to better heart health, strength, and improvements in fatigue and other patient-reported outcomes.

The guideline was not able to address metastatic cancer due to a gap in research on exercise use by people with metastatic disease. The PREFERABLE-EFFECT clinical trial offers new data to help fill the gap in breast cancer.

Results

Based at clinical centers in Australia and five European countries, the PREFERABLE-EFFECT clinical trial included 357 people with stage IV breast cancer of any type who had a life expectancy of six months or less. People with unstable bone metastases, a health problem for which exercise is not recommended, and those who already exercise at least 210 minutes per week were not eligible for the study.

Participants were assigned to one of two groups:

• The intervention group received a nine-month, structured and personalized exercise program involving two one-hour supervised exercise sessions, and exercise advice. Each exercise session included moderate- to high-impact aerobic training, usually on a stationary bicycle, resistance training, and balance training. After six months, one of the two weekly structured exercise sessions was replaced by an unsupervised one.
• The control group only received general exercise advice and a fitness tracker.

The two groups were similar in age (average age of approximately 55), marital status, education level, and body mass index. They were also similar in terms of cancer type and treatment history. Approximately two-thirds of participants had bone metastases. Most had HR-positive/HER2-negative breast cancer; the second most common type of cancer the participants had wasHER2-positive breast cancer, and the third most common type was triple-negative breast cancer. Data collected included questionnaires, blood samples, and physical fitness tests.

Using data from the start of the trial, three, six, and nine months, the findings were clear:

• At three and six months, people in the exercise group had higher physical fitness compared to people in the control group.
• Quality of life was higher in the exercise group throughout the duration of the study. The exercise group also saw a decline in fatigue that continued throughout the study period.
• Within quality of life, people in the exercise group had higher physical functioning than their counterparts in the control group. They were also better able to participate in family, work, or social life.
• Exercise, however, did not help with emotional fatigue or functioning. There were no differences in emotional fatigue or functioning between the two groups, suggesting that serious emotional fatigue may require another approach.
• Pain was significantly lower for people in the exercise group. Likewise, people in this group had less fatigue and dyspnea (difficulty breathing).

The research team is still analyzing the study results to see if people who exercised had better treatment adherence.

What does this mean for you?

If you have metastatic breast cancer, exercise may help you feel better. Contrary to what people in this clinical trial expected, their pain and fatigue improved with exercise. They also were better able to engage in work and home life. It is worth noting again that the study included people with and without bone metastases.

The study author concluded her talk by sharing this quote from a participant in the exercise program: “Wonderful. Even though I’m very ill with chemotherapy, I come, I exercise, and I leave better.”