Physical Fitness and Chemotherapy Tolerance in Patients with Early-Stage Breast Cancer

Groen, Wim G; Naaktgeboren, Willeke R; Harten, Wim H. van; Vulpen, Jonna K. van; Kool, Nathalie; Sonke, Gabe S.; Wall, Elsken van der; Velthuis, Miranda J.; Aaronson, Neil K.; May, Anne M.; Stuiver, Martijn M.

doi:10.1249/mss.0000000000002828

Cited by 17 publications

(22 citation statements)

References 35 publications

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“…An absolute percentage error of 10% for VȮ 2 could for instance result in a fireman not meeting a predefined VȮ 2max value required to continue their profession 11 and patients not meeting a predefined VȮ 2max value advised to undergo major surgery 12 or delay medical treatment. 13 Conversely, it could also lead to individuals falsely meeting the criteria, which increases subsequent during the profession in the case of the fireman, or during surgery for patients. For world-class athletes, even small differences in VȮ 2max (e.g., <1.5%) could lead to relevant inaccuracies in performance predictions (e.g., 64 ), or talent identification.…”

Section: Perspectivementioning

confidence: 99%

Accuracy of respiratory gas variables, substrate, and energy use from 15 CPET systems during simulated and human exercise

Van Hooren,

Souren,

Bongers

2023

Scandinavian Med Sci Sports

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PurposeVarious systems are available for cardiopulmonary exercise testing (CPET), but their accuracy remains largely unexplored. We evaluate the accuracy of 15 popular CPET systems to assess respiratory variables, substrate use, and energy expenditure during simulated exercise. Cross‐comparisons were also performed during human cycling experiments (i.e., verification of simulation findings), and between‐session reliability was assessed for a subset of systems.MethodsA metabolic simulator was used to simulate breath‐by‐breath gas exchange, and the values measured by each system (minute ventilation [V̇E], breathing frequency [BF], oxygen uptake [V̇O2], carbon dioxide production [V̇CO2], respiratory exchange ratio [RER], energy from carbs and fats, and total energy expenditure) were compared to the simulated values to assess the accuracy. The following manufacturers (system) were assessed: COSMED (Quark CPET, K5), Cortex (MetaLyzer 3B, MetaMax 3B), Vyaire (Vyntus CPX, Oxycon Pro), Maastricht Instruments (Omnical), MGC Diagnostics (Ergocard Clinical, Ergocard Pro, Ultima), Ganshorn/Schiller (PowerCube Ergo), Geratherm (Ergostik), VO2master (VO2masterPro), PNOĒ (PNOĒ), and Calibre Biometrics (Calibre).ResultsAbsolute percentage errors during the simulations ranged from 1.15%–50.3% for V̇E, 1.05–3.79% for BF, 1.10%–17.5% for V̇O2, 1.07%–18.3% for V̇CO2, 0.62%–14.8% for RER, 5.52%–99.0% for Kcal from carbs, 5.13%–133% for Kcal from fats, and 0.59%–12.1% for total energy expenditure. Between‐session variation ranged from 0.86%–22.4% for V̇O2 and 1.14%–20.2% for V̇CO2, respectively.ConclusionThe error of respiratory gas variables, substrate, and energy use differed substantially between systems, with only a few systems demonstrating a consistent acceptable error. We extensively discuss the implications of our findings for clinicians, researchers and other CPET users.

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Section: Perspectivementioning

confidence: 99%

Accuracy of respiratory gas variables, substrate, and energy use from 15 CPET systems during simulated and human exercise

Van Hooren,

Souren,

Bongers

2023

Scandinavian Med Sci Sports

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“…We speculate that patients with T1N0M0-stage disease can benefit from postoperative adjuvant chemotherapy because of its killing effect on early microscopic metastases in the liver, blood, or lymph nodes. In addition, some studies have attributed the benefits of adjuvant chemotherapy to the better physical condition and chemotherapy tolerance of patients with early-stage tumors and the higher completion rate of adjuvant chemotherapy [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of adjuvant chemotherapy in T1N0M0 intrahepatic cholangiocarcinoma after radical resection

Zhao

Zhou

et al. 2022

BMC Cancer

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Objective Adjuvant chemotherapy is necessary for radical resection of intrahepatic cholangiocarcinoma (ICC) with a high risk of recurrence (T2–4, N1). However, its use in the treatment of early-stage ICC remains controversial. This study aimed to investigate the role of adjuvant chemotherapy after radical resection in patients with early-stage ICC (T1N0M0). Data and methods The data of 148 patients with pathologically diagnosed ICC (T1N0M0) who underwent radical resection from January 2012 to January 2018 at the Sun Yat-sen University Cancer Center were retrospectively analyzed. Using consistent baseline data, Kaplan–Meier survival curves were constructed to compare relapse-free survival (RFS) and overall survival (OS) between patients who received postoperative adjuvant chemotherapy (AC group) and those who received only surgical treatment (non-AC group). Univariate and multivariate Cox regression analyses were used to screen for independent prognostic factors affecting survival. The RFS and OS of patients were analyzed after the administration of three adjuvant chemotherapy regimens (gemcitabine + capecitabine [GX], gemcitabine + cisplatin [GP], and capecitabine monotherapy [X]). Finally, the safety of adjuvant chemotherapy was evaluated based on the incidence of grade 1–4 adverse events. Results The median RFS was 18 months in the non-AC group and 25 months in the AC group. The median OS was 34 months in the non-AC group; however, it was not reached in the AC group. The OS of the AC group was significantly higher than that of the non-AC group (P = 0.005). Multivariate Cox analysis demonstrated that nerve invasion (P = 0.001), preoperative elevation of cancer antigen 19–9 (CA 19–9) levels (P = 0.009), and postoperative adjuvant chemotherapy (P = 0.009) were independent prognostic factors for early-stage ICC after radical resection. The OS rates of the GX, GP, X, and non-AC groups were significantly different (P = 0.023) and were higher in the GX group than in the non-AC group (P = 0.0052). Among patients with elevated preoperative CA 19–9 levels, the OS rate was higher in the AC group than in the non-AC group (P = 0.022). In terms of safety, the incidence of grade 3 or 4 adverse reactions was < 18.2% in the GX, GP, and X groups, without the occurrence of death owing to such reactions. Conclusion Adjuvant chemotherapy can prolong OS among patients with early-stage ICC who have undergone radical resection. Preoperative elevation of CA 19–9 levels and nerve invasion are independent prognostic factors for poor survival outcomes for early-stage ICC after radical resection. All chemotherapy regimens used in the study are safe.

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“…12 Similarly, Groen et al reported that lower pretreatment physical fitness was associated with lower odds of achieving ≥85%, even after correcting for age. 13 Few studies have evaluated the effect of exercise on RDI in mixed cancer sites, rather, focusing on a single cancer site. 9 However, cancer exercise physiologists routinely work with many cancer sites requiring studies that reflect the real-world value and practical realities of working in a clinical cancer care setting.…”

Section: Introductionmentioning

confidence: 99%

Exercise during chemotherapy: Friend or foe?

et al. 2023

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Background A higher chemotherapy completion rate is associated with better outcomes including treatment efficacy and overall survival. Exercise may have the potential to improve relative dose intensity (RDI) by reducing the frequency and severity of chemotherapy‐related toxicities. We examined the association between exercise adherence and RDI and possible clinical‐ and health‐related fitness predictors of RDI. Methods Chemotherapy records were extracted from the electronic medical record for patients enrolled in the ENACT trial (n = 105). Chemotherapy completion was assessed using average RDI. A threshold of 85% was established for “high” versus “low” RDI. Logistic regression analyses were used to estimate the associations between the clinical‐ and health‐related fitness predictors of RDI. Results Patients with breast cancer (BC) had a significantly higher average RDI (89.8% ± 17.6%) compared with gastrointestinal cancer (GI) (76.8% ± 20.9%, p = 0.004) and pancreatic cancer (PC) (65.2% ± 20.1%, p < 0.001). Only 25% of BC patents required a dose reduction compared to 56.3% of GI and 86.4% of PC patients. Cancer site was significantly associated with RDI. Compared with BC, patients with GI (β = −0.12, p = 0.03) and PC (β = −0.22, p = 0.006) achieved significantly lower RDI. Every 2.72 unit increase in overall exercise adherence led to a significant 7% decrease in RDI (p = 0.001) in GI patients. Metastatic GI patients had a 15% RDI increase for every 2.72 unit increase in exercise adherence (p = 0.04). Conclusion Exercise is a supportive therapy that has potential to enhance chemotherapy tolerance and completion. The relationship between exercise adherence and RDI is influenced by factor such as cancer site and treatment type. Special attention must be paid to how exercise is prescribed to ensure that exercise adherence does not negatively affect RDI. Cancer site, exercise dosage, and multimodal interventions to address toxicities are key areas identified for future research.

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Physical Fitness and Chemotherapy Tolerance in Patients with Early-Stage Breast Cancer

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Cited by 17 publications

References 35 publications

Accuracy of respiratory gas variables, substrate, and energy use from 15 CPET systems during simulated and human exercise

Accuracy of respiratory gas variables, substrate, and energy use from 15 CPET systems during simulated and human exercise

Efficacy and safety of adjuvant chemotherapy in T1N0M0 intrahepatic cholangiocarcinoma after radical resection

Exercise during chemotherapy: Friend or foe?

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