Exercise and cancer treatment symptoms in 408 newly diagnosed older cancer patients

https://doi.org/10.1016/j.jgo.2012.01.002Get rights and content

Abstract

While the benefits of exercise for managing cancer and treatment-related side effects have been shown among various populations of cancer survivors, a relative dearth of information exists among older cancer patients.

Objectives

To determine the prevalence of exercise participation during and after primary cancer treatment in older (≥ 65 years) and the oldest (≥ 80 years) cancer patients and to examine the relationships between exercise, symptoms, and self-rated health (SRH).

Materials and methods

408 newly diagnosed older cancer patients (mean age = 73, range = 65–92) scheduled to receive chemotherapy and/or radiation therapy reported symptoms and SRH prior to, during, and 6 months after treatment, and exercise participation during and following treatment.

Results

Forty-six percent of older and 41% of the oldest patients reported exercising during treatment. Sixty percent of older and 68% of the oldest patients reported exercising in the 6 months thereafter. Older patients who exercised during treatment reported less shortness of breath and better SRH during treatment, and better SRH following treatment. The oldest patients who exercised during treatment reported less memory loss and better SRH during treatment and less fatigue and better SRH following treatment. The oldest patients who exercised following treatment reported less fatigue, skin problems, and total symptom burden following treatment.

Conclusion

These data suggest a willingness of older cancer patients to attempt exercise during and after treatment. Exercise during these times is associated with less severe symptoms; further clinical research examining the efficacy of formal exercise interventions to reduce symptoms and improve SRH in older cancer patients is needed.

Introduction

Aging is associated with declines in physical[1], [2], [3], [4] and psychological[3], [4] function and cancer treatments can further exacerbate these functional decrements. Younger cancer patients often experience a transient decline in function, whereas older cancer patients may never fully recover.5 These decrements in physiological and psychological function can ultimately lead to reduced quality of life.[6], [7]

Older adults are at much greater risk of developing cancer than those who are younger. In the United States, approximately 60% of new cancer diagnoses occur in those over 65 years of age. By 2030, 70% of cancer patients will be elderly.8 Compared to older adults without a history of cancer, older cancer survivors suffer from a greater incidence of frailty and more limitations in activities of daily living,9 lower self-rated health,9 reduced quality of life,10 and a greater prevalence of geriatric syndromes such as dementia, depression, falls, incontinence, and osteoporosis.9 The severity of cancer-related fatigue, another problem facing many cancer patients during and following treatment, is related to the cancer and its treatment as well as age-related factors.11

Regular physical activity reduces the risk of developing many chronic conditions, such as coronary artery disease, hypertension, osteoporosis, type II diabetes, obesity, and chronic obstructive pulmonary disease, while playing a role in the management of anxiety, depression, dementia, and pain.12 The American College of Sports Medicine (ACSM) recommends that older adults, even those with chronic medical conditions, participate in regular aerobic exercise training (150–300 min per week) and resistance exercise training (at least 2 days a week).12 Evidence also supports the use of exercise for side-effect and symptom management in cancer survivors.[13], [14], [15] Among elders, especially those who are frail, physical activity intervention programs have resulted in improved muscular mass and strength,16 improved aerobic capacity,17 fall reduction,[18], [19], [20] improved perceived health status,21 and improved physical functioning.22

Exercise is a promising behavioral intervention with the potential to mitigate multiple symptoms and improve physical functioning in older cancer patients.[23], [24], [25], [26], [27] However, it is important to investigate the proportion of older cancer patients who participate in exercise during and following treatment and to investigate the possible associations between exercise and symptom severity in older cancer patients. The purpose of this paper is to describe the proportion of older cancer patients both during and following treatment who report using exercise and to describe the associations between exercise and symptom severity during these time frames.

Section snippets

Study Sample

Participants were newly-diagnosed cancer patients who were scheduled to receive chemo- or radiation-therapy. Patients who participated in this investigation met the following criteria: a) had a diagnosis of breast, gynecological, lung, hematologic, gastrointestinal, genitourinary tract, or head and neck cancer, b) had not received chemotherapy or radiation therapy in the past, c) had an estimated life expectancy of 10 months or more, d) were 65 years of age or older, and e) were able to read and

Sample Characteristics

A total of 408 patients 65 to 92 years of age provided evaluable information. Of those, 361 were between the ages of 65 and 79 and 47 were 80 years of age or older. The mean age of patients in this study was 73 years. Males comprised just over half of the sample. A majority of patients were white and married, had a Karnofsky performance status of 90 or greater and had undergone surgery for their cancer prior to chemotherapy and/or radiation therapy. The largest proportion of cancer diagnoses were

Discussion

The number of adults over 65 years of age is increasing more rapidly than any other age group, with those over 80 growing the fastest and expected to account for 20% of people over 65 by the year 2050.31 Cancer is a disease that disproportionally affects those over the age of 65.32 To our knowledge, this is one of the few studies to focus on symptom severity, self-rated health and exercise participation in older cancer patients undergoing chemotherapy and/or radiation therapy and one of the few

Author Contribution

Concept and Design:

Lisa Sprod

Karen Mustian

Data Collection:

Lisa Sprod

Gary Morrow

Raymond Lord

Howard Gross

Analysis and Interpretation of Data:

Lisa Sprod

Michelle Janelsins

Luke Peppone

Wendy Demark-Wahnefried

Supriya Mohile

Manuscript writing and approval:

Michelle Janelsins

Luke Peppone

Wendy Demark-Wahnefried

Supriya Mohile

Lisa Sprod

Gary Morrow

Raymond Lord

Howard Gross

Disclosure

None of the authors have anything to disclose.

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