Physical Activity and Cancer Survivorship: Meeting Summary
January 24-25, 2002
St. Gregory Hotel, Washington, D.C.
- Session 1: Physiologic Outcomes
- Session 2: Psychosocial Outcomes
- Session 3: Methodologic Issues
- Session 4: Exercise and the Elderly
Background and Significance
Recent evidence suggests a protective effect of physical activity (PA) against cancers of the colon, breast, and prostate. Plausible mechanisms include the prevention of weight gain or obesity, and thus the modulation of sex hormones or growth factors. In addition, it has been shown that PA affects many physiologic systems and may thus modify the carcinogenic process through many routes and at many stages. Research has focused on PA and exercise as a protective factor in the development of cancer. However, PA and exercise interventions that enhance the health and quality of life of those already diagnosed with cancer is an emerging research area. The growing population of cancer survivors, and the documented adverse physiologic and psychosocial sequelae of cancer and its treatment, present an opportunity to examine the potential impact of PA on prevention or control of late and long-term sequelae of survivorship, co-morbidities, and cancer recurrence.
The Office of Cancer Survivorship and the Applied Research Program, both within the Division of Cancer Control and Population Sciences, NCI, convened a meeting of researchers involved in studying the psychosocial and health-related effects of PA among cancer survivors. The goals of the meeting were to:
- review and synthesize Cancer Control Research on the efficacy of PA and exercise interventions in altering survivor outcomes (including both physical and emotional well-being) discuss challenges to delivery and assessment of physical activity interventions in populations of cancer survivors
- explore the range of medical and non-medical outcomes that might be affected by physical activity interventions
- identify research directions that could advance understanding of the role PA and exercise play in reducing morbidity related to illness and treatment, and increasing length of disease-free survival after cancer.
Meeting presentations were based on 4 broad areas of discussion:
- physiologic and psychosocial outcomes of physical activity interventions among cancer survivors
- methodological challenges to conducting physical activity research in this population
- issues of special relevance to PA research in the older adult cancer survivor population
Literature reviews were commissioned on each of the above topic areas, and meeting participants were provided the opportunity to comment on these draft manuscripts.
The presentations indicated that studies among cancer patients and survivors are few in number and relatively small in scale. Since exercise impacts many body systems, it could play a role in ameliorating many adverse consequences of cancer diagnosis and treatment. Concerns about possible deleterious effects of exercise among cancer patients were also presented and included a potential for adverse impact among patients with lymphedema or those with compromised cardiac function.
Pediatric cancer patients may require special consideration due to cardiovascular complications from cancer therapy. Exercise regimens may need to be modified for other subgroups of target populations.
Meeting participants concluded that studies of exercise and cancer survivorship could be built into ongoing case-control and prospective cohort etiologic investigations to evaluate overall relationships, and that clinical trials and specially targeted studies must be designed to evaluate specific mechanisms and enable researchers to distinguish the effects of PA on outcomes from other contributing or controlling factors. There was consensus regarding the continued need for descriptive and observational studies, and those testing specific hypotheses.
- American College of Sports Medicine (ACSM) guidelines should be revised to include those for cancer survivors.
- A review should be conducted of exercise and physical activity programs currently being offered to survivors nationally.
- A meeting should be convened to review the special recruitment challenges involved in PA research among survivors, and solutions to these.
- Investigators conducting PA research should strive for concordance on use of instruments to assess outcomes, and, as needed, develop common toxicity measures.
- Funding should be sought to permit the long-term follow-up of study participants.
- Studies including cost-effectiveness and economic impact of PA interventions should be conducted.
- Consideration should be given to the development and sponsorship of a survivor cohort consortium.