A landmark 17-year study has found that a workable exercise plan significantly improves survival and enduring health of people who have experienced colorectal cancer. So much so that, as one of the researchers noted, "Our findings will change the way we treat colon cancer."
Researchers from The University of Sydney, Queen's University Canada and the University of Alberta have made a huge breakthrough in colorectal cancer treatment in their study that followed 889 patients in six countries over nearly two decades.
The Challenge trial set out to investigate whether exercise was not just a supportive lifestyle change for cancer survivors but something that directly improved their chances of living longer and avoiding disease recurrence.
“Our study shows that exercise is no longer just a quality-of-life intervention – it is a treatment for colon cancer that must be made available to all patients," said study co-chair Dr Kerry Courneya, a Professor at the University of Alberta.
Colorectal – or colon – cancer has a knack of returning after treatment, with 30% of Stage III patients having to fight it again. It's also now the third most common cancer across the globe, and it's responsible for the second highest number of cancer-related deaths.
The exercise in the study is what the researchers call "structured," but is essentially an extra 250 minutes – or five 30-minute sessions, for example – each week, with a personalized plan tailored to what aerobic activities the patient preferred. So rather than a one-size-fits-all, the three-year regimen was more like a treatment schedule – something the participants weren't simply encouraged to do but prescribed and monitored on, following traditional medical intervention of surgery and/or chemotherapy.
It was measured against a more casual approach, with a cohort of the 889 participants randomly assigned a "health education program" that just advised them on diet and exercise changes to boost their health following their cancer treatment. This is typical of what's currently in place.
"This was in patients with colon cancer or bowel cancer who had already had surgery and then went on to have chemotherapy," said study co-chair Janette Vardy, a Professor at the Faculty of Medicine in Health at The University of Sydney. "And then two-to-six months after they finished the chemotherapy, they were randomized to one of two groups.
"One group were given health education materials promoting physical activity and nutrition, and the second group, in addition to those health education materials, had a structured exercise program."
Results showed that the participants adhering to the structured exercise plan fared significantly better. Overall, there was a 37% reduction in colorectal cancer deaths, and 28% lower likelihood of the cancer returning – or other types developing. It also boosted survival rates, from 83% to 90%.
"We started the Challenge study 17 years ago and what we were interested in seeing was whether physical activity could actually decrease the risk of a cancer recurrence, and could improve survival for patients with colon cancer," said study co-chair Janette Vardy, a Professor at the Faculty of Medicine in Health at The University of Sydney.
"But most importantly, we saw a difference in both disease-free survival and overall survival," she continued. "So we looked at five-year disease-free survival and what we found was that 80% were alive with no evidence of a recurrence of their disease at five years in the exercise group. And this was compared to 74% in the health education only group.
"This actually equates to a 28% reduction in the risk of having a cancer recurrence," she said. "Importantly, overall survival, which we looked at over an eight-year period was 90% compared to 83% in the health education group only. And again, this equates to a large difference. This was a 37 % reduction in the risk of death."
The participants with the structured exercise plan weren't running marathons, either; each cancer survivor had a personal plan developed for them, which for example could be an extra 150 minutes of brisk walking each week.
"So that's only 30 minutes, five times a week of brisk walking that we're talking about the difference to achieve these sorts of results between the two groups," said Vardy. "This should really change the standard of care for colon cancer patients worldwide and it may even be able to be generalized to other cancer groups."
It's not the first study that has shown the huge benefits that can be achieved by treating exercise like a prescription. It has also been looked at for chronic back pain and mental health treatment. Following the study's results, the researchers now call for medical professionals to make this post-treatment plan a non-negotiable.
"But based on our results, what we should definitely see is that a structured exercise program should be being offered to people at the latest for when they finish their chemotherapy," Vardy said. “This shows that exercise isn’t just beneficial, it can be lifesaving. Something as simple as physical activity can significantly improve life expectancy and long-term outcomes for people with colon cancer.
"Our findings will change the way we treat colon cancer," she added.
While percentages about risk factors and survival can often sound intangible and generalized, this study supports a growing body of evidence that sticking to such a "prescribed" exercise plan appears to have a positive biological effect on keeping cancers at bay. More research is needed to understand the link better, but with the average age of colon cancer patients being 68, it at the very least highlights the importance of staying consistently active even after successful drug or surgical treatment.
“As oncologists, one of the most common questions we’re asked by patients is what else they can do to improve their outcomes," said study co-chair Dr Christopher Booth, Medical Oncologist at Kingston Health Sciences Centre and Professor of Oncology at Queen’s University. “The Challenge (CO21) trial provides an answer: An exercise program after surgery and chemotherapy reduces the risk of recurrent or new cancer and improves survival, allowing patients to live longer and better lives.”
The study was published in the New England Journal of Medicine.
Source: The University of Sydney via Scimex