Recruitment to and pilot results of the PACES randomized trial of physical exercise during adjuvant chemotherapy for colon cancer

Waart, Hanna van; Stuiver, Martijn M.; Harten, Willem H. van; Geleijn, Edwin; Maaker-Berkhof, Marianne de; Schrama, J. G.; Geenen, Maud M.; Terwogt, Jetkse M. Meerum; Heiligenberg, Simone M. van den; Vreeswijk, Jeannette A.J.H. Hellendoorn-van; Sonke, Gabe S.; Aaronson, Neil K.

doi:10.1007/s00384-017-2921-6

Cited by 38 publications

(63 citation statements)

References 38 publications

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“…Of these, 106 were excluded and 19 trials were included in the review (low quality, n = 2 [11%]; high quality, n = 17 [89%], Supplementary content 3 ). Two trials involved two exercise intervention arms in addition to a usual care group; these included evaluation of a high- versus low-dose exercise intervention [ 36 ] and evaluation of a high-intensity supervised intervention versus a low-moderate intensity unsupervised intervention [ 37 ]. Therefore, data from a total of 21 exercise intervention arms and 19 usual care arms were included.…”

Section: Resultsmentioning

confidence: 99%

“…Time since diagnosis was reported in 10 trials (53%) and ranged between 8.8 and 44.8 months (median = 18.4). Most trials involved participants with colorectal cancer ( n = 13, 68%, [ 38 – 50 ]) and six trials ( n = 6, 32%, [ 36 , 37 , 51 – 54 ]). Only one trial (5%, [ 47 ]) included patients with metastatic (stage IV) disease.…”

Section: Resultsmentioning

confidence: 99%

“…Only one trial (5%, [ 47 ]) included patients with metastatic (stage IV) disease. Four trials (21%) evaluated the role of exercise pre-surgery [ 38 , 40 , 42 , 44 ], five (26%) were during chemotherapy [ 37 , 41 , 43 , 47 , 54 ] and 10 (53%) were post-treatment [ 36 , 39 , 45 , 46 , 48 – 53 ].…”

Section: Resultsmentioning

confidence: 99%

“…Intervention durations ranged between 1 week [ 51 ] and 6 months [ 36 ] (median 12 weeks). Four studies ( n = 4, 21%) evaluated aerobic exercise only [ 36 , 41 , 44 , 49 ], 14 studies (74%) evaluated mixed-mode exercise [ 37 – 40 , 42 , 43 , 45 – 48 , 51 – 54 ], one study ( n = 1, 5%, [ 50 ]) evaluated other modes of exercise (yoga) and no studies evaluated resistance exercise alone. Home-based, unsupervised exercise was prescribed for 10 (53%) of the interventions [ 36 , 40 – 42 , 44 – 46 , 48 , 49 , 53 ].…”

Section: Resultsmentioning

confidence: 99%

“…Home-based, unsupervised exercise was prescribed for 10 (53%) of the interventions [ 36 , 40 – 42 , 44 – 46 , 48 , 49 , 53 ]. Eight trials ( n = 8 [42%]) involved supervised interventions (i.e., over half of the exercise sessions involved face-to-face supervision [ 38 , 39 , 43 , 47 , 50 – 52 , 54 ], and one trial ( n = 1, 5%) involved a supervised and an unsupervised intervention group [ 37 ]. Supervised interventions were conducted at a range of facilities including hospital, clinical, university or rehabilitation settings.…”

Section: Resultsmentioning

confidence: 99%

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Exercise and colorectal cancer: a systematic review and meta-analysis of exercise safety, feasibility and effectiveness

Singh

Hayes

Spence

et al. 2020

Int J Behav Nutr Phys Act

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Background This meta-analysis evaluated the safety, feasibility and effect of exercise among individuals with colorectal cancer. Methods A database search (CINAHL, Ebscohost, MEDLINE, Pubmed, ProQuest Health and Medical Complete, ProQuest Nursing, Science Direct) for randomised, controlled, exercise trials involving individuals with colorectal cancer, published before January 1, 2020 was undertaken. Safety (adverse events), feasibility (withdrawal and adherence rates) and effect data (health outcomes including quality of life, QoL) were abstracted. Risk difference (RD) and standardised mean differences (SMD) were calculated to compare safety and effects between exercise and usual care (UC). Subgroup analyses were conducted to assess whether outcomes differed by exercise mode, duration, supervision and treatment. Risk of bias was assessed using the Physiotherapy Evidence Database tool. Results For the 19 trials included, there was no difference in adverse event risk between exercise and UC (RD = 0.00; 95% CI:–0.01, 0.01, p = 0.92). Median withdrawal rate was 12% (0–22%) and adherence was 86% (42–91%). Significant effects of exercise compared to UC were observed for QoL, fatigue, aerobic fitness, upper-body strength, depression, sleep and reduced body fat (SMD = 0.21–0.66, p < 0.05). Subgroup analyses suggested larger benefits (p < 0.05) for QoL and fatigue for supervised interventions; for QoL, aerobic fitness and reduced body fat for ≥12-week interventions; and for aerobic fitness when interventions were during chemotherapy. Conclusion Although reporting of safety and compliance data was lacking in most trials, findings support that exercise is safe and feasible in colorectal cancer. Further, participation in mixed-mode exercise, including unsupervised exercise, leads to improvements in various health-related outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Exercise and colorectal cancer: a systematic review and meta-analysis of exercise safety, feasibility and effectiveness

Singh

Hayes

Spence

et al. 2020

Int J Behav Nutr Phys Act

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Possible Underestimation of the Provision of Palliative Care

Buiting

Graas

2018

JAMA Oncol

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In Reply We appreciate Conner and colleagues for their interest in our article, 1 as well as their thoughtful comments. The authors raise 2 important questions: (1) is aggressive care truly discordant with patient wishes, and (2) do these data, when not placed in larger context, contribute to an "institutionalization of quitting?"In addressing the first argument, we would like to highlight a commonly encountered debate when discussing endof-life care-the issue of timing. This study was carefully limited to the last 30 days of life to distinguish between aggressive cancer care and aggressive end-of-life care. There is no doubt that tremendous, life-prolonging advancements have been made for patients with brain tumors, especially brain metastases. This study does not contest the utility of appropriately aggressive cancer treatment early in the disease course.However, most would agree that in the last 30 days of life, these treatments are of limited efficacy. Indeed, only a small proportion of patients receive cancer-directed treatment during this period. 2 Hospital-based care, at least in the context of our study, is most likely directed at managing symptoms related to terminal disease progression rather than attempts to provide a cure. This supports the authors' opening sentiment that physicians generally are not "going for broke" with heroic measures. Regardless, the primary costs of concern to us were not financial-nor should they ever be. 3 Our data ask that we all carefully consider why these patients so often require hospitalization immediately preceding death.An admitted bias of our study is that the last 30 days of life is much easier to define in retrospect than in real time. Our data concur with Conner and colleagues that physicians are poor at accurately predicting prognostic milestones such as living 30 days. 4 In fact, this is one of the strongest arguments for early integration of palliative care.The authors also raise the question of whether this study promotes the idea of "quitting" on older patients with cancer and ask that the data be put into context. The primary purpose of our analysis was to provide quantitative data to help create such context for future studies. To have any informed debate on appropriate end-of-life care, we need to better understand the current status of the delivery of care in this setting.This study is by no means meant to institutionalize quitting. Rather, we hope our data will help to deinstitutionalize the erroneous idea that palliative care is equated with quitting. Cancer care and palliative care are not mutually exclusive. On the contrary, there is mounting evidence that early integration of palliative care into routine cancer care actually improves quality of life and possibly even survival. 5 As our understanding of the mechanism of disease and treatment of cancer evolves, so too must our understanding of patients' wishes and how they are influenced by the language we use. 6 Getting past the idea of quitting will improve both the quality and effectiveness of end-of...

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Physical activity interventions for disease-related physical and mental health during and following treatment in people with non-advanced colorectal cancer

McGettigan

Cardwell

Cantwell

et al. 2020

Cochrane Database of Systematic Reviews

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Recruitment to and pilot results of the PACES randomized trial of physical exercise during adjuvant chemotherapy for colon cancer

Abstract: Netherlands Trial Register - NTR2159.

Cited by 38 publications

References 38 publications

Exercise and colorectal cancer: a systematic review and meta-analysis of exercise safety, feasibility and effectiveness

Exercise and colorectal cancer: a systematic review and meta-analysis of exercise safety, feasibility and effectiveness

Possible Underestimation of the Provision of Palliative Care

Physical activity interventions for disease-related physical and mental health during and following treatment in people with non-advanced colorectal cancer

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