Achieving a higher chemotherapy completion rate is associated with better outcomes in breast cancer patients. We examined the role of exercise and health-related fitness variables in predicting chemotherapy completion in early stage breast cancer patients.
We pooled data from two large, multicenter, exercise trials that obtained baseline (pre-chemotherapy) measures of exercise and health-related fitness in 543 breast cancer patients initiating adjuvant chemotherapy. Assessments included body composition, cardiovascular fitness, muscular strength, patient-reported physical functioning, and self-reported exercise behavior. Chemotherapy completion was assessed as the average relative dose intensity (RDI) for the originally planned regimen. We used logistic regression analyses with a two-sided p value of < 0.05 to estimate the associations between the predictors and an RDI of ≥ 85%.
Overall, 432 of 543 (79.6%) breast cancer patients received an RDI of ≥ 85%. In logistic regression analyses adjusted for significant covariates, patients in the highest 20% vs. lowest 80% of absolute VO2peak were significantly more likely to complete ≥ 85% RDI (89.0% vs. 77.2%; ORadj 2.06, 95% CI 1.07–3.96, p = 0.031). Moreover, patients in the highest 80% vs. lowest 20% of absolute chest strength were significantly more likely to complete ≥ 85% RDI (81.5% vs. 71.4%; ORadj 1.80, 95% CI 1.09–2.98, p = 0.021).
In these exploratory analyses, higher baseline (pre-chemotherapy) cardiovascular fitness and muscular strength were associated with higher rates of chemotherapy completion in early stage breast cancer patients. Aerobic and/or strength training interventions that increase cardiovascular fitness and muscular strength prior to chemotherapy for breast cancer may improve treatment tolerability and outcomes.
Clinical trial registration
START: NCT00115713, June 24, 2005; CARE: NCT00249015, November 7, 2005 (http://clinicaltrials.gov).
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The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Body Mass Index
Dual energy X-ray absorptiometry
Supervised Trial of Aerobic versus Resistance Training
Combined Aerobic and Resistance Exercise
Relative dose intensity
Trial Outcome Index-Fatigue
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START and CARE were funded by the Canadian Breast Cancer Research Alliance. K.S. Courneya is supported by the Canada Research Chairs Program. D.W. Kang was supported by an Alberta Innovates Graduate Studentship. C.M. Friedenreich was supported by a Health Senior Scholar award from Alberta Innovates Health Solution and the Alberta Cancer Foundation Weekend to End Women’s Cancers Breast Cancer Chair.
Conflict of interest
The authors declare that they have no conflict interests.
In both START and CARE, ethics approval was obtained for all three sites (i.e., the Cross Cancer Institute in Edmonton, Alberta; the Ottawa Hospital Integrated Cancer Program and Cancer Center in Ottawa, Ontario; and the British Columbia Cancer Agency in Vancouver, British Columbia, Canada). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.
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An, KY., Arthuso, F.Z., Kang, DW. et al. Exercise and health-related fitness predictors of chemotherapy completion in breast cancer patients: pooled analysis of two multicenter trials. Breast Cancer Res Treat 188, 399–407 (2021). https://doi.org/10.1007/s10549-021-06205-8
- Body composition
- Breast cancer
- Physical fitness