Is There a Role for Exercise When Treating Patients with Cancer with Immune Checkpoint Inhibitors? A Scoping Review

Jasmine Handford, Miaoqi Chen, Ridesh Rai, Charlotte L Moss, Deborah Enting, Nicola Peat, Sophia N Karagiannis, Mieke Van Hemelrijck, Beth Russell, Jasmine Handford, Miaoqi Chen, Ridesh Rai, Charlotte L Moss, Deborah Enting, Nicola Peat, Sophia N Karagiannis, Mieke Van Hemelrijck, Beth Russell

Abstract

The impact of using exercise as a non-pharmacological intervention in patients with cancer receiving immune checkpoint inhibitors (ICIs) is not well known. Our objective was to determine the extent of, and identify gaps within, available literature addressing the effect of exercise on (a) oncological outcomes and (b) quality of life (QoL) in patients with cancer receiving ICIs, and (c) the underlying biological mechanisms for such effects. We conducted searches across EMBASE, APA PsycInfo and Ovid MEDLINE(R). Studies were eligible if they addressed at least one aspect of the objective and were available in the English language. Results were synthesised using a narrative approach and subsequently discussed with multidisciplinary stakeholders. As of the final search on 5 April 2022, 11 eligible studies were identified, of which 8 were preclinical and 3 were clinical. Clinical studies only focused on QoL-related outcomes. When studies were grouped by whether they addressed oncological outcomes (n = 7), QoL (n = 5) or biological mechanisms (n = 7), they were found to be heterogeneous in methodology and findings. Additional evidence, particularly in the clinical setting, is required before robust recommendations about whether, and how, to include exercise alongside ICI treatment can be made.

Keywords: cancer; exercise; immune checkpoint; physical activity; quality of life; scoping review.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the protocol for this scoping review. Adapted using information from the published protocol [27]. [ICIs, immune checkpoint inhibitors; PPI, patient and public involvement; QoL, quality of life].
Figure 2
Figure 2
Flowchart of study selection. Adapted using the ‘PRISMA 2020 flow diagram for new systematic reviews which included searches of databases’ template [31]. † Different records relating to the same study (confirmed by comparison of authors, methodology and reported results) e.g., abstracts from different conferences relating to the same study. Where available, the duplicate record containing a full-text article was included. ‡ Two studies were abstract-only. [ICIs, immune checkpoint inhibitors].

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