Physical activity in older adults with metastatic gastrointestinal cancer: a pilot and feasibility study

Justin C Brown, Elizabeth Brighton, Nancy Campbell, Nadine J McCleary, Thomas A Abrams, James M Cleary, Peter C Enzinger, Kimmie Ng, Douglas Rubinson, Brian M Wolpin, Matthew B Yurgelun, Jeffrey A Meyerhardt, Justin C Brown, Elizabeth Brighton, Nancy Campbell, Nadine J McCleary, Thomas A Abrams, James M Cleary, Peter C Enzinger, Kimmie Ng, Douglas Rubinson, Brian M Wolpin, Matthew B Yurgelun, Jeffrey A Meyerhardt

Abstract

Objectives: This study determined the feasibility of delivering a 12-week structured physical activity programme during chemotherapy to older adults recently diagnosed with metastatic gastrointestinal (GI) cancer.

Methods: This study used a single-cohort design. Older adults (aged ≥65 years) diagnosed with metastatic oesophageal, gastric, pancreatic or colorectal cancer who planned to initiate chemotherapy were enrolled. The physical activity programme included a combination of aerobic, flexibility, strength and balance modalities delivered by a certified cancer exercise trainer during chemotherapy infusion appointments, then translated and sustained at home by participants. The co-primary endpoints included: (1) accrual of 20 participants in 12 months and (2) physical activity adherence of ≥50%.

Results: Between March and October 2018, 29 participants were screened, and 20 were enrolled within 12 months (recruitment rate: 69% (90% CI: 55% to 83%); p<0.001), meeting the first co-primary endpoint. The median age of participants was 73.3 years (IQR: 69.3-77.2). At week 12, 67% (90% CI: 48% to 85%) of participants adhered to ≥50% of the prescribed physical activity (p=0.079 (statistically significant)), meeting the second co-primary endpoint. From baseline to week 12, accelerometer-measured light-intensity and moderate-intensity to vigorous-intensity physical activity increased by 307.4 (95% CI: 152.6 to 462.2; p<0.001) and 25.0 min per week (95% CI: 9.9 to 40.1; p=0.001), respectively. There were no serious or unexpected adverse events. The median overall survival was 16.2 months (8.4-22.4).

Conclusion: These results establish the feasibility of a larger scale randomised controlled trial that enrols older adults with metastatic GI cancer and delivers a structured physical activity programme during chemotherapy.

Trial registration number: NCT03331406.

Keywords: accelerometer; cancer; death; exercise; physical activity.

Conflict of interest statement

Competing interests: JCB reported receiving grants from the National Institutes of Health and the American Institute for Cancer Research. JC reported research funding to his institution from Merus, Roche and Bristol Myers Squibb; he reported research funding from Merck, AstraZeneca, Esperas Pharma, Bayer and Tesaro; he reported honorarium for being on the advisory board of Syros Pharmaceuticals and Blueprint Medicines. MY reported receiving grants from Janssen Pharmaceuticals and personal fees from UpToDate for peer review services. JM reported receiving personal fees from Taiho for grant review for the National Comprehensive Cancer Network, fees for serving on the advisory boards of COTA Healthcare and Ignyta Single, and institutional support from Boston Biomedical for a clinical trial outside the submitted work.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow of participants.
Figure 2
Figure 2
Adherence to the physical activity programme by study week. Error bars depict 95% CIs.
Figure 3
Figure 3
Overall survival of study participants. Dashed vertical line represents end of physical activity programme. Shaded bands depict pointwise 95% CIs.

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