Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review

Abstract

Background: Cancer survivors often seek information about how lifestyle factors, such as physical activity, may influence their prognosis. We systematically reviewed studies that examined relationships between physical activity and mortality (cancer-specific and all-cause) and/or cancer biomarkers.

Methods: We identified 45 articles published from January 1950 to August 2011 through MEDLINE database searches that were related to physical activity, cancer survival, and biomarkers potentially relevant to cancer survival. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement to guide this review. Study characteristics, mortality outcomes, and biomarker-relevant and subgroup results were abstracted for each article that met the inclusion criteria (ie, research articles that included participants with a cancer diagnosis, mortality outcomes, and an assessment of physical activity).

Results: There was consistent evidence from 27 observational studies that physical activity is associated with reduced all-cause, breast cancer-specific, and colon cancer-specific mortality. There is currently insufficient evidence regarding the association between physical activity and mortality for survivors of other cancers. Randomized controlled trials of exercise that included biomarker endpoints suggest that exercise may result in beneficial changes in the circulating level of insulin, insulin-related pathways, inflammation, and, possibly, immunity; however, the evidence is still preliminary.

Conclusions: Future research directions identified include the need for more observational studies on additional types of cancer with larger sample sizes; the need to examine whether the association between physical activity and mortality varies by tumor, clinical, or risk factor characteristics; and the need for research on the biological mechanisms involved in the association between physical activity and survival after a cancer diagnosis. Future randomized controlled trials of exercise with biomarker and cancer-specific disease endpoints, such as recurrence, new primary cancers, and cancer-specific mortality in cancer survivors, are warranted.

Figures

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) study flow diagram. RCT = randomized controlled trial; Search A = physical activity and cancer survival; Search B = physical activity and biomarkers potentially relevant to cancer survival.

Figure 2

Forest plot of risk estimates from observational studies of physical activity and mortality outcomes in breast cancer survivors. Black circles indicate hazard ratios (HRs), and solid horizontal lines represent 95% confidence intervals (CIs). The vertical dotted line indicates point of unity.

Figure 3

Forest plot of risk estimates from observational studies of physical activity and mortality outcomes in survivors of cancers other than breast cancer. Black circles indicate hazard ratios (HRs), and solid horizontal lines represent 95% confidence intervals (CIs). The vertical dotted line indicates point of unity.