Prescribe Exercise to All Cancer Patients, Says New Guideline

Nick Mulcahy

Exercise should now be a part of the standard of care in treating all patients with cancer, according to a new position statement from the Clinical Oncology Society of Australia (COSA), the country's leading organization for cancer professionals. 

Oncologists and other cancer care professionals should discuss exercise as an adjunct treatment with patients, prescribe it routinely, and refer patients to exercise specialists, according to the guidance.

The document was published online May 7 in the Medical Journal of Australia  and on COSA's website.

Exercise should "be viewed as an adjunct therapy that helps counteract the adverse effects of cancer and its treatment," write the statement authors, led by Prue Cormie, PhD, from the Peter MacCallum Cancer Centre at the Royal Melbourne Hospital.

The Australian guidance was touted in multiple news reports as the world's first, but that claim may not be clear cut.

"Both Australia and the UK now 'prescribe' exercise as a part of standard cancer care because the data are very strong that exercise can help manage the toxicities and adverse effects of cancer therapy, be that fatigue or depression or many other problems," said Catherine Alfano, PhD, vice president of survivorship at the American Cancer Society (ACS) in Atlanta, Georgia.

"We are working toward a statement like this in the US, but we haven't created a message this strong yet," she told Medscape Medical News in an email.

We are working toward a statement like this in the US, but we haven't created a message this strong yet. - Dr Catherine Alfano

However, Alfano observed that guidance from both the ACS and the American College of Sports Medicine already recommends exercise, but she pointed out that those  guidelines are for patients with cancer and not for physicians and other providers. The Australian effort is for cancer care professionals.

More advice for US cancer clinicians is on the way. Alfano is part of a panel convened by the American Society of Clinical Oncology to help oncologists prescribe exercise and weight management interventions for their patients.

The Australian guidance calls for patients with cancer to perform the following:

  • At least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise (eg, walking, jogging, cycling, swimming) each week and

  • Two to three resistance exercise (eg, lifting weights) sessions each week involving moderate- to vigorous-intensity exercises targeting the major muscle groups

Exercise should be tailored to the individual's abilities, treatment-related adverse effects, anticipated disease trajectory, and health status, it adds.

"The notion that we must protect a patient, wrap them in cotton wool, is old-fashioned and not supported by the research," David Speakman, MD, the chief medical officer at the MacCallum Cancer Centre, said in an Australian news report.   

"We're at a point where the level of evidence is really indisputable and withholding exercise is probably harmful," said Cormie in the same news story.

The new Australian guidance comments that  the "strongest evidence" for the use of exercise is in improving physical function (such as aerobic fitness, muscular strength, and functional ability), attenuating cancer-related fatigue, alleviating psychological distress, and improving quality of life.

"Emerging evidence" indicates that regular exercise before, during, and/or after cancer treatment decreases the severity of other adverse side effects (in addition to fatigue and distress) and is associated with reduced risk of developing new cancers, say the guideline authors.

Furthermore, epidemiologic research "suggests" that physical activity protects against cancer recurrence, cancer-specific mortality, and all-cause mortality for some types of cancer. The Australian authors point out that this research is mostly in breast, colorectal, and prostate cancers.

Ongoing clinical trials will more definitively evaluate the effects of exercise on cancer survival.

The new position statement from COSA is supported by 26 other cancer groups in the country.

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