Disclosures: Friedenreich reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
November 12, 2020
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Physical activity before, after endometrial cancer diagnosis improves survival outcomes

Disclosures: Friedenreich reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Recreational physical activity appeared associated with improved survival outcomes among women with endometrial cancer, according to study results published in Journal of Clinical Oncology.

Women who maintained high levels of recreational physical activity before and after an endometrial cancer diagnosis had the greatest survival benefit, researchers noted.

Recreational physical activity appeared associated with improved survival outcomes among women with endometrial cancer.
Recreational physical activity appeared associated with improved survival outcomes among women with endometrial cancer.

“For nearly 30 years, I have been studying how physical activity is related to the risk for cancer and how exercise can be used to improve rehabilitation and survival after a cancer diagnosis,” Christine M. Friedenreich, PhD, FCAHS, FRSC, scientific director of cancer epidemiology and prevention research at Cancer Care Alberta of Alberta Health Services in Canada, told Healio. “We had conducted a case-control study of endometrial cancer that examined lifetime physical activity up to the time of diagnosis and found lower risks for developing endometrial cancer associated with higher levels of physical activity. We were then interested in determining if physical activity before and after endometrial cancer was associated with survival, as there had not been previous studies that examined the association.”

The prospective cohort study included 425 women (median age, 58 years; median BMI, 31 kg/m²) diagnosed with endometrial cancer between 2002 and 2006 and followed through 2019. More than 75% of the women, all of whom resided in Alberta, were married, white, postmenopausal and nonsmokers or former smokers.

Researchers administered the Lifetime Total Physical Activity Questionnaire to assess data on physical activity domain (total, recreational, household and occupational), intensity and dose (metabolic-equivalent task [MET]-hours per week/per year), and changes from before to after diagnosis. They then compared the associations between prediagnosis activity (assessed at a median 4.4 months after diagnosis) and postdiagnosis physical activity (assessed at a median 3.4 years after diagnosis) and survival outcomes.

Median follow-up was 14.5 years, during which 60 women died, including 18 due to endometrial cancer. In addition, 80 DFS events occurred, including 20 endometrial cancer recurrences, 22 instances of disease progression recurrence or disease progression followed by death, and 38 deaths.

Women who reported higher levels of prediagnosis recreational physical activity appeared significantly more likely to experience improvements in DFS (> 14 MET-hours per week/per year vs. 8 MET-hours per week/per year; HR = 0.54; 95% CI, 0.3-0.96), but not OS (HR = 0.56; 95% CI, 0.29-1.07).

Women who reported higher postdiagnosis recreational physical activity experienced improvements in both DFS (> 13 MET-hours per week/per year vs. 5 MET-hours per week/per year; HR = 0.33; 95% CI, 0.17-0.64) and OS (HR = 0.33; 95% CI, 0.15-0.75).

Christine M. Friedenreich, PhD, FCAHS, FRSC
Christine M. Friedenreich

“Taking part in even moderate levels of activity, such as brisk walking for 2.5 hours to 5 hours per week, may have a beneficial effect in substantially reducing the risk for mortality after endometrial cancer diagnosis,” Friedenreich said. “Even if someone has been inactive before their endometrial cancer diagnosis, they could still experience a benefit of being physically active.”

Compared with women who maintained low physical activity levels from before to after diagnosis, women who maintained high recreational activity levels experienced improvements in DFS (HR = 0.35; 95% CI, 0.18-0.69) and OS (HR = 0.43; 95% CI, 0.2-0.94).

“We were not surprised by the study outcomes, as there have now been more than 130 studies conducted worldwide that have examined some aspect of physical activity and how it is related to survival after cancer, with many demonstrating a beneficial effect associated with higher levels of activity,” Friedenreich said. “However, few had been conducted in endometrial cancer, so our study is definitely adding new evidence to this area of research. “The levels of activity that were shown to be beneficial in this study should be achievable by most people,” she added. “In addition, being active is safe and beneficial for many other chronic diseases that are of concern for endometrial cancer survivors, including cardiovascular disease and diabetes. Hence, we encourage all endometrial cancer survivors to speak with their clinicians and consider adding regular physical activity to their lifestyles.”

For more information:

Christine M. Friedenreich, PhD, FCAHS, FRSC, can be reached at Alberta Health Services, Room 514, 2210 2nd St. SW, Calgary, AB, Canada T2S 3C3; email: christine.friedenreich@albertahealthservices.ca.