Role of physical activity and sport in oncology: Scientific commission of the National Federation Sport and Cancer CAMI

https://doi.org/10.1016/j.critrevonc.2014.12.012Get rights and content

Highlights

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    PAS in oncology now represents a crucial part of supportive care, with positive effects on resistance to fatigue, cardio respiratory fitness, muscle strength, physical well-being, reduced anxiety and depression, and improved quality of life in the widest sense. This leads to established indications of PAS during and after cancer. The usefulness of a PAS programme intense enough to reach and go beyond intensity, frequency and duration thresholds necessary to obtain a significant benefit.

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    Because of the dose–response relation between physical activity and survival or physiological, psychological and biological effects, cancer survivors who wish to further improve their health may benefit by exceeding the minimum recommended amounts of physical activity and sports.

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    However, this implies a precise definition of the context of clinical management of these patients by means of a genuine prescription of a given type of PAS to a given patient with a given clinical status. In this process, qualified professionals specialised in PAS in oncology are needed to put the prescription into practice.

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    These points are discussed for clinical applications.

Abstract

This overview reports published data about the interaction between physical activity and sport during and after cancer on one hand and improvement in psychological parameters, survival and biological mechanisms underlying this effect on the other hand.

Practising physical activity and sport during cancer modifies parameters assessing fatigue and quality of life and reduces symptoms of depression. An association also exists between the practise of physical activity and sport and overall and cancer-specific survivals, especially after breast cancer, colon cancer and prostate cancer.

These benefits seem to be mediated by a modification of circulating levels of estrogens, insulin, IGF-1 and by a decrease in insulin-resistance, by alterations in the secretion of adipokines, and by a reduction in chronic inflammation through decreased levels of cytokines.

There exist some obstacles to the practise of physical activity. These obstacles are mainly related to a fear of pain induced by physical activity and to overweight.

These programmes of physical activity and sport cannot be offered to all patients since there are several contra-indications, with some being present since the initial visit and others appearing during cancer management either due to disease progression or related to iatrogenic effects.

Whereas benefits from physical activity and sport among cancer patients seem obvious, there are still several pending clinical and biological issues.

Introduction

Improvement in quality and effectiveness of health care consequently increases the number of cancer patients alive and in complete or partial remission after anti-cancer therapy. Several physiological and psychological responses occur during diagnosis and treatment of cancer, including fatigue, depression, and decrease in quality of life. Oncologic events may occur during follow-up of cancer patients such as second primary tumour, local or distant relapse. Benefits from physical activity and sport (PAS) to cancer patients are both physiological and psychological. These benefits are now well established, and support the necessary integration of physical activity and sports (under the form of intervention programmes based on structured exercises and sports) into support programmes to patients during and after anti-cancer therapy. Exercise and sport activities are included in leisure and programmed physical activities with measurable duration, frequency, intensity and regularity. These programmes should be distinguished from others types of physical activity including, for instance, transports, occupational activities and housework.

Section snippets

Material and methods

Studies were identified through systematic review of the available literature in the PubMed database, EMBASe through 1 September 15, 2013.

Eleven items were defined by the authors, physical activity in oncology and either fatigue, psychological effects, quality of life, physiological changes, overall and specific survival, biological responses, participation, information, complications.

The search algorithm used was: ((cancer) AND (physical activity) OR (exercise) OR (exercise programme) OR

Physiological and psychological effects

Improved effectiveness of anti-cancer therapies increases the percentage of patients reaching complete remission. Consequently, the management of treatment side effects and of physical and psychological sequellae should be included in care.

Fatigue is reported by patients more frequently than any other symptom during the course of treatment and approximately a third of patients will endure persistent fatigue for a number of years after treatment [1]. The aetiology of fatigue following cancer

What are the unsolved issues about the effects of PAS in oncology

The first issue deals with the modalities of PAS (type of exercise, duration of the session, intensity, frequency, practical aspects) and with the goals of physical activity (reinforcement of muscle tone, cardio-respiratory capacity, modifications of fat mass, fitness capacities, etc.). According to an overview of 29 RCTs of PAS in oncology, no publication in peer-reviewed journals provided detailed descriptions of PAS programmes, data about compliance, and PAS methods, which however are

Conclusions

PAS in oncology now represents a crucial part of supportive care, with positive effects on resistance to fatigue, cardio respiratory fitness, muscle strength, physical well-being, reduced anxiety and depression, and improved quality of life in the widest sense. This leads to established indications of PAS during and after cancer therapy. Clinical and biological data from studies of patients essentially treated for localised cancer in curative situations show the usefulness of a PAS programme

Conflict of interest statement

All of the authors state that there is no conflict of interest involved in this submission.

Reviewers

Fernando C. Dimeo, Ph.D., Charité Campus Benjamin Franklin, Section Sport Medicine, Hindenburgdamm 30, Berlin, D-12200, Germany.

Dr. Stephanie Ranque Garnier, Unité d’Aide Méthodologique à la Recherche Clinique, Assistance Publique, Hôpitaux de Marseille, France; Qualité de Vie Concepts, Usages et Limites, Déterminants’, Aix-Marseille Université, France Faculté de Médecine, 27 bd Jean Moulin, F-13385 Marseille Cedex, France.

Dr T. Bouillet, MD, Radiation oncologist, head of radiotherapy department in University hospital Avicenne. Oncologist in the Department of Medical Oncology of Pr. L Zelek at the Avicenne Hospital in Paris. President and founder of the national federation sport and cancer CAMI in France, Co founder of the Diploma “Sport and Cancer” at the University Paris 13 and member of the Sport Health Resource Hub of the French National Olympic and Sports Committee on physical activity and cancer.

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    Dr T. Bouillet, MD, Radiation oncologist, head of radiotherapy department in University hospital Avicenne. Oncologist in the Department of Medical Oncology of Pr. L Zelek at the Avicenne Hospital in Paris. President and founder of the national federation sport and cancer CAMI in France, Co founder of the Diploma “Sport and Cancer” at the University Paris 13 and member of the Sport Health Resource Hub of the French National Olympic and Sports Committee on physical activity and cancer.

    Professor X. Bigard (MD, PhD) is a physiologist, researcher and sports physician. He has research experience on several topics related to the effects of physical exercise, including the molecular and cellular events involved in the adaptation of skeletal muscle to physical training. His main focus is now the broad field of physical activity for health. He is currently coordinating several working groups intended to update French physical activity guidelines and to suggest physical activity recommendations during cancer treatments and for cancer survivors.

    C. Brami is a resident in oncology at the Institut Jean Godinot Cancer Center in Reims. She focuses her work in supportive care and integrative oncology. She has completed a six months training in integrative oncology at the Memorial Sloan Kettering Cancer Center. She has master degree in immunology from University Paris 7- Gustave Roussy institute. She has a special interested in neuroscience and mind-body stress reduction meditation for cancer patient.

    Dr K. Chouahnia is a medical oncologist at the University Hospital of Avicenne, APHP, France with competence in treatment of pain and large area of interest in all supportive care associated with other cancer treatment.

    S. Dauchy is a psychiatrist and has been working in psycho-oncology and palliative care field since 1996. She has been leading the Psycho-oncology Unit at a large comprehensive cancer care center, Gustave Roussy (Villejuif, France) since 2002. She is the chief of the Supportive Care Department in this hospital since 2007. She is particularly involved in the structuration of integrated palliative care. Sarah Dauchy is also serving as the President of the French Psycho-Oncology Society (SFPO).

    Dr C. Delcambre is a medical oncologist at centre F Baclesse Hospital, France. Her main interests are breast cancers and sarcoma.

    J.M. Descotes is National Federation CAMI Sport and Cancer's director and co-founder. He works with cancer patients and oncologists for 15 years and has developed a method to fight effectively against the side effects of treatment and promote the care course following. He leads the University Diploma “Sport and Cancer” at the University Paris and is a member of the Sport Health Resource Hub of the French National Olympic and Sports Committee.

    Pr. F. Joly completed her medical oncology degree in Basse Normandy University, France. Her postgraduate training included a followship in Princess Margaret Hospital, Toronto. The topic of her PHD was quality of life of long term cancer survivors.

    Her clinical activities includes care of patients with gyncological and genito-urinary cancers, with an active participation of clinical trials. She is co-president to the supportive-care french AFSOS-Unicancer intergroup and the president of the french GINECO group. Her accademic research is focused on the evaluation of supportive cares, impact of treatment on cognitive functions and quality of life in cancer

    Dr G. Lepeu Major of the Medical University of Montpellier, former Medical Director, he joins the Avignon Hospital and develops specialties in internal medicine, rheumatology, hematology, cancerology and becomes a reference in HIV infection. He is appointed Head of Department and then Head of the Cancerology Center. Passionate about clinical research, he enters various French and European cooperative groups, mostly in the hematology field. He is the author of more than 250 publications, mainly international.

    Dr A. Marre Radiation oncologist, head of the department of oncology Rodez Hospital, France Main topics include supportive care. Teaching at Rodez University on cancer and physical activity.

    Dr F. Scotte is MD-PHD, medical oncologist at Georges Pompidou European Hospital. He is head of the supportive care in cancer unit and the ambulatory department of chemotherapy. He is involved in Supportive Care in Cancer and member of many associations: faculty of ESMO, General secretary of AFSOS (French Speaking Association for Supportive Care in Cancer) and member of MASCC and ASCO.

    Pr. J.P. Spano is currently Professor in the Department of Medical Oncology of Pr. David Khayat at the Pitie-Salpetriere Hospital in Paris, France. He holds a medical oncology fellowship from the Internat des hôpitaux de Paris, and has worked at the Curie Institute, the Rothschild Hospital, the Gustave-Roussy Institute, and St. Louis Hospital in Paris. He also participated in a clinical exchange program with the MD Anderson Cancer Center in Houston, Texas.

    President (Honorary) of the Association of fellows in Oncology (AERIO) in France, which he founded in 1996, and is also a member of several well-known oncology societies, including the American Association for cancer Research (AACR), the European Society for Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO) and the International Society of Geriatric Oncology (SIOG). He is also active in the scientific committee of International Congress of Anti-Cancer Treatment (ICACT). He also belongs to the JCO editorial as he is also the Editor for the French JCO Edition and official reviewers for many international Journals dedicated to Oncology and HIV infection fields.

    Pr. Spano has published about 150 papers in haematology and oncology, especially in Breast cancer, GI malignancies and HIV malignancies. He has made several oral presentations at medical congresses, and is a very active poster presenter at the aforementioned medical societies.

    Pr. Spano obtained a PhD degree at the University of Paris in 2004. His PhD thesis was on EGFR, CXCR4 and PTEN as prognostic and predictive factors of metastases in oncogenesis. The title of his MD thesis is “Factors predictive of disease progression and death in aids-related Kaposi's sarcoma. His title of Professor of the Pierre et Marie Curie University was obtained in 2006. He is currently responsible of the French Rare Cancer Group, CANCERVIH, dedicated to HIV patients with malignancies, supported by the INCa. He is also working at INSERM, Unit 1136 (Institut Pierre Louis d’Epidémiologie et de Santé Publique), dedicated to HIV epidemiology and treatment, in France, directed by Dominique Costagliola.

    Dr L. Vanlemmens is a medical oncologist in the Breast Cancer Unit at Oscar Lambret, Cancer Centre, Lille, France. She is investigator in several ongoing clinical trials. Her clinical and research activities cover antineoplastic therapy with a focus on management of side effects and toxicities. Her main interests are in supportive care, physical activity, quality of life of patients and partners.

    Pr L. Zelek MD, is a Head of the department of Oncology, Avicenne Hospital, Bobigny, and Professor of Oncology at University Paris Nord. As a member of the Nutritional Epidemiology Research Team (INSERM Unit 1153, Pr S Hercberg, Bobigny), he is involved in research programs on cancer survivorship mainly based on the Su.Vi.Max prospective trial and the Nutrinet web-based cohort. Furthermore he coordinates health education programs based on nutrition and physical activity and designed for underprivileged communities.

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