Researching the role of exercise in cancer survivorship
Posted on: 02 October 2020
Over the past two decades research interest in exercise oncology has increased dramatically with a resultant recognition of the importance of exercise as a supportive intervention for patients with cancer. Considerable evidence establishes the efficacy of exercise to both mitigate treatment side-effects and to optimise quality-of-life, with emerging literature suggesting association with cancer survival.
With cancer survival rates improving across a range of cancers, it follows that the National Cancer Strategy 2017-2026, places cancer survivorship at the centre of the national cancer agenda. Exercise rehabilitation is a key part of survivorship care with the potential to optimise patient outcome at each step on the continuum of cancer care. The Trinity Exercise Oncology Research Group, as part of the Trinity St James Cancer Institute (TSJCI) prioritises research in complex cancer presentations, particularly upper gastrointestinal cancers, which require specialist rehabilitation expertise and multidisciplinary collaboration.
The group is a multidisciplinary research team conducting research into the role of exercise in patients with cancer, focussing on the area of prehabilitation for these patients (preparing them for cancer treatment including surgery) and recovery into survivorship. Their research is quite unique in this country as they focus on complex cancers, such as stomach, liver, pancreas and oesophagus. The Trinity St James’s Cancer Institute allows the Trinity team to work very closely with their clinical colleagues in St James’s Hospital. St James’s Hospital is the national centre for oesophago-gastric cancer and the success of the group’s research to date can be accredited to the huge support and opportunities for collaboration they have received from Professor John Reynolds and his team at St James’s Hospital.
Impact on cancer patients
Between 2014 and 2017, the group conducted the ReStOre Feasibility study and pilot randomised controlled trial (funded by the Health Research Board) which is the first trial to provide proof of principal for multidisciplinary rehabilitation in oesophago-gastric cancer survivorship. The 12-week ReStOre programme consisting of exercise, dietary advice and education was found to improve cardiovascular fitness along with the physical, mental and social well-being of oesophago-gastric cancer survivors. Participants also benefitted hugely from the peer support of the group intervention.
Highlighting the impact of the ReStOre study on patients, some of those who completed the programme said:
Patient A
It gave you an idea that there is a good living, you can live good now after it [the treatment].The negativity is gone in me – I can’t say ‘I’m not able’ or ‘That’s wrong if you do that, you’re lifting too much or you’re doing too much’. You can do it.
Patient B
Even though sometimes they [the exercise] were very tiring, at the same time I think it gave us a fresh look to say, ‘Well, look at the positive side rather than the negative side.’ There are so many people that tell you, ‘Sit down and don’t do anything,’ ‘Take it easy, you’re after being through a lot.’ And now we have the confidence, to say, ‘Go and do it’.
Next steps research for the Trinity Exercise Oncology Research Group
Following the success of the feasibility study, the research group has been awarded funding from the Health Research Board (HRB) , the Medical Research Charities Group and the Irish Cancer Society to investigate further the value of exercise for patients with complex cancers.
The PRE-HIIT trial will examine if a special type of exercise programme, called high intensity interval training (HIIT), can improve cardiorespiratory fitness in advance of major thoracic surgery for cancer of the oesophagus or lung. In general, patients with higher levels of physical fitness tend to cope better with major surgery and have less complications, so the results of this trial will be very important.
The group will also conduct a ReStOre II trial which will further examine the efficacy of the ReStOre programme in a larger cohort of cancer survivors. This trial will aim to recruit 120 survivors of oesophageal, gastric, pancreatic and liver cancer over the next three years and will further explore the impact of the ReStOre programme on cardiorespiratory fitness, body composition, fatigue and health related quality of life. The project will also establish an Upper Gastrointestinal Cancer Survivorship Biobank which will be a fantastic resource to help answer some of the questions regarding the impact of exercise rehabilitation on key biomarkers.
Dr Linda O’Neill, Postdoctoral Research Fellow, Physiotherapy, Trinity College said:
As survival rates for complex cancers such as cancer of the oesophagus and stomach slowly improve it is imperative that we develop strategies to support these patients through their cancer journey and optimise their quality of life in survivorship. Through this research, we hope to be able to provide further evidence in support of exercise interventions for these patients to help inform the development of much needed services.
We are extremely grateful to the Health Research Board, Medical Research Charities Board and Irish Cancer Society for supporting the work of the Trinity Exercise Oncology Research Group.
Trinity St James’s Cancer Institute (TSJCI)
The mission of Trinity St James’s Cancer Institute is to integrate innovative and ground-breaking cancer science with compassionate, multi-disciplinary , patient-focussed care through translation of key research findings into incremental advances in the prevention, diagnosis and treatment of cancer.
More information about the Trinity Exercise Research Oncology Group can be found here: https://www.tcd.ie/medicine/physiotherapy/research/exercise-oncology.php
Please note: The research programme has been largely affected by the covid-19 pandemic. The team is now utilising telehealth to deliver the planned intervention for the PRE-HIIT trial remotely to patients’ homes and we are also undertaking an additional feasibility study to examine the feasibility of delivering the ReStOre programme via telehealth.