Exercise holds comparable significance to medications in minimizing the recurrence of colon cancer.
In the global cancer landscape, colorectal cancer ranks as the third most common cancer, accounting for around 10% of all cancer diagnoses[1]. This malignancy is also the second leading cause of cancer-related deaths worldwide[1]. Traditional treatment methods include surgery, radiotherapy, and chemotherapy[2]. After the initial treatment, patients are often advised to adopt a healthier lifestyle and, in some cases, undergo further drug treatments to decrease the chances of a recurrence[2].
In a groundbreaking study led by Canadian researchers, a structured exercise program proved to be more effective than drug treatments in preventing colon cancer recurrence[3][4]. The study, published in The New England Journal of Medicine (NEJM), found that patients who participated in a supervised exercise program, following surgery and chemotherapy for colon cancer, had a 28% lower risk of cancer recurrence compared to those who were only given health advice[3][4]. Furthermore, the structured exercise program reduced the risk of death from any cause by 37%[3][4].
Leading experts have hailed these results, stating that exercise could be "better than a drug" in the prevention of colon cancer recurrence[3]. Speaking to the Science Media Centre, David Sebag-Montefiore, an eminent oncologist from the University of Leeds, commented that structured moderate-intensity exercise offers benefits without the downside of the side effects typically associated with our other treatments[3].
Structured exercise versus health advice for cancer prevention
The research team enrolled 889 participants, mostly from Canada and Australia, but with some participants from the United States, the United Kingdom, and France, for this study, which was part of the Colon Health and Lifelong Exercise Change (CHALLENGE) trial[2]. All participants had undergone surgery for stage 3 or high-risk stage 2 colon cancer, followed by adjuvant chemotherapy to help prevent the cancer from returning. They ranged in age from 19 to 84 years, with a median age of 61[2]. Most participants had a Body Mass Index (BMI) indicating overweight or obesity, and none exercised for more than 150 minutes per week before the trial[2].
Researchers randomly assigned all participants to one of two groups. The exercise group, consisting of 445 patients, worked with a certified physical activity consultant for 3 years. The consultants initially saw the participants every week for the first 6 months, then fortnightly for the second 6 months, and monthly for the next 2 years[2]. These participants could choose the type, frequency, and intensity of aerobic exercise, with the aim being to achieve the equivalent of 3-4 brisk 45-60-minute walks per week[2]. The health-education group (444 patients) received general health-education materials promoting physical activity and healthy nutrition, in addition to standard surveillance[2].
At a median follow-up of 7.9 years, 93 participants in the exercise group and 131 in the health-education group had experienced cancer recurrence, a new primary cancer, or had died. In total, 107 participants died from any cause – 41 from the exercise group, and 66 from the health-education group[2]. Participants in the exercise group did not lose weight, but they did experience general improvements in physical functioning and significantly longer disease-free survivals, with an annual incidence of recurrence, new primary cancer, or death of 3.7%, compared to 5.4% in the health-education group[2].
Lead author Kerry S. Courneya, PhD, Professor and Canada Research Chair in Physical Activity and Cancer at the University of Alberta in Edmonton, Canada, told Medical News Today that the most significant finding of their study was the overall improvement in survival[4].
Is exercise better than drugs for cancer prevention?
Julie Gralow, MD, the Chief Medical Officer of the American Society of Clinical Oncology (ASCO), who was not involved in the trial, stated that the findings suggest that exercise could be "better than a drug" for cancer patient outcomes due to its absence of related side effects[4]. However, she cautioned that her intention was not to suggest that drugs should be avoided in favor of exercise but to compare the magnitude of benefit derived from standard therapies to that of structured exercise in terms of reduced recurrences and deaths, taking toxicity into account[4].
She added that while there are effective drugs that help prevent recurrence in patients with specific colon cancer mutations, exercise's benefit is not limited to these specific mutations[4]. Courneya emphasized the benefits of their exercise program:"The 'side effects' of exercise are almost all good (fitter, stronger, less fatigue, less depression, lower cardiovascular disease risk, etc.). I think exercise keeps having an effect on new primary cancers and possibly other causes of death. Intervention participants were still doing more exercise than health education at years 4 and 5."[4]
A structured exercise program can also be much cheaper than medication. Courneya pointed out that the program cost maybe 3,000 to 5,000 Canadian dollars, while it is not uncommon for some cancer drugs to be tens of thousands – even reaching 100,000 dollars[2].
Support is key to helping people exercise
Vicky Coyle, the U.K. lead researcher for the trial and Clinical Professor at Queen's University Belfast, Northern Ireland, stressed the importance of physical activity in reducing the risk of cancer recurrence for some patients with colon cancer[4]. She stated that they now need to collaborate with policymakers and healthcare providers to integrate exercise into treatment plans where appropriate[4].
Joe Henson, PhD, Associate Professor in Lifestyle Medicine at the University of Leicester, who led exercise sessions in Leicester, U.K. for the trial, highlighted the need for support. He stated that despite proven benefits, many people still face barriers to engaging in regular exercise[4]. Therefore, Henson emphasized the importance of making exercise advice a routine part of cancer care and offering people tailored support[4].
Although she places a strong emphasis on exercise for her patients, Gralow noted that implementing exercise programs like those in this study could be difficult[4]. She questioned whether most clinics have enough personnel to accommodate the number of visits required, especially since prior observational data indicates that many other common cancer types – such as breast and prostate cancer – also benefit from exercise[4]. Inevitably, we need to find alternative ways to support our patients in incorporating exercise into their lives without requiring frequent clinic visits, while also offering regular support and encouragement[4]. Lastly, she stressed that as clinicians, they must recommend exercise to their patients.
- In the colorectal cancer landscape, a structured exercise program has been found to be more effective than drug treatments in preventing colon cancer recurrence, as revealed in a study led by Canadian researchers.
- The research, published in The New England Journal of Medicine (NEJM), discovered that patients who participated in a supervised exercise program, following surgery and chemotherapy for colon cancer, had a 28% lower risk of cancer recurrence.
- While some patients may undergo further drug treatments after the initial treatment to decrease the chances of a recurrence, leading experts have hailed structured exercise as a potential replacement or supplement to drugs, stating that it could be "better than a drug" in the prevention of colon cancer recurrence.
- The study showed that exercise offers benefits without the downside of the side effects typically associated with traditional cancer treatments, making it a valuable addition to health-and-wellness and fitness-and-exercise routines for cancer patients.
- In terms of cost, a structured exercise program can be much cheaper than medication, with the program cost estimated to be between 3,000 to 5,000 Canadian dollars, while it is not uncommon for some cancer drugs to be tens of thousands – even reaching 100,000 dollars.
- Collaboration with policymakers and healthcare providers is necessary to integrate exercise into treatment plans for patients with colon cancer, as shown by the importance of physical activity in reducing the risk of cancer recurrence and improving overall health and wellness.
