Exercise During Active Cancer Treatment: New ASCO Guideline

The American Society of Clinical Oncology (ASCO) has issued a new guideline on exercise, diet, and weight management during active cancer treatment in adults.

The main endorsement was for oncology providers to recommend aerobic and resistance exercise to patients who are undergoing active treatment with curative intent, in order to mitigate side effects associated with therapy.

Clinicians may also recommend preoperative exercise for patients who are scheduled to undergo surgery for lung cancer.

A second key point applies to dietary changes. The guideline states that there is insufficient evidence to support a recommendation for or against specific diets. There is also insufficient evidence to support intentional interventions focused on weight loss or weight gain prevention during active cancer therapy.

"During the treatment period, many patients with cancer are looking to make doctor-recommended changes to their lifestyle," said Jennifer A. Ligibel, MD, of the Dana-Farber Cancer Institute in Boston, Massachusetts, and co-chair of the guideline expert panel, commented in the ASCO Daily News. "What we are really hoping is that this guideline helps spur that discussion and action in the oncology clinic."

The guidelines were published online on May 16 in the Journal of Clinical Oncology.

The guidelines focus specifically on patients with cancer who are currently undergoing active treatment, and they were drawn up by a multidisciplinary expert panel after a systematic review of the published literature. Only data from randomized controlled trials were considered.

The document "represents an important step in providing guidance for adult patients regarding exercise, diet, and weight management during cancer treatment," the ASCO panel concludes. "Although the lack of evidence base, especially for diet and weight management, limited the number of recommendations ultimately made, the panel recommended the incorporation of exercise into cancer treatment for patients receiving systemic therapy and radiotherapy, as well as potentially in the preoperative setting for patients with lung cancer."

Physical Activity

Supporting the recommendation on physical activity is evidence showing that exercise interventions during active treatment reduce fatigue, preserve cardiorespiratory fitness, physical functioning, and strength, the authors note. Among some patient groups, exercise during active treatment may also improve quality of life and reduce anxiety and depression.

There is a low risk of adverse events associated with exercise during treatment, the authors add. But there was insufficient information to recommend for or against exercise during treatment to improve cancer control outcomes or treatment completion rates.

Sufficient evidence supports recommending preoperative exercise for patients undergoing surgery for lung cancer, to reduce length of hospital stay as well as postoperative complications. But these same benefits were not evident for those undergoing abdominal surgery for gastrointestinal or genitourinary cancers, the authors comment.

Dietary Evidence Not Specific

For diet, evidence is currently insufficient to recommend for or against specific types of diets to improve outcomes related to quality of life, treatment toxicity, or cancer control, the ASCO panel comments. This includes interventions such as ketogenic or low-carbohydrate diets, low-fat diets, functional foods, or fasting.

In addition, the ASCO panel notes it does not recommend neutropenic diets (specifically diets that exclude raw fruits and vegetables) to prevent infection in patients with cancer during active treatment.

While among the general population, obesity has been linked to an increased risk of a number of cancer types, the panel notes that there have been few randomized controlled trials that have evaluated weight management interventions during cancer treatment. Most of the studies conducted to date have small cohorts, had weight loss as the primary endpoint, or assessed feasibility, but it remains unclear what effect weight loss could have on patient-reported or other outcomes among those on active treatment.

Overall, the evidence suggests that intentional weight loss is feasible during cancer treatment (at least in patients with breast cancer, and possibly prostate cancers), but there is limited evidence for this providing a significant benefit.

Ligibel has disclosed no relevant financial relationships. Several co-authors disclosed relationships with industry, as listed in the paper.

J Clin Oncol. Published online May 16, 2022. Full text

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