Exercise during early-stage breast cancer decreases health care utilization

1. Patients in the control group had higher mean health care utilization costs across the following measures: total unplanned expenditures, emergency visits, outpatient visits, office-based visits, and unplanned hospitalizations.

2. The exercise group had improved physical fitness measures, ECOG scores, energy levels and quality of life measures.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Despite several reports of exercise benefits in cancer patients, very few patients are referred to an exercise oncology program during their treatment. This study performed a cost-savings analysis of an individualized exercise oncology program in hopes of integrating such programs into the standard care of clinical practice. This study randomly assigned early-stage breast cancer patients into an exercise group and a control group, where the former received a 12-week individualized exercise program, while the latter received standard care (a handout with tips on healthy eating and standard exercises). The exercise group had a lower mean health care utilization cost across all measures, including emergency visits, outpatient visits, office-based visits, and unplanned hospitalizations. The exercise group experienced improvements in physical fitness and Eastern Cooperative Oncology Group (ECOG) scores. Patient-reported outcomes included the Functional Assessment of Cancer Therapy-Breast (FACT-B), measuring the quality of life, and the Brief Fatigue Inventory (BFI), measuring energy levels, which were higher in the exercise group. Limitations to this study are that it did track long-term health care costs and only evaluated exercise benefits to early-stage breast cancer patients. The strengths of this study are that it has limited bias given its design and that it provides an improvement to the standard of care for cancer patients. Overall, a 12-week individualized exercise program is a viable addition to the standard of care for cancer patients.

Click to read the study in JCO Oncology Practice

Relevant Reading: American college of sports medicine roundtable on exercise guidelines for cancer survivors

In-Depth [randomized controlled trial]: This randomized, prospective study randomly assigned 243 patients with stage 1 and 2 breast cancer into two groups; 123 in the exercise group and 120 in the control group. The former group participated in a 12-week individualized exercise program aligning with the American College of Sports Medicine exercise guidelines, whereas the latter received a handout comprised of tips regarding healthy eating and standard exercises. Patients in the control group had a total mean health care utilization across all subgroups, including total unplanned expenditures ($8,598 vs. $6,356), emergency visits ($989 vs. $661), outpatient visits ($4,191 vs. $3,292), office-based visits ($3,259 vs. $1,898), and hospital inpatient care ($11,443 vs. $9,447). All subgroups but inpatient care were unanticipated costs. Physical fitness parameters in the exercise group were all higher than the control group. Between-group measurements were higher for cardiorespiratory fitness (10.5%, p <0.0128), muscular endurance (11.3%, p <0.017), muscular strength (6.2%, p <0.03), and flexibility (13.5%, p <0.001). After stratifying ECOG scores by cancer stage, 29% and 19.5% of patients with stage 2 cancer in the exercise group had ECOG scores of 0-1 and 2 respectively. Conversely, 17.4% and 27.9% of stage 2 cancer patients in the control group had ECOG scores of 0-1 and 2, respectively. Between-group difference in the FACT-B was 14.3 (95% confidence interval [CI], 18.3 to 9.4; P<0.001) and -4.2 for the BFI (95% CI, -5.4 to -2.3; P<0.001). Overall, a 12-week individualized exercise intervention significantly improved fitness parameters, ECOG scores, and decreased health care utilization in stage 1 and 2 breast cancer patients.

Image: PD

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