Impact of Exercise on Ovarian Cancer Prognosis Studied

Division of Cancer Control and Population Sciences

Studies suggesting a benefit of physical activity and exercise for people with certain cancers, particularly breast cancer, are well documented in the medical literature. However, very few studies published to date discuss the beneficial effects of exercise after a diagnosis of ovarian cancer. Melinda Irwin, Ph.D., M.P.H., an epidemiologist at the Yale University School of Public Health, is seeking to address that gap with the Women’s Activity and Lifestyle Study in Connecticut (WALC).

The need for interventions to improve symptom-control and alleviate treatment side effects is critical for ovarian cancer patients, Dr. Irwin noted. “When you look at women with ovarian cancer, with the treatments they go through and the surgery and the later stage of diagnosis, their quality of life (QOL) is often significantly impaired,” she said. “I believe exercise will be very beneficial for these patients.”

With support from NCI*, Dr. Irwin and her colleagues aim to enroll up to 230 sedentary women diagnosed with Stage I-III ovarian cancer, who are being randomized for 6 months into either a home-based walking program or into an “attention control” group who receive weekly health education sessions over the phone with a counselor. The counselor also contacts the women in the exercise arm of the study by phone, Dr. Irwin added. The counselor helps motivate and guide them to complete 150 minutes of walking per week.

The walking program intervention used for WALC is designed to gradually build in intensity, Dr. Irwin explained. “It’s not as though they’re training for a marathon but we’re able to get the exercise levels up to exceed the recommended amount of 150 minutes a week of brisk walking. They wear a heart-rate monitor when they exercise and put a pedometer on every day.” Women in the exercise group also walk a 1-mile route every month to monitor their improvement in walking speed. “When they first start the study, it may take some women about 30 minutes to walk that mile, but at 2-3 months into it, they might be walking it in 20 minutes,” she reported.

Regular exercise can be challenging for women with late-stage ovarian cancer, Dr. Irwin commented. Such patients often experience disease recurrence and need to go back on chemotherapy. “Some of them also suffer from peripheral neuropathy, so they have a fear of falling,” she added. “We recommend they use the Nordic walking poles to help with balance when they need to and until that fear of falling subsides and they’re more confident.”

There are a number of approaches and strategies the researchers use to make it easier for women to continue in the exercise program, Dr. Irwin added, and so far, “there is never a woman who comes back from an exercise session who says she doesn’t feel good.”

Measuring and comparing the impact of exercise, versus the health education control group, on the patients’ QOL (such as fatigue, anxiety, and depression) “is the primary endpoint in our study,” Dr. Irwin continued. In addition, the researchers are conducting baseline and 6-month clinic visits for study participants to evaluate the patients’ QOL and surrogate biomarkers for ovarian cancer progression, Dr. Irwin added.

“We’re collecting fasting blood samples at the beginning and at the end of the study because there are some serum markers, such as leptin and insulin-like growth factors (IGFs), that we know are related to ovarian cancer that have also been shown to be related to exercise or body weight,” Dr. Irwin noted. The researchers will assess any changes to these biomarkers, in both the exercise and control groups, at the end of the 6-month intervention period.

The study, which is expected to end in 2014, has been expanded to include enrollment of patients from outside of Connecticut, Dr. Irwin said. She plans to submit an abstract and possibly present preliminary findings from the study at the 2013 American Society of Clinical Oncology (ASCO) Annual Meeting. If the findings show a positive impact of exercise on ovarian cancer patients’ QOL and disease biomarkers, Dr. Irwin hopes to conduct a follow-up investigation to assess its long-term (3-5 years) effects on disease progression and survival among these patients.

Currently, only about one-third of cancer centers in the United States offer some sort of exercise program to their patients and cancer survivors, Dr. Irwin commented, and often such programs are tailored for or limited to breast cancer patients. She hopes to add to the evidence base that opens up exercise interventions to more cancer patients, including women with ovarian cancer. “If we show that WALC is an effective program when done over the phone, it could easily be done and replicated nationally,” she commented.

Catherine M. Alfano, Ph.D., deputy director NCI Office of Cancer Survivorship, commented: “Dr. Irwin’s study addresses an important gap in NCI’s grant portfolio of exercise and survivorship studies that have almost exclusively focused on women with breast cancer. This study will help us understand whether exercise can play a role in the rehabilitation of ovarian cancer survivors by alleviating persistent cancer-related symptoms and improving functional impairments and the ability to fully participate in life after cancer treatment.”