Pan-Cancer Analysis of Postdiagnosis Exercise and Mortality

Abstract

Purpose: The impact of postdiagnosis exercise on cause-specific mortality in cancer survivors and whether this differs on the basis of cancer site is unclear.

Methods: We performed an analysis of 11,480 patients with cancer enrolled in the Prostate, Lung, Colorectal, and Ovarian cancer screening trial. Patients with a confirmed diagnosis of cancer completing a standardized survey quantifying exercise after diagnosis were included. The primary outcome was all-cause mortality (ACM); secondary end points were cancer mortality and mortality from other causes. Cox models were used to estimate the cause-specific hazard ratios (HRs) for ACM, cancer, and noncancer mortality as a function of meeting exercise guidelines versus not meeting guidelines with adjustment for important clinical covariates.

Results: After a median follow-up of 16 years from diagnosis, 4,665 deaths were documented (1,940 due to cancer and 2,725 due to other causes). In multivariable analyses, exercise consistent with guidelines was associated with a 25% reduced risk of ACM compared with nonexercise (HR, 0.75; 95% CI, 0.70 to 0.80). Compared with nonexercise, exercise consistent with guidelines was associated with a significant reduction in cancer mortality (HR, 0.79; 95% CI, 0.72 to 0.88) and mortality from other causes (HR, 0.72; 95% CI, 0.66 to 0.78). The inverse relationship between exercise and cause-specific mortality varied by exercise dose. Exercise consistent with guidelines was associated with a reduced hazard of ACM for multiple cancer sites. Reduction in cancer mortality for exercisers was only observed in head and neck and renal cancer.

Conclusion: In this pan-cancer sample of long-term cancer survivors, exercise consistent with guidelines was associated with substantial ACM benefit driven by both reductions in cancer and noncancer mortality. The cause-specific impact of exercise differed as a function of cancer site.

Figure 1.

Cumulative incidence for all-cause mortality (A), cancer mortality (B) and mortality from other causes (C) by meeting exercise guidelines versus not meeting guidelines. The x-axis indicates years from diagnosis and begins at 0.5 years to reflect the landmark time.

Figure 2.

Cumulative incidence for all-cause mortality (A), cancer mortality (B) and mortality from other causes (C) by exercise dose. The x-axis indicates years from diagnosis and begins at 0.5 years to reflect the landmark time.

Figure 3.

Hazard ratios for all-cause mortality (A), cancer mortality (B) and mortality from other causes (C) for all cancers and by cancer site.

Figure 3.

Hazard ratios for all-cause mortality (A), cancer mortality (B) and mortality from other causes (C) for all cancers and by cancer site.

Figure 3.

Hazard ratios for all-cause mortality (A), cancer mortality (B) and mortality from other causes (C) for all cancers and by cancer site.