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Randomized Controlled Trial
. 2024 May;205(1):75-86.
doi: 10.1007/s10549-023-07220-7. Epub 2024 Jan 29.

Effects of physical exercise during adjuvant chemotherapy for breast cancer on long-term tested and perceived cognition: results of a pragmatic follow-up study

Willeke R Naaktgeboren  1   2 , Emmie W Koevoets  1   2 , Martijn M Stuiver  1   3   4 , Wim H van Harten  1   5   6 , Neil K Aaronson  1 , Elsken van der Wall  7 , Miranda Velthuis  8 , Gabe Sonke  9 , Sanne B Schagen  1   10 , Wim G Groen #  11   12   13 , Anne M May #  14
Affiliations
Randomized Controlled Trial

Effects of physical exercise during adjuvant chemotherapy for breast cancer on long-term tested and perceived cognition: results of a pragmatic follow-up study

Willeke R Naaktgeboren et al. Breast Cancer Res Treat. 2024 May.

Abstract

Purpose: Cancer-related cognitive impairment (CRCI) following chemotherapy is commonly reported in breast cancer survivors, even years after treatment. Data from preclinical studies suggest that exercise during chemotherapy may prevent or diminish cognitive problems; however, clinical data are scarce.

Methods: This is a pragmatic follow-up study of two original randomized trials, which compares breast cancer patients randomized to exercise during chemotherapy to non-exercise controls 8.5 years post-treatment. Cognitive outcomes include an online neuropsychological test battery and self-reported cognitive complaints. Cognitive performance was compared to normative data and expressed as age-adjusted z-scores.

Results: A total of 143 patients participated in the online cognitive testing. Overall, cognitive performance was mildly impaired on some, but not all, cognitive domains, with no significant differences between groups. Clinically relevant cognitive impairment was present in 25% to 40% of all participants, regardless of study group. We observed no statistically significant effect of exercise, or being physically active during chemotherapy, on long-term cognitive performance or self-reported cognition, except for the task reaction time, which favored the control group (β = -2.04, 95% confidence interval: -38.48; -2.38). We observed no significant association between self-reported higher physical activity levels during chemotherapy or at follow-up and better cognitive outcomes.

Conclusion: In this pragmatic follow-up study, exercising and being overall more physically active during or after adjuvant chemotherapy for breast cancer was not associated with better tested or self-reported cognitive functioning, on average, 8.5 years after treatment. Future prospective studies are needed to document the complex relationship between exercise and CRCI in cancer survivors.

Keywords: Breast cancer; Cognition; Exercise; Physical activity.

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Conflict of interest statement

GS has received institutional research support from AstraZeneca, Merck, Novartis, Roche, and Seagen; and is a consultant for Biovica. Other authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of participants in the original PACT and PACES studies, and in the Pact-Paces-Heart study with cognitive testing
See this image and copyright information in PMC

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