Dropout from exercise trials among cancer survivors-An individual patient data meta-analysis from the POLARIS study

Benedikte Western¹, Andreas Ivarsson², Ingvild Vistad^{3

4

5}, Ingrid Demmelmaier^{1

6}, Neil K Aaronson⁷, Gillian Radcliffe⁸, Marc van Beurden⁹, Martin Bohus^{10

11

12}, Kerry S Courneya¹³, Amanda J Daley¹⁴, Daniel A Galvão¹⁵, Rachel Garrod¹⁶, Martine M Goedendorp^{17

18}, Kathleen A Griffith¹⁹, Wim H van Harten^{7

20}, Sandi C Hayes²¹, Fernando Herrero-Roman²², Anouk E Hiensch²³, Melinda L Irwin²⁴, Erica James²⁵, Marlou-Floor Kenkhuis²⁶, Marie José Kersten²⁷, Hans Knoop²⁸, Alejandro Lucia²⁹, Anne M May²³, Alex McConnachie³⁰, Willem van Mechelen^{31

32

33

34}, Nanette Mutrie³⁵, Robert U Newton¹⁵, Frans Nollet^{36

37}, Hester S Oldenburg⁹, Ron Plotnikoff³⁸, Martina E Schmidt³⁹, Katie H Schmitz⁴⁰, Karl-Heinz Schulz⁴¹, Camille E Short^{42

43}, Gabe S Sonke⁹, Karen Steindorf³⁹, Martijn M Stuiver⁷, Dennis R Taaffe¹⁵, Lene Thorsen^{44

45}, Miranda J Velthuis⁴⁶, Jennifer Wenzel⁴⁷, Kerri M Winters-Stone⁴⁸, Joachim Wiskemann⁴⁹, Sveinung Berntsen¹, Laurien M Buffart⁵⁰

Affiliations

¹ Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway.
² Centre of Research on Welfare, Health and Sport, Halmstad University, Halmstad, Sweden.
³ Department of Clinical Science, University of Bergen, Bergen, Norway.
⁴ Department of Obstetrics and Gynecology, Sørlandet Hospital, Kristiansand, Norway.
⁵ Faculty of Medicine, University of Oslo, Oslo, Norway.
⁶ Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
⁷ Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
⁸ Lane Fox Respiratory Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁹ Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
¹⁰ Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
¹¹ Heidelberg University, Heidelberg, Germany.
¹² Faculty of Health, University of Antwerp, Antwerp, Belgium.
¹³ Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada.
¹⁴ Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
¹⁵ Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.
¹⁶ Department of Respiratory Medicine, King's College London, London, UK.
¹⁷ Department of Psychology, University of Groningen, Groningen, Netherlands.
¹⁸ Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
¹⁹ The George Washington University, Washington, District of Columbia, USA.
²⁰ University of Twente, Enschede, The Netherlands.
²¹ School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
²² Fundación GIAFyS Cancer, Miranda de Ebro, Spain.
²³ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
²⁴ Yale School of Public Health, New Haven, Connecticut, USA.
²⁵ School of Medicine & Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.
²⁶ Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands.
²⁷ Department of Hematology, Amsterdam University Medical Centers, Cancer Center Amsterdam and LYMMCARE, Amsterdam, The Netherlands.
²⁸ Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
²⁹ European University, Madrid, Spain.
³⁰ School of Health and Wellbeing, University of Glasgow, Glasgow, UK.
³¹ Department of Public and Occupational Health, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
³² Faculty of Health and Behavioural Sciences, School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia.
³³ Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
³⁴ UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
³⁵ Physical Activity for Health Research Center, University of Edinburgh, Edinburgh, UK.
³⁶ Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
³⁷ Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands.
³⁸ Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, Callaghan, New South Wales, Australia.
³⁹ Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany.
⁴⁰ University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁴¹ Competence Center for Sports- and Exercise Medicine (Athleticum) and Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁴² Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
⁴³ Cancer and Exercise Recovery Research Group (CanRex), Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
⁴⁴ National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.
⁴⁵ Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.
⁴⁶ Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
⁴⁷ Johns Hopkins School of Nursing, Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA.
⁴⁸ Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA.
⁴⁹ Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and Heidelberg University Clinic, Heidelberg, Germany.
⁵⁰ Department of Physiology, Radboudumc, Nijmegen, The Netherlands.

PMID: 38339809
DOI: 10.1111/sms.14575

Meta-Analysis

Dropout from exercise trials among cancer survivors-An individual patient data meta-analysis from the POLARIS study

Benedikte Western et al. Scand J Med Sci Sports. 2024 Feb.

. 2024 Feb;34(2):e14575.

doi: 10.1111/sms.14575.

Authors

Affiliations

¹ Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway.
² Centre of Research on Welfare, Health and Sport, Halmstad University, Halmstad, Sweden.
³ Department of Clinical Science, University of Bergen, Bergen, Norway.
⁴ Department of Obstetrics and Gynecology, Sørlandet Hospital, Kristiansand, Norway.
⁵ Faculty of Medicine, University of Oslo, Oslo, Norway.
⁶ Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
⁷ Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
⁸ Lane Fox Respiratory Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁹ Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
¹⁰ Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
¹¹ Heidelberg University, Heidelberg, Germany.
¹² Faculty of Health, University of Antwerp, Antwerp, Belgium.
¹³ Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada.
¹⁴ Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
¹⁵ Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.
¹⁶ Department of Respiratory Medicine, King's College London, London, UK.
¹⁷ Department of Psychology, University of Groningen, Groningen, Netherlands.
¹⁸ Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
¹⁹ The George Washington University, Washington, District of Columbia, USA.
²⁰ University of Twente, Enschede, The Netherlands.
²¹ School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
²² Fundación GIAFyS Cancer, Miranda de Ebro, Spain.
²³ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
²⁴ Yale School of Public Health, New Haven, Connecticut, USA.
²⁵ School of Medicine & Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.
²⁶ Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands.
²⁷ Department of Hematology, Amsterdam University Medical Centers, Cancer Center Amsterdam and LYMMCARE, Amsterdam, The Netherlands.
²⁸ Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
²⁹ European University, Madrid, Spain.
³⁰ School of Health and Wellbeing, University of Glasgow, Glasgow, UK.
³¹ Department of Public and Occupational Health, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
³² Faculty of Health and Behavioural Sciences, School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia.
³³ Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
³⁴ UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
³⁵ Physical Activity for Health Research Center, University of Edinburgh, Edinburgh, UK.
³⁶ Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
³⁷ Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands.
³⁸ Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, Callaghan, New South Wales, Australia.
³⁹ Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany.
⁴⁰ University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁴¹ Competence Center for Sports- and Exercise Medicine (Athleticum) and Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁴² Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
⁴³ Cancer and Exercise Recovery Research Group (CanRex), Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
⁴⁴ National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.
⁴⁵ Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.
⁴⁶ Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
⁴⁷ Johns Hopkins School of Nursing, Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA.
⁴⁸ Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA.
⁴⁹ Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and Heidelberg University Clinic, Heidelberg, Germany.
⁵⁰ Department of Physiology, Radboudumc, Nijmegen, The Netherlands.

PMID: 38339809
DOI: 10.1111/sms.14575

Abstract

Introduction: The number of randomized controlled trials (RCTs) investigating the effects of exercise among cancer survivors has increased in recent years; however, participants dropping out of the trials are rarely described. The objective of the present study was to assess which combinations of participant and exercise program characteristics were associated with dropout from the exercise arms of RCTs among cancer survivors.

Methods: This study used data collected in the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) study, an international database of RCTs investigating the effects of exercise among cancer survivors. Thirty-four exercise trials, with a total of 2467 patients without metastatic disease randomized to an exercise arm were included. Harmonized studies included a pre and a posttest, and participants were classified as dropouts when missing all assessments at the post-intervention test. Subgroups were identified with a conditional inference tree.

Results: Overall, 9.6% of the participants dropped out. Five subgroups were identified in the conditional inference tree based on four significant associations with dropout. Most dropout was observed for participants with BMI >28.4 kg/m² , performing supervised resistance or unsupervised mixed exercise (19.8% dropout) or had low-medium education and performed aerobic or supervised mixed exercise (13.5%). The lowest dropout was found for participants with BMI >28.4 kg/m² and high education performing aerobic or supervised mixed exercise (5.1%), and participants with BMI ≤28.4 kg/m² exercising during (5.2%) or post (9.5%) treatment.

Conclusions: There are several systematic differences between cancer survivors completing and dropping out from exercise trials, possibly affecting the external validity of exercise effects.

Keywords: cancer; decision tree; exercise oncology; individual patient data meta-analysis.

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References

REFERENCES

1. Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51(11):2375-2390.
1. Buffart LM, Kalter J, Sweegers MG, et al. Effects and moderators of exercise on quality of life and physical function in patients with cancer: an individual patient data meta-analysis of 34 RCTs. Cancer Treat Rev. 2017;52:91-104.
1. Sweegers MG, Altenburg TM, Brug J, et al. Effects and moderators of exercise on muscle strength, muscle function and aerobic fitness in patients with cancer: a meta-analysis of individual patient data. Br J Sports Med. 2019;53(13):812.
1. Van Vulpen JK, Sweegers MG, Peeters PHM, et al. Moderators of exercise effects on cancer-related fatigue: a meta-analysis of individual patient data. Med Sci Sports Exerc. 2020;52(2):303-314.
1. Friedenreich CM, Stone CR, Cheung WY, Hayes SC. Physical activity and mortality in cancer survivors: a systematic review and meta-analysis. JNCI Cancer Spectrum. 2020;4(1):pkz080.

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Dropout from exercise trials among cancer survivors-An individual patient data meta-analysis from the POLARIS study

Affiliations

Dropout from exercise trials among cancer survivors-An individual patient data meta-analysis from the POLARIS study

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

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LinkOut - more resources

Full Text Sources

Medical