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. 2025 Aug 18;33(9):795.
doi: 10.1007/s00520-025-09824-9.

Objective measurement of physical activity levels and patient-reported outcomes in cancer patients receiving immune-checkpoint inhibitors: a cross-sectional study

Rita Carrilho Pichel  1 , Luísa Soares Miranda  2   3   4   5 , Hugo Miguel Miranda  2   3 , Susana Vale  4   5 , João Queirós Coelho  2 , Laura Pratas Guerra  2 , Miguel Martins Braga  2 , Gustavo Pinhol  2 , Paula Fidalgo  2 , Alexandra Araújo  2 , António Araújo  2   3
Affiliations

Objective measurement of physical activity levels and patient-reported outcomes in cancer patients receiving immune-checkpoint inhibitors: a cross-sectional study

Rita Carrilho Pichel et al. Support Care Cancer. .

Abstract

Objectives: This study aimed to objectively assess physical activity levels in cancer patients treated with immune-checkpoint inhibitors (ICIs) and explore their association with patient-reported fatigue and quality of life (QoL).

Methods: A cross-sectional study was conducted among adult patients with solid cancer receiving ICI treatment in the day hospital of our institution from March 26 to April 24, 2024. Physical activity levels were assessed using accelerometer monitors and the IPAQ questionnaire, while patient-reported fatigue and QoL were assessed with the FACIT-Fatigue and EQ-5D questionnaires, respectively. Descriptive statistics and between-group comparisons were performed, specifically between active and non-active patients, based on the WHO recommendation for healthy PA of ≥ 150 min/week of moderate-to-vigorous PA (MVPA), as well as between patients with or without problems in QoL domains.

Results: A total of 23 patients were enrolled, with a mean age of 61 ± 12 years, 65.5% male. Eleven patients (47.8%) were active, with a mean MVPA of 22.5 ± 16.5 min/day based on objective measurements. Active and non-active subgroups were balanced for characteristics other than BMI. Based on 18 objective measurements, the mean MVPA time was 22.5 ± 16.5 min/day. Reported fatigue was higher than population norms, and 85.7% reported issues in QoL domains. Patients without problems in self-care or in usual activities reached higher PA levels, and patients without problems in mobility, self-care, or pain/discomfort reported less fatigue and a higher index of global health.

Conclusion: Less than half of ICI-treated patients follow the recommendation for healthy PA. Patients engaging in more MVPA may have less problems in self-care and in usual activities. It reinforces the need to promote PA during immunotherapy.

Keywords: Accelerometer monitoring; Cancer; Immune-checkpoint inhibitors; Patient-reported outcomes; Physical activity; Quality of life.

Plain language summary

Cancer patients receiving chemotherapy often experience fatigue and reduced physical activity levels, but little is known about the physical activity levels of those receiving immunotherapy with immune-checkpoint inhibitors. Emerging research suggests that exercise might enhance the results of immunotherapy. Our study aimed to measure physical activity levels during immunotherapy and examine their relationship with patient-reported fatigue and quality of life. We found that fewer than half of patients met physical activity recommendations and that patients who were more physically active reported fewer problems in self-care and usual activities.These findings highlight the need to encourage physical activity in patients undergoing immunotherapy and may guide future research on improving their quality of life.

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Conflict of interest statement

Declarations. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Administration Board, Ethics Committee, Data Protection Committee, and Department of Investigation of Centro Hospitalar Universitário de Santo António, Ref. No. 2024.078 (070-DEFI/071-CE). Consent to participate: Informed consent was obtained from all individual participants included in the study. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of selection. IPAQ International Physical Activity Questionnaire
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