Exercise, Diet Interventions Boost Fat-Free Mass, Reduce Fatigue in Patients With OC

Exercise and dietary interventions improved fat-free mass (FFM), physical functioning, and fatigue in patients with ovarian cancer (OC), although there were no significant differences in improvement between the experimental and control groups, according to a study published in the British Journal of Cancer.¹

The researchers explained that typical OC treatment consists of cytoreductive surgery and six 3-week cycles of neoadjuvant or adjuvant chemotherapy treatment.² They noted that this can lead to various psychosocial and physical problems, including fatigue, reduced physical functioning, and malnutrition, all of which can significantly compromise patients’ health-related quality of life (HRQoL).¹

Past studies established that dietary interventions and exercise help to significantly improve body composition, HRQoL, physical fitness, and fatigue in patients with cancer, resulting in international guidelines recommending both in cancer care. However, most of the related studies involved patients with breast cancer receiving curative treatment.³ Therefore, it remains unclear whether these findings apply to patients with OC, as they have different characteristics, treatment types, and trajectories.⁴

Female patient exercising | Image Credit: Kiattisak - stock.adobe.com

Because of this, the researchers conducted a 2-arm multicenter randomized controlled trial to compare the effectiveness of dietary support and exercise interventions with typical OC treatment.¹ Patients were randomized to receive either usual care (control group) or usual care plus a combined dietary and exercise intervention (intervention group).

The researchers recruited patients from 3 gynecological cancer centers and their affiliated peripheral hospitals in the Netherlands between 2018 and 2022; those eligible were aged older than 18 years with primary epithelial OC and scheduled for (neo)adjuvant chemotherapy treatment.

The study’s primary outcomes were physical functioning, body composition, and fatigue; the researchers assessed FFM by bioelectrical impedance analysis, while they assessed both fatigue and physical functioning using questionnaires. The researchers performed measurements at baseline before randomization (T0), after the last cycle of chemotherapy (T1), and 12 weeks after T1 (T2); they assessed the primary outcomes at all time points.

The researchers also noted that the intervention started at the first 3-week cycle of chemotherapy and continued until the last chemotherapy cycle (between T0 and T1). The intervention addressed both exercise and dietary intake throughout chemotherapy treatment. More specifically, the exercise program included two 1-hour sessions per week, including moderate- to high-intensity aerobic and resistance exercise.

Also, dietary counseling was delivered by oncology-specialized dietitians once every 3 weeks during 30-to-45-minute sessions in the hospital or by telephone. Counseling was tailored to the nutritional needs of each patient and considered factors like body composition, nutritional status, and dietary intake; the primary focus of counseling was to prevent weight loss by ensuring adequate nutritional intake.

Of the 257 eligible patients, 81 (31.5%) participated in the trial; the mean (SD) age of patients in the trial was 59 (11) years. Of these patients, 60% received primary surgery followed by adjuvant chemotherapy treatment, and 42.7% had a high education level.

The researchers found that FFM and physical functioning significantly increased in both groups over time, while general fatigue significantly decreased. However, they did not find significant differences between the intervention and control groups in terms of FFM (β, –0.5; 95% CI, –3.2 to 2.1) physical function (β, 1.4; 95% CI, –5.4 to 8.3) or fatigue (β, 0.7; 95% CI, –2.3 to 2.1) at T1. Similarly, there were no differences in FFM (β, –0.9; 95% CI, –3.5 to 1.8), physical functioning (β, –1.6; 95% CI, –8.7 to 5.5), or fatigue (β, –0.1; 95% CI, –2.3 to 2.1) between the groups at T2.

"Both groups exhibited enhancements in body composition, physical functioning, and fatigue levels during chemotherapy," the authors wrote. "Hence, the intervention group did not demonstrate additional benefits when compared to the control group, although the wide confidence intervals suggest that some individuals may have derived greater benefit than others."

Lastly, the researchers acknowledged study limitations, one being that the study population consisted of patients from the Netherlands, so the findings may not be generalizable to international populations. Therefore, they made suggestions for future research and treatment interventions.

“The unique characteristics and needs of patients with OC necessitate tailored research and interventions specific to this population,” the authors concluded. “Furthermore, the differential effects of exercise and diet during chemotherapy as compared with other cancer populations underscore the importance of conducting research in understudied populations, as results may not be directly applicable or generalizable across diverse cancer types.”

References

1. Kenkhuis MF, Stelten S, Hartman YA, et al. Effects of a combined exercise and dietary intervention on body composition, physical functioning and fatigue in patients with ovarian cancer: results of the PADOVA trial. Br J Cancer. doi:10.1038/s41416-024-02694-8
2. Ledermann JA, Raja FA, Fotopoulou C, et al. Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 Suppl 6:vi24-vi32. doi:10.1093/annonc/mdt333
3. McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS. Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ. 2006;175(1):34-41. doi:10.1503/cmaj.051073
4. Reid BM, Permuth JB, Sellers TA. Epidemiology of ovarian cancer: a review. Cancer Biol Med. 2017;14(1):9-32. doi:10.20892/j.issn.2095-3941.2016.0084