At WomenCan we raise funds to support ANZGOG’s clinical trials enabling women to live longer and live better. Some of ANZGOG's trials explore the effects of exercise on gynaecological cancer treatment outcomes.
At present, multiple academic and clinical studies from all around the world have highlighted the role of exercise in preventing cancer, and the benefits of exercise for cancer patients during and after treatment.
The following article has been medically reviewed by Dr Diana Adams.
Dr Diana Adams is a Medical Oncologist and ANZGOG Member with a specific interest in survivorship care. Dr Adams was a guest speaker at the 2019 Annual Scientific Meeting ANZGOG Public Forum, where she shared her expert opinion on implementing exercise as a resource in gynaecological cancer treatment and survival.
Why exercise is so important when living with a gynaecological cancer?
Here are a few things you should know about the links between exercise and gynaecological cancer:
Does exercise reduce risk of gynaecological cancer?
The answer is yes, exercise can reduce the chances of developing most cancers as it encourages weightloss and prevents obesity. In recent years, obesity has been well on its way to replacing smoking as the number one preventable modifiable cause of cancer. Obesity can be linked to various types of cancer including gynaecological cancers, namely endometrial cancer.
Endometrial cancer incidence has increased by 55% in the last 10 years, coinciding with an increase in obesity rates among Australian adults. In 1995, just one in five Australians were obese, a stark contrast to one in three according to stats from 2017-18. As more young adults are becoming overweight, we are seeing more women affected by endometrial cancer earlier in their lives.
Not only is obesity a major risk factor, it can also lower chances of survival and affect the impact and delivery of cancer treatment. Research shows that the higher the individuals BMI, the more aggressive the cancer is, leading to a worse prognosis. Morbidly obese individuals may not even be able to undergo therapy due to other obesity related conditions such as diabetes or heart disease.
Exercise and gynaecological cancer treatment
When most people are diagnosed with cancer, their levels of exercise decline due to emotional and physical fatigue from treatment. Even after treatment, most people never regain their pre-cancer levels of physical activity. This is unfortunate because exercise is one of the best complements to cancer treatment. Here are a few ways exercise can benefit patients during and after cancer treatment:
- Exercise reduces fatigue, a common side effect of cancer treatment.
- Exercise improves the patient’s ability to tolerate a higher dose of treatment drugs.
- Exercise improves muscle to fat ratio, that in turn strengthens the immune system and improves the response of natural killer cells (white blood cells responsible for controlling viral infections and the growth of tumours).
- Exercise helps reduce stress levels and improves overall wellbeing.
- Exercise improves core strength and balance, countering the side effects of chemotherapy drugs. Chemotherapy drugs are known to affect nerve endings and create balance problems and these side effects can last long after treatment ends.
- Exercise also has benefits for improves cardio-respiratory endurance. This is important as research shows that cardiovascular disease is the leading cause of death for endometrial cancer survivors.
- Exercise counters weight gain from sedentary lifestyle or drugs used during treatment. This reduces the risk of obesity which can be linked to the recurrence of cancer.
Incorporating exercise into cancer care plans before and after treatment can improve quality of life outcomes for patients and lessen any side effects resulting from treatment.
Can you exercise with gynaecological cancer?
The advantages that exercise can provide for cancer patients are so great that peak national bodies, such as the Clinical Oncology Society of Australia (COSA) in its revised Position Statement on Exercise in Cancer Care, have called for all oncologists and multidisciplinary cancer teams to promote and embed exercise as part of cancer treatment care. However, most still see cancer and structured exercise such as in a gym as incompatible.
"Exercise is actually safe during and after treatment."
Exercise plans need to be individualised for some with limiting factors such as weakened immunity, poor balance, bone weakness, skin irritation, bowel abnormality, pelvic floor issues or limited mobility due to recent surgery or having to wear a chemo pump. Clinical judgement needs to be applied and these factors accounted for.
"While these factors may affect the intensity and type of exercise prescribed, they don’t have to be barriers to reintroducing physical activity."
We recommend that patients book in a few sessions with an Exercise and Sports Science Australia (ESSA) accredited exercise physiologist or Australian Physiotherapy Council (APC) accredited physiotherapist with experience in cancer care before attempting to exercise on their own.
ESSA and APC accredited exercise professionals are experienced in prescribing exercise to patients with chronic illness and can help devise a safe exercise plan to meet individual needs and goals. Some exercise physiologist sessions are covered under Medicare and certain health funds. Please contact a healthcare provider for more information about eligibility.
Effective exercise prescriptions can be delivered across a variety of settings including the hospital, cancer treatment centres, community as well as home based (e.g. self-managed).
Watch ANZGOG member Dr Diana Adams speak about obesity and exercise in gynaecological cancer outcomes at the 2019 ASM ANZGOG Public Forum.
Recommended exercises for gynaecological cancer patients
Here are a few examples of exercises that can benefit gynaecological cancer patients. Make sure you consult your doctor or treatment team before commencing any of these activities.
Aerobic exercises that work large muscle groups and improve cardio-respiratory fitness. It is best to start at a comfortable level and increase duration and intensity as it gets easier.
- Walking or jogging
- Aerobics or dance class
- Daily chores like cleaning or gardening
Strength training exercises that increase strength and endurance of muscles and bones. Defer to an exercise professional on which weights to use.
- Body weight exercises e.g. push-ups or squats
- Free weight exercises utilising dumbbells or barbells e.g. bicep curls or upright rows
- Exercises that utilise weight machines or elastic resistance bands
It is also recommended that patients include stretching exercises that improve flexibility and range of motion, along with pelvic floor exercises in order to counter effects of treatment abdominal surgery. Exercise professionals can provide more guidance on what exercises you should include.
ANZGOG’s clinical trials on the effects of exercise and gynaecological cancer treatment
In spite of existing evidence demonstrating the positive effects of exercise on gynaecological cancer outcomes, more research is needed in order to further encourage exercise alongside cancer therapy and better improve the way in which exercise is incorporated as part of gynaecological cancer treatment plans. Unfortunately, since exercise is not a pill, research to discover its benefits are less likely to be funded by the big players in the pharmaceutical industry.
Funds donated through WomenCan go towards supporting ANZGOG’s clinical trials, including the ECHO trial led by Griffith University and the Menzies Health Institute Queensland. The ECHO trial aims to examine the effect of exercise for ovarian cancer patients during their chemotherapy treatment.
The ECHO trial has recruited over 300 patients (as of Dec 2020) and with a grant from the Cancer Council Queensland is expected to extend patient recruitment to 200 more women. The first phase of the study demonstrated that it was safe to use exercise during ovarian cancer treatment, and future stages of the trial aim to evaluate the effect of exercise on function, quality of life, treatment outcomes and survival.