Researchers have created a new framework to help clinicians effectively integrate the right kinds of exercise into cancer care at the right times to maximize benefits and minimize risks for patients.
"It's intended to get clinicians and researchers to think of exercise within a package of treatments rather than as a single treatment," says Kerry Courneya, an exercise oncologist in the Faculty of Kinesiology, Sport, and Recreation and Canada Research Chair in Physical Activity and Cancer.
"It's going to help us be strategic about how and when we introduce exercise as part of an individual's care so they get the best benefit — not only from their treatment, but also in terms of their quality of life," adds Margaret McNeely, professor in the Faculty of Rehabilitation Medicine and adjunct professor in the Department of Oncology.
The framework, called Exercise Across the Postdiagnosis Cancer Continuum (EPiCC), provides key terminology and a structured way of approaching the distinct role exercise has in cancer care, from treatment to supportive interventions.
Advances in medicine have led to new cancer treatments along with chemotherapy and radiation, giving clinicians more options when creating treatment plans for patients. However, this means finding the ideal combination of treatments is increasingly complex.
Exercise is often an essential component in cancer care, but like medication, there's no one-size-fits-all prescription — different types and intensities of exercise are appropriate during different phases of a patient's treatment. Clinicians also need to consider how exercise interacts with other treatments the patient is undergoing.
"In the past, we thought of cancer treatment as a singular thing — you go on treatment and then off it," says Courneya. "With the modern cancer treatment landscape we have so many options available, and clinical oncologists are trying to figure out how to combine them, which ones should go together and how to sequence them."
The framework, which Courneya and McNeely crafted with collaborators Christopher Booth at Queen's University and Christine Friedenreich at the University of Calgary, identifies six key periods in cancer care where exercise plays an important role: before, during and between treatments, as well as immediately after treatment, during survivorship and during end of life after treatment has been unsuccessful.
As McNeely explains, the framework offers guidance for incorporating exercise as part of the primary treatment and care plan, and as part of the recovery and supportive care plan. It also highlights future research directions and questions for exercise oncologists to consider as they determine how to position exercise within a treatment plan.
There's a misconception that exercise is always beneficial, but Courneya notes the ideal exercise prescription requires the same level of thought in terms of type, duration and intensity as deciding on the appropriate dosage of a medication for a particular patient.
A patient who is going through a challenging round of chemotherapy, for example, may be best served by reserving as much energy as possible for the treatment, so exercise may pose more risk than benefit. On the other hand, a newly diagnosed patient may want to focus on building their fitness as they prepare for a round of treatment.
The framework can also help clinicians explain what their exercise recommendations are meant to achieve for patients, McNeely adds: "I think people appreciate they need to be active, but they don't always see how it ties into what they're experiencing in terms of their cancer."
"This framework will allow much more precision," says Courneya. "It'll allow us to get the right exercise prescription to the right patient at the right time."
McNeely is a member of the Women and Children's Health Research Institute and both McNeely and Courneya are members of the Cancer Research Institute of Northern Alberta.
