|The following article features coverage from the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting. Click here to read more of Oncology Nurse Advisor‘s conference coverage.|
A symptom-adapted physical activity intervention with behavioral counseling during induction chemotherapy showed promise in preventing clinically meaningful decline in physical function among older adults with acute myeloid leukemia (AML). The findings were presented during the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting.
“In our conceptual model, we highlight factors associated with chemotherapy treatment such as toxicity and inactivity, which contributes to decline in physical function during treatment with the potential consequences of increased disability, worse quality of life, higher symptom burden, and potentially increased mortality. Waiting to intervene after treatment may be too late,” said Heidi Klepin, MD, of Wake Forest Baptist Health.
The single-institution randomized pilot study (ClinicalTrials.gov Identifier: NCT01519596) assessed feasibility and compared symptom-adapted physical activity intervention during treatment with the usual care (control). Patients with newly diagnosed AML were eligible if they were aged 60 years and older, ambulatory, and scheduled to receive intensive induction chemotherapy. Prespecified feasibility goals were 60% for recruitment, 85% for adherence, and 96% for retention.
Patients in the intervention arm were offered physical activity sessions 5 days per week during the induction hospitalization. Each day, patients could elect 1 of 3 sessions that had been tailored to common symptoms and conditions in older adults with AML. The options were: (1) standard/ward-based (walking + balance training + resistance exercises); (2) intermediate/room-based (upper-body ergometer + balance training + resistance exercises); and (3) low-intensity/bed-based (upper-body ergometer + resistance exercises). To establish physical activity goals and help patients overcome barriers, behavioral counseling sessions were conducted weekly during hospitalization and monthly following discharge.
Physical function was assessed at baseline, weekly during hospitalization (4 to 6 weeks), 3 months, and 6 months. The primary functional outcome of interest was the Short Physical Performance Battery (SPPB), which includes a repetitive chair stand test, a gait speed test, and a balance test. The sum of the 3 assessments, ranging from 0 to 12, is the SPPB score; higher scores indicate better physical function and lower disability. Clinically significant change in physical function was defined as a change of 1.0 or more in SPPB score.
Of 96 eligible patients, 70 patients enrolled in the study (randomly assigned 1:1). Most participants were male (70%). The mean age was 72.1±6.3 years. The mean baseline SPPB score was 7.0±3.8, indicating frailty (generally considered <9.0) among the study participants.
For the intervention arm (n=35), the total number of potential sessions was 732. Of those, 13% were not administered due to medical contraindication and 20% were declined by the participants. The average participation was 3±1.6 sessions/week, and the mean total number of sessions per participant was 14.5±9.4. The study surpassed its prespecified feasibility outcome goals for recruitment (72%) and retention (96%); adherence was 80%.
In the surviving intention to treat population (N=66), more patients in the intervention arm than in the control arm maintained or improved their SPPB score from baseline to the end of induction hospitalization (39% vs 26%; P =.28); however, the difference did not reach statistical significance. Among those who achieved remission (N=42), significantly more patients in the intervention arm than in the control arm maintained or improved their SPPB score from baseline to the end of induction (55% vs 23%; P=.05). From baseline to last follow up (3- or 6-month postenrollment), maintenance or improvement in SPPB score was higher, but not significantly different, in the intervention arm vs the control arm among the intention to treat cohort (N = 50; 62% vs 54%) and among those who achieved remission (N =40; 67% vs 55%).
“In conclusion, a physical activity intervention with behavioral counseling during treatment is feasible and shows promise in preventing clinically meaningful decline in physical function among older adults with AML which achieve remission,” said Dr Klepin. “Continued maintenance intervention may sustain benefits observed.”
Disclosure: This research was supported by US National Institutes of Health, Other Foundation. Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Read more of Oncology Nurse Advisor’s coverage of the 2021 ASCO Annual Meeting by visiting the conference page.
Klepin HD, Tooze JA, Geiger AM, et al. A symptom-adapted physical activity intervention during induction chemotherapy for older adults with acute myeloid leukemia (AML) to maintain physical function. J Clin Oncol. 2021;39(suppl 15; abstr 12009). doi:10.1200/JCO.2021.39.15_suppl.12009