RESULTS

A total of 124 patients were eligible (Table 1) with a mean age of 66.2 years (range 37–94 years). The average age of patients invited to participate was 62.6 years (95% CI 59.6–65.7), significantly different from those who were not (68.6 years) (95% CI 66.2–70.9; P=0.0026). A total of 53 patients were invited to participate; 41 patients accepted and 35 patients completed the initial assessment. No difference was seen in the invitation rate when sex, race, and tumor type were analyzed. 

The medical oncologist reviewed reasons for noninvitation. The category accounting for 48% of such patients described cancer-related issues with advanced age and/or fatigue; rapid deterioration and death within the first or second cycle of treatment; and orthopedic and/or neurological issues precluding exercise participation. In 11% of cases, there were no clear reasons for noninvitation (Table 2).


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The attrition rate was 24% using the previously stated definition. The rate of participation varied (Figure 1), and the median number of weekly classes attended was 16 (range 1–89). The mean compliance rate was 73.1% (95% CI 67.0–79.4). During this study, 15 participants died, 7 participants completed their palliative systemic treatment and stopped participating, and 1 patient moved to another hospital.

Patients who died stopped participating in the exercise program at a mean of 164 days (95% CI 76.5–251, median 100 days) prior to their death. Patients completing their course of palliative chemotherapy continued to participate in the exercise program a mean of 7.6 days after completion of treatment (95% CI 73.1 days prior to ending chemotherapy to 88.3 days after completing chemotherapy).

There were no pre-to-post changes in the FACIT-General (P=0.83), FACIT-Specific (P=0.31), or PFS (P=0.98) at 30 weeks. 

Participants improved their 6-minute walk test at posttest by an average of 75 m (467 m, 95% CI 425–508 m vs 542 m, 95% CI 483–600 m, P=0.002).

For CRC patients, the average DI of participants was 96% (n=12), and for nonparticipants, it was significantly lower at 86% (95% CI 75–96, P=0.035). For multiple myeloma patients, participant’s DI was 100% (n=3), and for nonparticipants, it was 98% (95% CI 93–104; P=0.37).

Twenty patients with metastatic CRC were treated with chemotherapy during the pilot study, with surgical sections available for 19 patients, 12 accepting the invitation and 9 taking part in the exercise pilot (Table 1). β-Catenin staining and survival analysis were undertaken for all metastatic CRC patients with available pathology specimens treated with chemotherapy during the conduct of this pilot study, regardless of participation in the exercise pilot. Fourteen of the patients died, with a median survival of 2.45 years (95% CI 1.9–6.4). Forty-two percent of the sections stained strongly for β-catenin in the nucleus. For overall mortality, strong nuclear staining for β-catenin was associated with a lower risk of death (HR =0.54, 95% CI 0.14–1.96). Participation in the exercise pilot was not associated with any difference in survival (HR =0.98, 95% CI 0.32–2.97, Figure 2A). However, participants in the exercise pilot who had weak nuclear staining for β-catenin had a lower risk of mortality (HR =0.39, 95% CI 0.025–6.1, Figure 2B).

(To view a larger version of Figure 2, click here.)