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Exercise following breast cancer: exploratory survival analyses of two randomised, controlled trials

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A Correction to this article was published on 10 November 2017

This article has been updated

Abstract

Purpose

The Exercise for Health trials were randomised, controlled trials designed to evaluate an 8-month pragmatic exercise intervention, commencing 6 weeks post-surgery for women with newly diagnosed breast cancer residing in urban or rural/regional Australia. For these exploratory analyses, the primary and secondary outcomes were overall survival (OS) and disease-free survival (DFS), respectively.

Methods

Consenting urban- (n = 194) and rural/regional-residing women (n = 143) were randomised to exercise (intervention delivered face-to-face or by telephone) or usual care. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for survival outcomes (exercise group, n = 207, 65% urban women; usual care group, n = 130, 46% urban women).

Results

After a median follow-up of 8.3 years, there were 11 (5.3%) deaths in the exercise group compared with 15 (11.5%) deaths in the usual care group (OS HR for the exercise group: 0.45, 95% CI 0.20–0.96; p = 0.04). DFS events for the exercise versus usual care group were 25 (12.1%) and 23 (17.7%), respectively (HR: 0.66, 95% CI 0.38–1.17; p = 0.16). HRs for OS favoured exercise irrespective of age, body mass index, stage of disease, intervention compliance, and physical activity levels at 12 months post-diagnosis, although were stronger (p < 0.05) for younger women, women with stage II + disease, women with 1 + comorbidity at time of diagnosis, higher intervention compliance and for those who met national physical activity guidelines at 12 months post-diagnosis.

Conclusion

An exercise intervention delivered during and beyond treatment for breast cancer, and that was designed to cater for all women irrespective of place of residence and access to health services, has clear potential to benefit survival. Trial numbers: ACT RN: 012606000233527; ACT RN: 12609000809235.

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Change history

  • 10 November 2017

    In the original publication of the article, under the heading Discussion, 1st paragraph, the sentence that reads as, “Nonetheless, our observed improvements of over 50% for OS and over 30% for DFS (HRs: 0.45 and 0.66, respectively) are consistent with results from other available studies” should read as “Nonetheless, our observed improvements of over 50% for OS and DFS (HRs: 0.45 and 0.66, respectively) are consistent with results from other available studies.” Under the heading Discussion, 3rd paragraph, the sentence that reads as “We cannot discount the possibility …such as education, income and access to care [1, 7]” should read as “We cannot discount the possibility…such as education, income and access to care, which ultimately have on survival outcomes [1, 7].”

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Acknowledgements

Study investigators would like to acknowledge and thank those who agreed to participate in the Exercise for Health trials. Their contributions to improving future breast cancer care are significant. Thank you also to the breast care nurses, exercise physiologists and research staff, in particular Sheree Rye and Tracey DiSipio, for their efforts in study recruitment, implementation and analysis, and to Emeritus Professor Beth Newman, who has provided invaluable review of this manuscript and mentorship throughout all phases of these trials.

Funding

The EfH urban and rural/regional trials were supported by two National Breast Cancer Foundation (NBCF) project grants. During the conduct of the EfH trials, SH and EE were supported by NBCF and National Health and Medical Research Council (NHMRC) research fellowships, respectively. SH is currently supported by a Cancer Council Queensland Fellowship.

Author information

Authors and Affiliations

  1. Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia

    S. C. Hayes, M. L. Steele, R. R. Spence & D. Battistutta

  2. QIMR Berghofer Medical Research Institute, Brisbane, Australia

    L. Gordon

  3. Wesley Hospital, Brisbane, Australia

    J. Bashford

  4. Mater Public and Private Hospital, Brisbane, Australia

    C. Pyke

  5. University of Western Australia, Perth, Australia

    C. Saunders

  6. School of Public Health, Cancer Prevention Research Centre, The University of Queensland, Brisbane, Australia

    E. Eakin

Authors
  1. S. C. Hayes
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  2. M. L. Steele
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  3. R. R. Spence
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  4. L. Gordon
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  5. D. Battistutta
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  6. J. Bashford
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  7. C. Pyke
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  8. C. Saunders
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  9. E. Eakin
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Corresponding author

Correspondence to S. C. Hayes.

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Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

A correction to this article is available online at https://doi.org/10.1007/s10549-017-4569-x.

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Hayes, S.C., Steele, M.L., Spence, R.R. et al. Exercise following breast cancer: exploratory survival analyses of two randomised, controlled trials. Breast Cancer Res Treat 167, 505–514 (2018). https://doi.org/10.1007/s10549-017-4541-9

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  • DOI: https://doi.org/10.1007/s10549-017-4541-9

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