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Cancer – Improves quality of life

Evidence summary (Updated 2022)

In the first evidence summary launched in 2018, no improvement in quality of life (QoL) was demonstrated in meta-analysis and systematic reviews for breast or prostate cancer, however for head and neck cancers there was control or improvement.(1–3)
In a recent review of the evidence 57 reviews were shown to have a definite positive effect on quality of life outcome measures(4–60).
One of these studies was a Cochrane review by McGettigan et al who found that physical activity had a positive effect on the HR-QoL (Health related Quality of Life) for up to a 6 month follow-up period (SMD 0.36, 95% CI 0.10 to 0.62; 6 studies, 230 participants; I2 = 0%; moderate-quality evidence) for non-advanced colo-rectal cancer.(58)
Four of 57 studies reported an improvement seen before the treatment stage/ prehabilitation before surgery(30,39,43,50). Ten of 57 studies reported an improvement on QoL seen during the treatment stage(4,10,21,27,28,32,36,37,40,58). The majority reported on interventions during and post treatment(6–9,12–14,17,18,23,26,29,31–35,42,44–47,54,57). Ten of 57 studies reported on improved QoL outcomes with PA interventions following cancer treatment(16,20,24,38,41,49,51–53,55). Nine of 57 did not specify the treatment stage of the interventions(5,11,15,19,22,25,48,56,59).
While the majority reported on multiple cancer types(19,27–33,38,39,42–46,51–53,57,59), these included any combination of the following; breast, lung, gastrointestinal, gynaecological, prostate, testicular or haematological and with bone metastases(60). Several reported on a single cancer only; improved QoL outcomes with the physical activity intervention group was seen in breast(4,5,7–10,12–18,20–26), gastrointestinal(34,49,53–56,58), prostate(35–37), lung(40,41), urological(47,50), brain(6), head and neck(48) cancer patients.
When considering the intervention type studies considered multiple or combination physical activity/exercise interventions (6,8,25,28,35–37,39,41,54–56,9,57,60,11,12,16,18,20,21,24). Combined aerobic and anaerobic activities were evaluated (4,7,10,14,23,29,32,38,40,43,44,46–51,58,59). Studies evaluating single activity type interventions found resistance training(15), HIIT(31,45,52), aerobic(17,34), exer-gaming(42), mind-body exercises(33) such as Qigong(19), Tai Chi, yoga(9,26), and Pilates(13) exercise interventions were shown to be effective(5,27).
Interventions of any frequency, intensity and duration were included in several the studies. Improvements in QoL were seen in moderate(17,27), moderate-vigorous(4,6,29,36,38) and vigorous(31) intensity interventions. Published reviews also looked at the combined role of nutritional and exercise interventions(53).

Quality of evidence
Grade B – Moderate

Strength of recommendation
Grade 2 – weak

Improvements have been seen in QoL outcomes, mental health outcomes and sleep quality. The evidence is mostly moderate in quality. There is high heterogeneity in both interventions and outcome measure. Overall patients would expect an improvement in quality of life with benefits outweighing risks.


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