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Published: Jun 2, 2014
By Ed Susman , Contributing Writer, MedPage Today
CHICAGO — A structured physical exercise program appears to reduce cytokine production related to depression and inflammatory processes that may impact prostate cancer progression, researchers said here.
Patients receiving usual care experienced a 0.08 log10 increase in pro-inflammatory interleukin-6 production, while patients treated with an exercise program experienced a 0.03 log10 decrease in IL-6 (P<0.05), said Charles Kamen, PhD, research assistant professor at the University of Rochester Medical Center in New York.
In his oral presentation at the annual meeting of the American Society of Clinical Oncology, Kamen and colleagues observed a similar relationship with another pro-inflammatory cytokine, interleukin-8. In the control patients, the researchers noted a 0.03 log10 increase compared with a 0.04 log10 decrease among the exercise group, Kamen said.
Using the Profile of Mood States (POMS), the research team determined that psychological distress decreased 5.17 points among the exercise group but increased 2.43 points in the patients who were in the usual control group (P=0.02).
“This study supports the use of exercise for cancer patients for reducing psychological distress and suggests a potential biological mechanism by which this improvement occurs, namely by reducing systemic inflammation,” Kamen said in his presentation.
The research team enrolled 23 patients in the control arm — who were given what was considered usual practice treatment regimens for prostate cancer — and 35 patients (34 finished the study) for the exercise-based study.
Patients were eligible for the study if they had prostate cancer, were scheduled to begin radiation therapy or androgen deprivation therapy, had a Karnofsky Performance Scale score of 60 or higher, had a life expectancy of at least a year, and had approval of their treating physician.
During the first week of the study, the patients were given questionnaires and their history was taken; they were also measured for exercise function capability. Patients were then randomized to standard care — radiation therapy or androgen deprivation therapy — or exercise plus radiation or androgen deprivation therapy.
After week seven, the patients were reassessed.
The mean age of the patients was 67 years, ranging from 51 to 81. Kamen said 16 patients (28%) were older than 75. All the participants were Caucasian; all had a high school degree or higher, and 86% were currently married. A total of 27 patients had opted for radiation treatment, while the remaining 31 had undergone androgen deprivation therapy during the time of the study.
Previous treatment included surgery (23%), chemotherapy (21%), radiation (36%), and hormone therapy (67%), Kamen said.
He said that no adverse events in the study were related to treatment; all were related to prostate cancer or other comorbidities.
The POMS scores were overall significantly in favor of the exercise group, and the subscales all trended in favor of exercise, except for the anger subscale in which there was virtually no change, Kamen said.
Similarly, most pro-inflammatory markers were reduced as well, he said.
In his discussion of the study from the podium, Nathan Berger, MD, of Case Western Reserve University in Cleveland, said there are biological mechanisms of action that support the researcher. “I tell all my patients to exercise,” he said.
Richard Lee, MD, PhD, assistant professor of medicine at Harvard Medical School/Massachusetts General Hospital in Boston, told MedPage Today, “We think exercise is good for all patients; particularly in prostate cancer patients who are undergoing hormone therapies — androgen deprivation therapies — it is even more critical.
“The treatments affect change in metabolism, cause weight gain, cause loss of lean muscle mass, change lipids, increase rates of diabetes, and it thins bones. We are strong proponents of exercise.”
Whether the reduction of marker of inflammation as reported in the study will impact outcomes in prostate cancer “remains an unanswered question,” Lee said. “This is a small, exploratory study that gives us some interesting hypotheses.”
He said that he saw no detrimental issues with encouraging exercise.
Kamen and Berger disclosed no relevant relationships with industry.
Lee disclosed no relevant relationships with industry.