Reductions in exercise behavior and tumor progression in newly diagnosed glioblastoma (GBM) patients.
Peters, KB; Threatt, S; Healy, P; Herndon, JE; Lipp, ES; Panta, S; Randazzo, D; Vlahovic, G; Friedman, HS; Desjardins, A
Published in: Journal of Clinical Oncology
e21636 Background: At diagnosis, GBM patients face the immediate challenge of significant morbidity and mortality. In this population, we have shown that better exercise behavior is an independent prognostic factor for improved survival. The association between tumor progression and exercise behavior in newly diagnosed GBM patients was explored within a clinical study investigating the use of bevacizumab (BV) with concurrent chemoradiation, followed by BV and temozolomide with the continuation of BV following progression. Methods: In this prospective single-center study, exercise behavior was evaluated using the Modified Godin Leisure Questionnaire at time of study enrollment (before chemoradiation), after chemoradiation, and then every 6 mos until study discontinuation or subject demise. Physical activity was defined as MET-hr/wk with higher number equaling a better exercise behavior. Results: 68 newly diagnosed GBM patients were initially included with a mean age of 55.4 yrs (sd = 10.7 yrs). KPS range was 70-100 with the following being 70 (n = 4), 80 (n = 28), 90 (n = 34), and 100 (n = 2). Subjects who continued study participation 6 mos after the completion of chemoradiation were divided into two groups: subjects with (n = 13) and without (n = 34) tumor progression 6 mos after chemoradiation completion. Subjects that experience tumor progression < 6 mos after chemoradiation had a lower exercise behavior at baseline in comparison to their counterparts that did not experience progression < 6 mos after chemoradiation (mean = 12.8 MET-hr/wk (sd = 22.2) vs. mean = 22.4 MET-hr/wk (sd = 28.9). Moreover, this exercise behavior decreased in subjects that had tumor progression to mean = 6.6 MET-hr/wk (sd = 7.6) and remained relatively stable in subjects that did not progress with mean = 23.9 MET-hr/wk (sd = 44.9). Conclusions: Our observations of exercise behavior over time suggest that poorer baseline exercise behavior is associated with a disease progression within 6 mos of chemoradiation completion in newly diagnosed GBM patients. Moreover, this exercise behavior continues to decline after progression. Based on these observations, a greater understanding of the role of physical functioning is merited in GBM patients. Clinical trial information: NCT01740258.
