Researchers assessed the impact of physical activity levels before and after cancer diagnosis on overall survival (OS) and lymphoma-specific survival (LSS) outcomes in patients with lymphoma. They found that higher levels of physical activity during adult life and within three years of diagnosis improve survival. Priyanka Pophali, MD, at the Mayo Clinic in Rochester, MN, discussed the findings at the ASH Annual Meeting.
A total of 4,087 patients were prospectively enrolled within nine months of diagnosis into the Lymphoma SPORE Molecular Epidemiology Resource cohort between 2002 and 2012. At baseline, patients reported their usual level of mild, moderate, and strenuous physical activity during most of their adult life and again at the three-year follow-up for survivors, which was used to calculate the Godin Leisure Score Index (LSI). At follow-up, patients self-reported change in physical activity since diagnosis as increased, decreased, or no change.
Data were evaluable for 3,129 patients at baseline data (3,060 evaluable for LSI) and for 1,845 at three-year follow-up (1,395 evaluable for LSI).
The median age at diagnosis was 62 years (range = 18–92), and almost all (95%) had and Eastern Cooperative Oncology Group performance status score of less than 2 (95%). Most (85.8%) had no B symptoms (i.e., fever, night sweats, and weight loss), and 63% had advanced disease at diagnosis (stage III–IV).
Diagnoses included chronic lymphocytic leukemia or small lymphocytic lymphoma (25.9%), follicular lymphoma (18.1%), diffuse large B-cell lymphoma (16.8%), marginal zone lymphoma (8.1%), Hodgkin lymphoma (6.9%), mantle cell lymphoma (4.8%), T-cell lymphoma (5%), and other lymphomas (14.3%).
The median LSI was 28 at baseline (range = 0–57) and 25 at three-year follow-up (range = 0–67), with a median change in LSI of –2 (range = –57–61). At a median follow-up of 84 months (interquartile range = 59–119) from diagnosis in the cohort with evaluable baseline physical activity data, 806 deaths (271 in patients with physical activity data at three-year follow-up) and 423 lymphoma-related deaths (104 in patients with physical activity data at three-year follow-up) occurred.
Patients with a higher level of usual physical activity during adult life had significantly better OS and LSS after lymphoma diagnosis compared to those who were less physically active. Baseline LSI was associated with OS (hazard ratio [HR] = 0.95, 95% CI = 0.91–0.99) and LSS (HR = 0.95, 95% CI = 0.90–1.01), and patients in the highest LSI tertile had superior OS (HR = 0.81, 95% CI = 0.68–0.97) and LSS (HR = 0.81, 95% CI = 0.63–1.04) compared to those in the lowest tertile.
Continuous LSI at three-year follow-up was also associated with superior OS (HR = 0.84, 95% CI = 0.77–0.92) and LSS (HR = 0.76, 95% CI = 0.65–0.89). Again, patients in the highest LSI tertile had superior OS (HR = 0.51, 95% CI = 0.34–0.77) and LSS (HR = 0.33, 95% CI = 0.16–0.67) compared to those in the lowest tertile.
A change in LSI from baseline to three-year follow physical activity was associated with superior OS (HR = 0.84, 95% CI = 0.76–0.92) and LSS (HR = 0.74, 95% CI = 0.64–0.87). Compared to patients with stable LSI (defined as a change of LSI between –10 and 5 points from baseline, n = 429), patients who increased LSI by more than 5 points (n = 464) had improved OS (HR = 0.67, 95% CI = 0.45–1.00) and LSS (HR = 0.47, 95% CI = 0.23–0.94), whereas patients who decreased LSI by more than 10 points (n = 477) experienced no impact on OS and LSS.
Higher physical activity at three years was associated with improved survival, whereas a reduction in physical activity was associated with worse outcomes. Self-reported change in physical activity from baseline to three years was associated with OS (p < 0.0001). Compared to those who reported no change, an increase in physical activity was not associated with OS (HR = 0.79, 95% CI = 0.42–1.48) or LSS (odds ratio = 0.73, 0.26–2.07), while a reduction in physical activity was associated with inferior OS (HR = 1.94, 95% CI = 1.49–2.53) and LSS (HR = 2.51, 95% CI = 1.62–3.88).
When excluding patients with any events through three years, the associations for physical activity change and OS remained significant for change in LSI (HR = 0.91, 95% CI = 0.83–1.00) and self-reported decrease in physical activity (HR = 1.83, 95% CI = 1.32–2.53).
“These data support an important role for physical activity in lymphoma survivorship and also provide a strong rationale for a physical activity intervention trial in [patients with] lymphoma,” the researchers concluded.