Evaluating the role of exercise as a management strategy to counteract the burden of cancer cachexia

Cancer cachexia is a multifactorial syndrome characterised by progressive, involuntary body weight loss and skeletal muscle wasting. Cachexia disproportionately affects patients with advanced or incurable cancers and significantly contributes to cancer morbidity and mortality. The physical and psychosocial burden of cancer cachexia is extensive and includes reductions in physical function, a greater number of and more severe cancer symptoms, increased patient-reported distress (i.e., anxiety and depression), and lower overall quality of life (QOL). Despite the burden of cancer cachexia, no universal therapies exist for its treatment and management. Moreover, supportive care options for cancer cachexia are limited and understudied. Many patients do not feel their cachexia receives enough attention and particularly in its early stages, cancer cachexia often goes clinically unnoticed. Exercise is safe, accessible, and inexpensive relative to other pharmaceutical and medical interventions. Exercise also has established health and QOL benefits in people with cancer, although this is principally established among patients with early-stage disease who do not have cachexia. There is both a strong rationale and preliminary evidence in people with more advanced disease to suggest exercise may be an important addition to cancer cachexia management strategies to address unmet patient needs.

The current thesis aims to evaluate the role of exercise as a management strategy to counteract the burden of cancer cachexia in a series of carefully designed studies. The primary findings are: 1) an existing multidisciplinary clinical service for cancer cachexia that prescribes combined medical, pharmaceutical, dietary, and exercise-based support is associated with significant improvements in patient-reported QOL and symptoms, but not clinically-assessed physical function and muscular strength; 2) people with advanced cancer and cachexia perceive exercise as important for their physical and psychosocial health and wellbeing and prefer exercise options with greater support (e.g., professionally supervised and structured exercise) and access (e.g., convenient exercise options) to overcome multifaceted exercise barriers and maximise the potential benefits of exercise; and 3) a virtually supervised exercise intervention delivered using an internet-based videoconference platform is safe and feasible in people with advanced cancer and cachexia and has benefits on physical function and patient-reported outcomes. Overall, findings from the current thesis help fill critical research gaps on the potential role of exercise for people with advanced cancer and cachexia. The current thesis contributes important new knowledge underscoring that exercise is valued by patients with cancer cachexia and has the potential to be a meaningful intervention. Further, a virtually supervised, structured exercise intervention is feasible in patients with advanced cancer and cachexia and may be a critical new way to provide convenient high-quality exercise-based support to higher risk patients. Altogether, results from the current thesis lay the much-needed groundwork for future high-impact studies in the emerging field of exercise and cancer cachexia research.