The ECHO trial: exercise during chemotherapy for ovarian cancer

Sandra Hayes's research study looks at ovarian cancer in Australia, and whether exercise during chemotherapy is an effective and cost-effective way to improve health outcomes

  • Topic: Ovarian cancer
  • Institution: Queensland University of Technology
  • Country: Australia
  • Status: Ongoing

Scientific abstract

(View plain language abstract)

Background

Ovarian cancer is the most common cause of gynaecological cancer death, with an overall five-year relative survival of only 43%. Treatment typically involves extensive surgery and high-dose chemotherapy. Adverse treatment effects are common, contribute to declines observed in physical wellbeing and overall quality of life during chemotherapy and significantly increase health care costs associated with ovarian cancer treatment. Further, only about one-third of Australian women treated with chemotherapy for ovarian cancer complete the standard chemotherapy regime without dose reduction or delay, potentially compromising outcomes including progression-free survival. Participating in exercise during chemotherapy for other cancer types has been shown to reduce the number and severity of physical and psychosocial treatment-related side effects and improve quality of life (QoL), in particular physical wellbeing. There is also preliminary evidence in the breast cancer setting showing an association between participation in exercise and greater adherence to chemotherapy and improved progression-free survival. Furthermore, physical wellbeing and QoL predict survival in patients with ovarian cancer and are important prognostic variables that are potentially modifiable and amenable to change. However, the potential quality and quantity of life benefits of exercise have not been assessed in women undertaking chemotherapy for ovarian cancer.

Hypothesis and objectives

The aim of this study is to evaluate the effects of an exercise intervention during first-line chemotherapy for ovarian cancer on physical wellbeing, chemotherapy-related adverse events and adherence, physical function, overall QoL, progression-free survival and health care resource use. We hypothesise that a structured exercise intervention during chemotherapy will result in better physical wellbeing post-chemotherapy, fewer and less severe reported chemotherapy-related adverse events, improved chemotherapy adherence, higher physical function and QoL and lower health care costs for complications of ovarian cancer treatment. Compared to women in the usual care group, women in the intervention group will also have improved three-year progression-free survival.

Settings and methods

The proposed study is a phase III, randomised, controlled trial evaluating the effect of an exercise intervention among women undergoing chemotherapy for ovarian cancer. A total of 330 women will be randomized to the usual care or intervention group, with those in the intervention to receive a supervised exercise program (total weekly dose: 150 minutes of moderate-intensity, aerobic- and resistance-based exercise) throughout the duration of their chemotherapy (~18 weeks). Study outcomes will be assessed pre- and post-intervention, as well as at 6- and 12-months post-diagnosis.

Impact

This trial will identify whether incorporation of an exercise program into the management of ovarian cancer is an effective and cost-effective way to improve health outcomes in this understudied patient group. To the best of our knowledge, this is the only exercise trial of women with ovarian cancer during chemotherapy worldwide, with results able to address gaps in the literature currently preventing the translation of exercise into standard cancer care.

Plain language abstract

Background

Ovarian cancer is the most common cause of gynaecological cancer death. Side effects from the disease and its treatments are common, contributing to chemotherapy dose reductions or delays, morbidity and declines in overall quality of life and mortality. Participating in exercise during chemotherapy for other cancer types has been shown to reduce the number and severity of physical and psychosocial treatment-related side effects and improve quality of life, in particular physical wellbeing. There is also preliminary evidence in the breast cancer setting showing an association between participation in exercise and greater adherence to chemotherapy and improved progression-free survival.

Aims and objectives

The aim of the ECHO study is to evaluate the effects of an exercise intervention during first-line chemotherapy for ovarian cancer. More specifically, ECHO will be the first study to assess whether exercise during chemotherapy for ovarian cancer can improve outcomes that matter to the patient (eg, treatment-related side effects, function, quality of life and survival), her treating doctors (adherence to chemotherapy treatment) and the broader health system (morbidity and use of health services).

How it will be done

ECHO is a randomized, controlled trial, evaluating exercise during chemotherapy for ovarian cancer. This means that about half of the women who agree to participate in this trial will be prescribed exercise during their chemotherapy (for approximately 18 weeks), while the other way will continue with standard ovarian cancer care. All women will be asked to participate in data collection sessions before and after their chemotherapy, and at 6- and 12-months post-diagnosis.

Potential impact

This study will identify whether exercise during chemotherapy for ovarian cancer is an effective and cost-effective way to improve health outcomes in this patient group. While women with ovarian cancer are the focus of this study, findings will be of international interest as they will inform cancer care within and beyond the gynaecological cancer setting.