Latest news with #ChristopherBooth
Medscape
8 hours ago
- Health
- Medscape
Can Lifestyle Changes Save Lives in Colon Cancer?
Can exercise 'therapy' and diet improve survival in patients with colon cancer? It appears so, according to two pivotal studies presented at American Society of Clinical Oncology (ASCO) 2025 annual meeting. In the CHALLENGE trial, a structured exercise program after surgery and adjuvant chemotherapy cut the risk for colon cancer recurrence in patients with stage III and high-risk stage II disease by more than one quarter and the risk for death by more than one third. 'The magnitude of benefit with exercise is substantial. In fact, it is comparable, and in some cases exceeds the magnitude of benefit of many of our very good standard medical therapies in oncology,' study presenter Christopher Booth, MD, with Queen's University, Kingston, Ontario, Canada, told attendees. Results of the study were published online in The New England Journal of Medicine to coincide with the presentation at the meeting. The findings are 'nothing short of a major milestone,' said study discussant Peter Campbell, PhD, with Montefiore Einstein Comprehensive Cancer Center, Bronx, New York. The other study showed that eating a less inflammatory diet may reduce the risk for death in patients with colon cancer, with the greatest benefits seen in those who embraced anti-inflammatory foods and exercised regularly. 'Putting these two abstracts into perspective, we as physicians need to be essentially prescribing healthy diet and exercise. The combination of the two are synergistic,' Julie Gralow, MD, ASCO chief medical officer and executive vice president, told attendees. Despite the benefits of these lifestyle changes, exercise and diet are meant to supplement, not replace, established colon cancer treatments. It would be a false binary to frame this as lifestyle vs cancer treatment, explained Mark Lewis, MD, director of Gastrointestinal Oncology at Intermountain Healthcare in Salt Lake City, Utah. With exercise, for instance, 'the key is giving enough chemo to protect against recurrence and eliminate micrometastases but not so much that we cause neuropathy and reduce function and ability to follow the CHALLENGE structured program,' Lewis said. Exercise and Survival Colon cancer remains the second leading cause of cancer death worldwide. Even with surgery and chemotherapy, roughly 30% of patients with stage III and high-risk stage II colon cancer will experience disease recurrence. 'As oncologists, one of the most common questions we get asked by patients is — what else can I do to improve my outcome?' Booth said. Observational studies published nearly two decades ago hinted that physically active cancer survivors fare better, but no randomized trial has definitively tested whether exercise could alter disease course. That knowledge gap prompted the Canadian Cancer Trials Group to launch the CHALLENGE trial. Between 2009 and 2023, the phase 3 study enrolled 889 adults (median age, 61 years; 51% women) who had completed surgery and adjuvant chemotherapy for stage III (90%) or high-risk stage II (10%) colon cancer. Most patients were from Canada and Australia and were enrolled 2-6 months after completing chemotherapy. Half of study participants were randomly allocated to a structured exercise program (n = 445) and half to receive standard health education materials promoting physical activity and healthy eating (control individuals, n = 444). As part of the structured exercise intervention, patients met with a physical activity consultant twice a month for the first 6 months. These sessions included exercise coaching and supervised exercise. Patients could choose their preferred aerobic exercise and most picked brisk walking. The consultants gave each patient an 'exercise prescription' to hit a specific amount of exercise. The target was an additional 10 metabolic equivalent (MET)–hours of aerobic activity per week — about three to four brisk walks each lasting 45-60 minutes. After 6 months, patients met with their consultants once a month, with additional sessions available for extra support if needed. Structured exercise led to 'substantial and sustained' increases in the amount of exercise participants did, as well as physiologic measures of their fitness, with 'highly relevant' improvements in VO2 max, 6-minute walk test, and patient-reported physical function, underscoring that participants were not only exercising more but also getting fitter, Booth said. Exercise was associated with a clinically meaningful and statistically significant 28% reduction in the risk for recurrent or new cancer (hazard ratio [HR], 0.72; P = .017), with a 5-year disease free survival rate of 80% in the exercise group and 74% in the control group. In other words, 'for every 16 patients that went on the exercise program, exercise prevented 1 person from recurrent or new cancer' at 5 years, Booth reported. Overall survival results were 'even more impressive,' he said. At 8 years, 90% of patients in the exercise program were alive vs 83% of those in the control group, which translated to a 37% lower risk for death (HR, 0.63; P = .022). 'For every 14 patients who went on the exercise program, exercise prevented 1 person from dying' at the 8-year mark, Booth noted. 'Notably, this difference in survival was not driven by difference in cardiovascular deaths but by a reduction in the risk of death from colon cancer,' he said. Besides a slight uptick in musculoskeletal aches, no major safety signals emerged in the exercise group. It's important to note that the survival benefit associated with exercise came after patients had received surgery followed by chemotherapy — in other words, exercise did not replace established cancer treatments. It's also unclear whether initiating an exercise intervention earlier in the treatment trajectory — before surgery or during chemotherapy, instead of after chemotherapy — could further improve cancer outcomes, the authors noted. Still, 'exercise as an intervention is a no brainer and should be implemented broadly,' said ASCO expert Pamela Kunz, MD, with Yale School of Medicine, New Haven, Connecticut. Marco Gerlinger, MD, with Barts Cancer Institute, London, England, agreed. 'Oncologists can now make a very clear evidence-based recommendation for patients who just completed their chemotherapy for bowel cancer and are fit enough for such an exercise program,' Gerlinger said in a statement from the nonprofit UK Science Media Centre. Booth noted that knowledge alone will not be sufficient to allow most patients to change their lifestyle and realize the health benefits. 'The policy implementation piece of this is really key, and we need health systems, hospitals, and payers to invest in these behavior support programs so that patients have access to a physical activity consultant and can realize the health benefits,' he said. 'This intervention is empowering and achievable for patients and with much, much lower cost than many of our therapies. It is also sustainable for health systems,' he concluded. Diet and Survival Diet can also affect outcomes in patients with colon cancer. In the same session describing the CHALLENGE results, Sara Char, MD, with Dana-Farber Cancer Institute in Boston, reported findings showing that consuming a diet high in proinflammatory foods was associated with worse overall survival in patients with stage III colon cancer. A proinflammatory diet includes red and processed meats, sugary drinks, and refined grains, while an anti-inflammatory diet focuses on fruits, vegetables, whole grains, fish, and olive oil. Chronic systemic inflammation has been implicated in both colon cancer development and in its progression, and elevated levels of inflammatory markers in the blood have previously been associated with worse survival outcomes in patients with stage III colon cancer. Char and colleagues analyzed dietary patterns of a subset of 1625 patients (mean age, 61 years) with resected stage III colon cancer enrolled in the phase 3 CALGB/SWOG 80702 (Alliance) clinical trial, which compared 3 months of adjuvant chemotherapy with 6 months of adjuvant chemotherapy, with or without the anti-inflammatory medication celecoxib. As part of the trial, participants reported their diet and exercise habits at various timepoints. Their diets were scored using the validated empirical dietary inflammatory pattern (EDIP) tool, which is a weighted sum of 18 food groups — nine proinflammatory and nine anti-inflammatory. A high EDIP score marks a proinflammatory diet, and a low EDIP score indicates a less inflammatory diet. During median follow-up of nearly 4 years, researchers noted a trend toward worse disease-free survival in patients with high proinflammatory diets (HR, 1.46), but this association was not significant in the multivariable adjusted model (HR, 1.36; P = .22), Char reported. However, higher intake of proinflammatory foods was associated with significantly worse overall survival. Patients who consumed the most proinflammatory foods (top 20%) had an 87% higher risk for death compared with those who consumed the least (bottom 20%; HR, 1.87). The median overall survival in the highest quintile was 7.7 years and was not reached in the lowest quintile. Combine Exercise and Diet for Best Results To examine the joint effect of physical activity and diet on overall survival, patients were divided into higher and lower levels of physical activity using a cut-off of 9 MET hours per week, which roughly correlates to 30 minutes of vigorous walking five days a week with a little bit of light yoga, Char explained. In this analysis, patients with less proinflammatory diets and higher physical activity levels had the best overall survival outcomes, with a 63% lower risk for death compared with peers who consumed more pro-inflammatory diets and exercised less (HR, 0.37; P < .0001). Daily celecoxib use and low-dose aspirin use (< 100 mg/d) did not affect the association between inflammatory diet and survival. Char cautioned, that while the EDIP tool is useful to measure the inflammatory potential of a diet, 'this is not a dietary recommendation, and we need further studies to be able to tailor our findings into dietary recommendations that can be provided to patients at the bedside.' Gralow said this 'early but promising observational study suggests a powerful synergy: Patients with stage III colon cancer who embraced anti-inflammatory foods and exercised regularly showed the best overall survival compared to those with inflammatory diets and limited exercise.'
Hamilton Spectator
3 days ago
- Health
- Hamilton Spectator
Exercise improves colon cancer survival, Canadian researchers say
TORONTO - Canadian researchers say a new study shows regular exercise improves survival for colon cancer patients. The study, published Sunday in the New England Journal of Medicine, found that patients who participated in a supervised exercise program after completing their chemotherapy were 28 per cent less likely to have their colon cancer return than patients in the control group. 'It's the first clinical trial in the world asking whether exercise can improve cancer survival. And in fact, the results were astounding,' Dr. Christopher Booth, a co-chair of the international study and a medical oncologist at Kingston Health Sciences Centre in Kingston, Ont., said in an interview. The patients in the exercise group regularly met with a physical activity consultant — usually a physiotherapist, kinesiologist or personal trainer — to help them stick to a structured exercise program for three years. The patients in the control group received health education materials that encouraged physical fitness after their chemotherapy, but were not given a physical activity support person. The patients in the structured exercise group had a 37 per cent lower risk of death than those in the control group, the study said. The study, which was conducted in cancer centres across Canada and in other countries including Australia and the U.K., shows a prescription for a structured exercise program should be part of the treatment for colon cancer, said Booth, who is also a professor of oncology at Queen's University. 'If we had a cancer drug with this amount of benefit, it would cost between $100,000 and $200,000 per year (and) it would be celebrated in all the major guidelines across oncology societies worldwide,' he said. 'And there's no question it would be funded by health systems worldwide and included as a standard of care.' Although the research team hasn't yet done a formal cost-benefit analysis, Booth said the cost of providing a physical activity support person for three years would likely be between $3,000 and $5,000 per patient. That would be a worthwhile investment for the health-care system to make, he said. 'When we have something like exercise, which is both incredibly affordable and sustainable for health systems with comparable magnitude of benefit, I think it would be a tragic failure of health policy not to ensure this is provided to all patients.' Booth and his colleagues started the randomized control trial, a model widely considered the gold standard in medical research, more than 15 years ago after seeing promising data in observational studies suggesting exercise would benefit colon cancer patients. The trial included 889 colon cancer patients, followed between 2009 and 2024, who had completed their chemotherapy treatments. The researchers assessed their baseline level of fitness and randomized them to assign half the participants to the structured exercise group and the other half to the control group. Those in the exercise group saw a physical activity consultant every two weeks for their first year in the study and then once a month for two years afterward. During those sessions, they would work on motivation and goal-setting to reach their targeted hours of exercise per week. The second part of the session was a supervised exercise session. Their goal was to increase their exercise level by at least 10 metabolic equivalents, or METS, per week. A MET is a unit of energy expended. Participants could choose what exercises they wanted to do as long as they met their MET target. Many chose brisk walking, which adds up to about four METS an hour. One of those participants was Terri Swain-Collins, who lives in Kingston and is one of Booth's patients. Now 62, Swain-Collins was diagnosed with stage 3 colon cancer in June 2021 after a screening test and follow-up colonoscopy. When Booth asked if she would be interested in participating in the study, she didn't know whether she would be in the structured exercise group or the control group. Swain-Collins was assigned to the exercise group. At the time, she was returning to work as a busy X-ray technologist after her treatment, plus helping to manage her husband's business, and wasn't sure where she'd find the time for exercise. Thanks to the physiotherapist assigned to her, she was motivated to walk for at least 45 minutes, three times a week. 'Being accountable to her is what really helped me continue with it,' Swain-Collins said in an interview. 'If I'd have been just told, you know, 'exercise is good for you and off you go,' I never would have done what I'm doing now,' she said. There's no sign of her cancer returning and Swain-Collins said she's 'definitely' more fit now. 'I hope anyone diagnosed with cancer does get this type of opportunity,' she said. 'I think it might really make a difference.' This report by The Canadian Press was first published June 1, 2025. Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
Winnipeg Free Press
3 days ago
- Health
- Winnipeg Free Press
Exercise improves colon cancer survival, Canadian researchers say
TORONTO – Canadian researchers say a new study shows regular exercise improves survival for colon cancer patients. The study, published Sunday in the New England Journal of Medicine, found that patients who participated in a supervised exercise program after completing their chemotherapy were 28 per cent less likely to have their colon cancer return than patients in the control group. 'It's the first clinical trial in the world asking whether exercise can improve cancer survival. And in fact, the results were astounding,' Dr. Christopher Booth, a co-chair of the international study and a medical oncologist at Kingston Health Sciences Centre in Kingston, Ont., said in an interview. The patients in the exercise group regularly met with a physical activity consultant — usually a physiotherapist, kinesiologist or personal trainer — to help them stick to a structured exercise program for three years. The patients in the control group received health education materials that encouraged physical fitness after their chemotherapy, but were not given a physical activity support person. The patients in the structured exercise group had a 37 per cent lower risk of death than those in the control group, the study said. The study, which was conducted in cancer centres across Canada and in other countries including Australia and the U.K., shows a prescription for a structured exercise program should be part of the treatment for colon cancer, said Booth, who is also a professor of oncology at Queen's University. 'If we had a cancer drug with this amount of benefit, it would cost between $100,000 and $200,000 per year (and) it would be celebrated in all the major guidelines across oncology societies worldwide,' he said. 'And there's no question it would be funded by health systems worldwide and included as a standard of care.' Although the research team hasn't yet done a formal cost-benefit analysis, Booth said the cost of providing a physical activity support person for three years would likely be between $3,000 and $5,000 per patient. That would be a worthwhile investment for the health-care system to make, he said. 'When we have something like exercise, which is both incredibly affordable and sustainable for health systems with comparable magnitude of benefit, I think it would be a tragic failure of health policy not to ensure this is provided to all patients.' Booth and his colleagues started the randomized control trial, a model widely considered the gold standard in medical research, more than 15 years ago after seeing promising data in observational studies suggesting exercise would benefit colon cancer patients. The trial included 889 colon cancer patients, followed between 2009 and 2024, who had completed their chemotherapy treatments. The researchers assessed their baseline level of fitness and randomized them to assign half the participants to the structured exercise group and the other half to the control group. Those in the exercise group saw a physical activity consultant every two weeks for their first year in the study and then once a month for two years afterward. During those sessions, they would work on motivation and goal-setting to reach their targeted hours of exercise per week. The second part of the session was a supervised exercise session. Their goal was to increase their exercise level by at least 10 metabolic equivalents, or METS, per week. A MET is a unit of energy expended. Participants could choose what exercises they wanted to do as long as they met their MET target. Many chose brisk walking, which adds up to about four METS an hour. One of those participants was Terri Swain-Collins, who lives in Kingston and is one of Booth's patients. Now 62, Swain-Collins was diagnosed with stage 3 colon cancer in June 2021 after a screening test and follow-up colonoscopy. When Booth asked if she would be interested in participating in the study, she didn't know whether she would be in the structured exercise group or the control group. Swain-Collins was assigned to the exercise group. At the time, she was returning to work as a busy X-ray technologist after her treatment, plus helping to manage her husband's business, and wasn't sure where she'd find the time for exercise. Thanks to the physiotherapist assigned to her, she was motivated to walk for at least 45 minutes, three times a week. 'Being accountable to her is what really helped me continue with it,' Swain-Collins said in an interview. 'If I'd have been just told, you know, 'exercise is good for you and off you go,' I never would have done what I'm doing now,' she said. There's no sign of her cancer returning and Swain-Collins said she's 'definitely' more fit now. 'I hope anyone diagnosed with cancer does get this type of opportunity,' she said. 'I think it might really make a difference.' This report by The Canadian Press was first published June 1, 2025. Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
Globe and Mail
3 days ago
- Health
- Globe and Mail
International clinical trial shows exercise improves survival for colon cancer patients
For nearly two decades, researchers from around the world have explored a question in a clinical trial considered the first of its kind: Can physical activity improve cancer survival? The answer, according to their research, is a resounding yes. The study from a trial called the CO.21 Challenge, published in the New England Journal of Medicine on Sunday, says a structured exercise program significantly improves survival for colon cancer patients. From 2009 until 2024, researchers looked at the impact of physical activity on patients with Stage 3 or high-risk Stage 2 colon cancer. The trial included 889 patients who'd had surgery and chemotherapy. The participants were randomly assigned to participate in a structured exercise program with an exercise therapist over a three-year period, or they received health education materials on the benefits of physical activity and nutrition. The patients also received cancer surveillance and follow-up care. The results showed a significant improvement in overall survival and disease-free survival among participants assigned to the exercise program in comparison with those who only received the health education materials. The research found patients in the structured exercise program had a 37-per-cent lower risk of death and a 28-per-cent lower risk of recurrence or developing other cancers. Christopher Booth, an oncologist at Kingston Health Sciences Centre and a professor of oncology at Queen's University who co-chaired the global cancer trial, said that he didn't sleep for days after first seeing the results. He experienced a sense of joy and exhilaration, for both patients and for the future of cancer care. 'I think this really does change the landscape of cancer treatment; it opens an entirely new avenue of cancer therapy,' Dr. Booth told The Globe and Mail by phone. Dr. Booth's fellow chair is Kerry Courneya, a professor and Canada Research Chair in physical activity and cancer at the University of Alberta. He said the study shows exercise is no longer only an intervention for quality-of-life. 'It is a treatment for colon cancer that must be made available to all patients,' Dr. Courneya said. Gen X and millennials blindsided by rising rates of cancer Terri Swain-Collins, a 62-year old who lives in Kingston and who participated in the trial, said working with a trainer over a three-year period helped her establish and maintain a fitness plan. She was diagnosed with colon cancer in June, 2021. Ms. Swain-Collins said the sense of accountability made 'all the difference' and simply being told to work out by a doctor would not have been enough. She appreciated the regular check-ins, as well as being able to have someone with her while she logged steps on a treadmill. Dr. Booth, Ms. Swain-Collins's oncologist, said researchers were thrilled to see behavioural changes could lead to positive outcomes for patients. For example, he said they felt better; their fitness improved. On top of that, he said, the scale of the benefit of exercise is, in some cases, better than what is offered through many standard cancer drug regimes. Dr. Booth said it is important to note that the exercise program offered added benefits on top of those from surgery and chemotherapy. After nearly two decades of working on the research (for reference, Dr. Booth started working on it when his wife was pregnant with their child who is now 18), he is hopeful the findings can help change the standards for colon cancer care. But he said knowledge of the benefits of exercise won't be sufficient to see most people change their lifestyle and to sustain change. A new model, he said, should see patients who have had surgery and received chemotherapy treatments with oncologists like himself referred to an exercise specialist who can then work with them over the next three years. 'We need to ensure the health systems provide this structured behaviour change intervention,' he said, adding an exercise consultant should be part of the health care team.
New York Times
3 days ago
- Health
- New York Times
Exercise Extends Life for People With Cancer, Study Shows
A first-of-its kind study adds powerful new evidence to research showing that exercise improves cancer survival. The study, a randomized controlled trial of nearly 900 patients at 55 cancer centers in six countries, showed that people who participated in a structured exercise program lived longer without their cancer coming back and without the occurrence of new cancers. Participants in the exercise program had a 37 percent lower risk of dying and a 28 percent lower risk of recurrent or new cancer than those in the control group. Earlier research had suggested such a benefit, but the data were from observational studies that did not prove a causal link, experts said. 'We now have definitive evidence that exercise is not just an intervention for quality of life and fitness. This is an intervention that improves survival and should be standard of care,' said Dr. Christopher Booth, the senior author of the paper and a professor of oncology at Queen's University in Canada. The study, which was published Sunday in the New England Journal of Medicine, looked at patients with Stage III or high-risk Stage II colon cancer who received standard surgery and chemotherapy treatment. Researchers randomly assigned these patients to a control group, which received educational materials promoting physical activity and healthy nutrition, or to a treatment group, which also received support from a 'physical activity consultant' — a hybrid of personal trainer and life coach — over three years to increase their aerobic exercise and sustain it. Patients could choose a number of activities, such as biking, jogging, swimming or kayaking, but most opted for a brisk walk of 45 minutes four times a week, Dr. Booth said. Eighty percent of patients in the exercise group remained disease-free after five years, compared to 74 percent of patients in the control group. After eight years, the exercise program had prevented one death for every 14 people who participated in the exercise arm of the study. Want all of The Times? Subscribe.
