Latest news with #JulieGralow
Medscape
11 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.'
Mint
2 days ago
- Health
- Mint
Exercise more effective than drugs in lowering 37% cancer deaths, 28% recurrence, shows new international trial
A groundbreaking international trial involving patients from the US, UK, Australia, France, Canada, and Israel has discovered that following a structured exercise programme after treatment can significantly lower the risk of cancer deaths by third, recurrence, or the development of a new cancer and is even more effective than drugs, The Guardian reported. Patients who started a structured exercise program with the support of a personal trainer or health coach after finishing treatment experienced a 37% lower risk of death and a 28% reduced risk of cancer recurrence or new cancers, compared to those who received only health advice, the trial found. The findings were revealed in Chicago at the American Society of Clinical Oncology (ASCO) annual meeting, the world's largest cancer conference, and published in the New England Journal of Medicine. For the first time in medical history, there is clear evidence that exercise surpasses many commonly prescribed medications in preventing cancer recurrence and death, according to one of the world's leading cancer specialists. In the trial, researchers enrolled 889 colon cancer patients from 2009 to 2023, with the majority (90%) diagnosed with stage three disease. Patients were randomly assigned to participate in a structured exercise programme (445) or to just get a healthy lifestyle booklet (444). Patients in the exercise group met with a personal trainer twice a month for coaching and supervised workouts, later reducing to once a month, continuing this routine for a total of three years. The exercise group received coaching and support to help them reach specific exercise goals. Their weekly target was the equivalent of three to four walks lasting 45 to 60 minutes each, though patients were free to choose their preferred activities, some opted for kayaking or skiing, for example. After five years, those in the exercise group showed a 28% lower risk of cancer recurrence or new cancers compared to the control group. After eight years, they also had a 37% lower risk of death than patients who only received the healthy lifestyle booklet. Dr. Julie Gralow, Chief Medical Officer of ASCO and not involved in the decade-long study, described the quality of the findings as the 'highest level of evidence' and stated that they would bring about 'a major shift in recognising the importance of promoting physical activity during and after treatment.' 'We titled [the session it was presented in] As Good as a Drug. I would have retitled it Better than a Drug, because you don't have all the side-effects. It's the same magnitude of benefit of many drugs that get approved for this kind of magnitude of benefit – 28% decreased risk of occurrence, 37% decreased risk of death. Drugs get approved for less than that, and they're expensive and they're toxic. When I started three decades ago it was still the era where we'd be gentle and say, don't overdo yourself when you're on chemo. We've reversed that. I would say [exercise is] better than a drug,' The Guardian quoted her as saying.
Scottish Sun
3 days ago
- Health
- Scottish Sun
Exercise boosts cancer recovery and slashes risk of death or relapse by a third, major study finds
'BETTER THAN A DRUG' Exercise boosts cancer recovery and slashes risk of death or relapse by a third, major study finds EXERCISE is 'better than a drug' at stopping cancer coming back, a landmark trial suggests. Top doctors say recovering patients should be prescribed personal trainers to boost survival. Advertisement 1 People only needed to walk for three to four hours per week to slash their risk of dying (stock image) Credit: Alamy A Cancer Research UK study showed it could slash bowel cancer patients' risk of death or relapse. Following an exercise programme after treatment reduced their risk of dying within eight years by 37 per cent. And it reduced the chance of a patient's cancer growing back within five years by 28 per cent. Physical activity also appeared to cut the risk for breast and prostate cancers, the two most common types. Advertisement 'Drugs are approved for less' Dr Julie Gralow, president of the American Society of Clinical Oncology, said: 'This is the same magnitude of benefit as many drugs. 'Drugs get approved for less than that and they're expensive and toxic, so I would say it's better than a drug.' Dr Pamela Kunz, of Yale University in the US, said prescribing it was a 'no-brainer'. The world-first trial involved 889 people from Canada and Australia who had received surgery and chemotherapy for colon cancer, the most common form of bowel cancer. Advertisement It affects around 32,000 people per year in the UK and develops in the large intestine. Half of the participants were given basic exercise advice and the other half were assigned personal trainers and given tailored exercise programmes for three years. Sun Health Explainer: Bowel Cancer The plan added the equivalent of three to four hours of walking on top of patients' normal daily activity. At the end of the 15-year trial, people in the personal trainer group were significantly less likely to have relapsed or died. Advertisement Study author Dr Christopher Booth, from Queen's University in Kingston, Canada, said: 'These results are clear: an exercise program that includes a personal trainer will reduce the risk of recurrent or new cancer, make you feel better and help you live longer. 'Most patients chose a walking program and could reach their targets by going for a walk of 45 to 60 minutes three to four times per week. 'The benefit was substantial and in some cases exceeded the benefit of many of our very good medical therapies. 'This sets a new standard of care for colon cancer.' Advertisement If you start exercising after you get through your treatment you still get the benefits – it's not too late Dr Julie Gralow He said that one life was saved for every 14 patients who enlisted in the exercise programme. It cost an estimated £2,500 per patient over three years and the Canadian government is now looking at including it in hospital care. Dr Gralow added: 'If you start exercising after you get through your treatment you absolutely still get the benefits – it's not too late. 'Three decades ago it was still the era of doctors being gentle and saying don't overdo it, but we've reversed that and had a major shift in understanding the importance of physical activity. Advertisement 'We should be doing all we can to help patients be active.'
Boston Globe
3 days ago
- Health
- Boston Globe
Exercise boosts survival rates in cancer patients, study shows
Prior evidence was based on comparing active people with sedentary people, a type of study that can't prove cause and effect. The new study — conducted in Canada, Australia, the United Kingdom, Israel and the United States — compared people who were randomly selected for an exercise program with those who instead received an educational booklet. Get Love Letters: The Newsletter A weekly dispatch with all the best relationship content and commentary – plus exclusive content for fans of Love Letters, Dinner With Cupid, weddings, therapy talk, and more. Enter Email Sign Up 'This is about as high a quality of evidence as you can get,' said Dr. Julie Gralow, chief medical officer of the American Society of Clinical Oncology. 'I love this study because it's something I've been promoting but with less strong evidence for a long time.' Advertisement The findings were featured Sunday at ASCO's annual meeting in Chicago and published by the New England Journal of Medicine. Academic research groups in Canada, Australia and the U.K. funded the work. Researchers followed 889 patients with treatable colon cancer who had completed chemotherapy. Half were given information promoting fitness and nutrition. The others worked with a coach, meeting every two weeks for a year, then monthly for the next two years. Advertisement Coaches helped participants find ways to increase their physical activity. Many people, including Terri Swain-Collins, chose to walk for about 45 minutes several times a week. 'This is something I could do for myself to make me feel better,' said Swain-Collins, 62, of Kingston, Ontario. Regular contact with a friendly coach kept her motivated and accountable, she said. 'I wouldn't want to go there and say, 'I didn't do anything,' so I was always doing stuff and making sure I got it done.' After eight years, the people in the structured exercise program not only became more active than those in the control group but also had 28% fewer cancers and 37% fewer deaths from any cause. There were more muscle strains and other similar problems in the exercise group. 'When we saw the results, we were just astounded,' said study co-author Dr. Christopher Booth, a cancer doctor at Kingston Health Sciences Centre in Kingston, Ontario. Exercise programs can be offered for several thousand dollars per patient, Booth said, 'a remarkably affordable intervention that will make people feel better, have fewer cancer recurrences and help them live longer.' Researchers collected blood from participants and will look for clues tying exercise to cancer prevention, whether through insulin processing or building up the immune system or something else. Swain-Collins' coaching program ended, but she is still exercising. She listens to music while she walks in the countryside near her home. That kind of behavior change can be achieved when people believe in the benefits, when they find ways to make it fun and when there's a social component, said paper co-author Kerry Courneya, who studies exercise and cancer at the University of Alberta. The new evidence will give cancer patients a reason to stay motivated. Advertisement 'Now we can say definitively exercise causes improvements in survival,' Courneya said.
Daily Mail
3 days ago
- Health
- Daily Mail
Simple lifestyle switch can slash colon cancer death by a third: 'It's better than any drug', according to top expert
An hour an a half of daily exercise could slash the risk of dying from colon cancer by more than a third, a pivotal trial has suggested. Regular exercise has long been lauded as a crucial way to not only help stave off cancer, but also lower the chances of it spreading. Now, groundbreaking research has shown patients with the disease saw their risk of death cut by 37 per cent by completing 10 hours of physical activity per week. Anything from a brisk walk to high intensity interval training (HIIT) counted, meaning patients could also choose an activity that best fitted into their lifestyle. Researchers, presenting the findings at the American Society of Clinical Oncology (ASCO) conference in Chicago today, said the study was 'one of the strongest bits of evidence that exercise works' to keep cancer at bay. ASCO president and top cancer specialist Julie Gralow added that findings suggested exercise was 'better than a drug because it doesn't involve side effects'. 'This study shows it's not too late to start exercising even once diagnosed or if patients have started treatment.' The research comes amid a rising ride of colon cancer striking people in their 20s, 30s and 40s —a phenomenon that has baffled doctors around the world. Bowel cancer can cause you to have blood in your poo, a change in bowel habit, a lump inside your bowel which can cause an obstructions. Some people also suffer with weight loss a s a result of these symptoms Over the last 30 years, young diagnoses of the disease have shot up by 80 per cent across the globe. In the world-first trial, a group of international researchers tracked 889 people from six countries, including the UK, Australia and Canada, all of who had undergone surgery and chemotherapy for colon cancer that had spread to nearby lymph nodes but not reached other organs or tissues. Half were prescribed a structured exercise programme, with the other half given health education materials alongside standard follow-up care and surveillance. Those on the exercise regime received in-person coaching sessions every week for the first six months and once a month for the following two and a half years. After five years, scientists found 80 per cent of volunteers in the exercise group remained cancer-free, compared to 74 per cent in the control contingent. They also discovered the risk of death was a third lower in the exercise group. The benefits remained after eight years—patients who stuck to the exercise programme had a 37 per cent lower risk of death, the authors reported in the New England Journal of Medicine. Professor Vicky Coyle, UK lead researcher and clinical professor at Queen's University Belfast, said: 'We supported people to reach their weekly exercise target in a way that worked for them. 'This could be a long, brisk walk every day, but some patients were also doing circuit classes, cycling, swimming, and many other activities. 'Our study gives clear, encouraging evidence that physical activity can reduce the risk of cancer returning for some people with colon cancer.' Dr Joe Henson, study co-author and associate professor in lifestyle medicine at the University of Leicester, added: 'I saw first hand that the exercise reduced fatigue, lifted people's mood, and boosted their physical strength.' He added more research is needed to uncover the reasons behind the positive impact of exercise. Previous research has suggested that exercise can trigger the release of chemicals in the blood that help the immune system hunt and destroy cancer cells. Studies have also found that regular exercise reduces levels of inflammatory proteins in the body that are known to fuel the development of tumours. Natasha Wood, now 40, who lives in London, was diagnosed with stage three colon cancer in 2015 at the age of just 30. She had surgery, followed by six months of chemotherapy and has been in remission since 2016. Ms Wood, who completed half-marathons before her diagnosis, was told by doctors that her baseline fitness level would improve her outcomes. She said: 'The results of this trial corroborate my own personal experience whereby exercise has played a pivotal role both during treatment and in the years following. 'Throughout my treatment I continued to run, swim, cycle and lift weights, habits I've retained in the decade since. 'Exercise has been a cornerstone of my own healthy lifestyle and supported my physical and mental health in equal measure.' The disease, the third most common cancer in the UK, is the same type that killed Dame Deborah James aged 40 in 2022. Although the vast majority of diagnoses affect those aged over 50, rates in older age-groups has either declined or held stable while diagnoses in younger adults have soared over the last 30 years. Doctors have suggested obesity, antibiotic over-use, mobile phone radiation and even invisible particles of plastic in drinking water are potential triggers. However, a growing number of experts are also pointing to ultra-processed foods as a cause. Around 32,000 cases of colon cancer are diagnosed every year in the UK and 142,000 in the US. Symptoms include changes in bowel movements such as consistent and new diarrhoea or constipation, needing or feeling the need to poo more or less frequently and blood in the stool. Stomach pain, a lump in the stomach, bloating, unexpected weight-loss and fatigue are among other common signs.
