Exercise therapy (ET) is shown to improve toxicity and surrogates of survival for patients receiving chemotherapy. Current National Comprehensive Cancer Network (NCCN) guidelines lack recommendations for concurrent radiation therapy (RT) and ET.
To determine the impact of concurrent ET+RT with respect to (1) acceptability, feasibility, safety; and (2) to demonstrate how incorporating ET in cancer treatment can enhance patient reported outcomes (PROs) and physical function-defined as strength or exercise capacity.
A PICOS/PRISMA selection protocol was used to search PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Review for prospective randomized controlled trials evaluating concurrent ET+RT, including >10 patients and with one or more study arms. Acceptability, feasibility, and safety rates were calculated. PROs were assessed with study-specific metrics. Physical function was defined as improvements in strength or range of motion. Statistically significant improvement was defined by p<0.05.
26 of 693 screened studies included 1,574 patients (834 receiving exercise, 740 controls) with localized breast (65.8% of patients), prostate (28.8%), head and neck cancers (2.7%), and spinal metastases (2.7%) were assessed. Objective 1. Among 3,081 patients approached for ET, 1,864 (60.5%) accepted the treatment; of those, 1,574 patients (84.4%) completed the trials. Objective 2. Statistical improvements were noted in these PROs: QOL (12/13 studies), fatigue (14/16 studies), mood (9/10), and anxiety (7/8). Physical function improved statically in 16/16 studies.
Combination ET+RT is safe and well-tolerated with improvements in PROs and physical function. Additional studies are needed in patients with metastatic cancers, to assess survival, and to compare effectiveness of different exercise regimens.

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