Combined exercise and diet interventions show potential in improving ovarian cancer patients’ outcomes

A recent British Journal of Cancer study assesses whether a combined routine of exercise and dietary intervention improved fatigue, body composition, and physical functions in patients with ovarian cancer.

Study: Effects of a combined exercise and dietary intervention on body composition, physical functioning and fatigue in patients with ovarian cancer: Results of the PADOVA trial. Image Credit: Hananeko_Studio / Shutterstock.com

Lifestyle treatments for ovarian cancer

Ovarian cancer is one of the most common cancer types that occurs in women. Since this cancer type is usually diagnosed at a very advanced stage, the overall survival rate is poor.

A typical treatment strategy for ovarian cancer is cytoreductive surgery followed by chemotherapy. After this treatment, patients often experience many physical and psychosocial problems, such as fatigue, reduced physical functioning, sarcopenia, and malnutrition, all of which significantly reduce their health-related quality of life (HRQoL).

Proper diet and regular physical activity can significantly benefit a cancer patient’s body composition, HRQoL, fitness, and fatigue levels, so these strategies have been incorporated into international guidelines for cancer care. 

Likewise, many studies have reported the benefits of exercise and dietary interventions on the health outcomes of patients with breast cancer. Since every patient diagnosed with ovarian cancer undergoes different forms of treatment and exhibits varied outcome patterns, it is important to evaluate the efficacy of these interventions in patients with ovarian cancer. 

Although some pilot studies have reported the benefits of moderate-intensity exercise interventions during chemotherapy in patients with ovarian cancer, a well-designed randomized controlled trial (RCT) is needed to assess the effectiveness of a combined exercise and diet intervention approach in this patient population.

About the study

The Physical Activity and Dietary Intervention in OVArian cancer (PADOVA) trial was conducted to evaluate the efficacy of combined exercise and dietary intervention in patients with ovarian cancer and receiving neoadjuvant chemotherapy. The primary outcomes assessed were physical functioning, body composition, and fatigue, while secondary outcomes included HRQoL, physical fitness, anxiety, sleep disturbances, and neuropathy symptoms.

The PADOVA trial is a two-arm multicenter RCT that recruited participants from three gynecological cancer centers in the Netherlands. All study participants were 18 years of age or older, diagnosed with primary epithelial ovarian cancer, and scheduled to receive neoadjuvant chemotherapy. Individuals diagnosed with ovarian cancer for up to five years and not able to perform basic daily activities were excluded from the study.

All study participants were evaluated at baseline (T0), before the first or second chemotherapy cycle, and before randomization. Additionally, each study participant was assessed after the last cycle of chemotherapy (T1) and  12 weeks after T1 (T2). The combined exercise and dietary intervention initiated at the first three-week cycle of chemotherapy continued until the last chemotherapy cycle.

At baseline, the stage of ovarian cancer was stratified by the FIGO stage, which includes the low (I/II) and high (III/IV) stages, with treatment strategies determined accordingly. Subsequently, study participants were randomly assigned to the intervention or control group within each stratum.

Study findings

No significant difference was observed in physical functioning, body composition, or fatigue between the intervention and control groups. A total of 81 individuals completed the trial, with an additional 63 candidates completing only the baseline questionnaire.

The average age of the participants was 59 years, and 60% of the cohort received primary surgery followed by adjuvant chemotherapy treatment. There was no significant age difference between the intervention and control groups.

Patients who received neoadjuvant chemotherapy were more likely to opt out of follow-up visits than those who received adjuvant chemotherapy treatment. Both intervention and control groups exhibited similar trajectories of increasing body composition and physical functioning and decreasing fatigue.

The diagnosis of ovarian cancer at an advanced stage could be one reason for the lack of a difference in outcomes between the intervention and control groups. In an advanced stage, patients experience multiple syndromes, such as pain, which already influences their physical functioning and HRQoL at diagnosis. Surgery and chemotherapy could mitigate these symptoms and improve HRQoL.

The explorative analysis indicates that the efficacy of the combinational exercise and dietary intervention significantly depends on the level of adherence. 

Strengths and limitations

A primary strength of the current study is its randomized controlled design. Another strength is that the intervention was developed based on state-of-the-art dietary guidelines, exercise principles, and Bandura’s Social Cognitive Theory, each of which has been identified as important factors that can improve health behaviors in cancer patients.

The current study has some limitations, including using the bioelectrical impedance assessment (BIA) method instead of using computed tomography (CT) scans to determine body composition. Furthermore, the BIA method has limitations in patients with ascites, which could affect the accuracy of body composition measurements.

In comparison to breast cancer patients, who are often diagnosed at an earlier stage, ovarian cancer is often diagnosed in women between 50 and 79 years of age at a later stage. Therefore, screening for women with ovarian cancer in the younger cohort could project a lower number of patients.