進行がんに対する運動療法RCT

進行がん患者に対する運動療法の効果をみたランダム化比較試験の論文を紹介します。

Line M. Oldervoll, et al: Physical Exercise for Cancer Patients with Advanced Disease: A Randomized Controlled Trial. The Oncologist First Published Online September 26, 2011 doi: 10.1634/theoncologist.2011-0133

生命予後2年以内と判断された進行がん患者231人を対象に、介入群は1回60分、週2回、8週間の運動を行いました。一次アウトカムは疲労（Fatigue Questionnaireで測定）、二次アウトカムはShuttle Walk Testと握力です。

結果ですが、まず介入群の36％と対照群の23％ががんの進行などのために脱落しています。疲労は統計学的有意差を認めませんでしたが、Shuttle Walk Testと握力は介入群で有意によい結果した。これより進行がん患者に対する運動療法は、疲労は改善しないが身体機能の維持に有効な可能性があるとしています。

一次アウトカムで有意差がなかったので、二次アウトカムで有意差があっても仮説以上のものにはなりませんが、仮説として進行がん患者の悪液質に対して、運動療法が有効だと私は考えています。この仮説を検証した論文とはいえないのでやや残念ですが、このようなRCTも実施できるのだと感心しました。

Abstract
Abstract Background. Physical exercise can improve cancer patients' functioning and reduce their symptom levels. A randomized, controlled trial was launched to test the hypothesis that physical exercise reduces fatigue and improves physical performance in cancer patients with advanced and incurable disease.

Methods. Cancer patients (n = 231) with a life expectancy ≤2 years were randomized to a physical exercise group (PEG, n = 121) or a control usual care group (UCG, n = 110). The PEG exercised under supervision 60 minutes twice a week for 8 weeks. Assessments were performed before and after the intervention. The primary outcome was physical fatigue (PF) measured by the Fatigue Questionnaire. Physical performance was a secondary outcome measured by the Shuttle Walk Test (SWT) and hand grip strength (HGS) test. Analyses were performed after multiple imputations for missing data. The trial is registered with ClinicalTrials.gov (identifier, NCT00397774).

Findings. Thirty-six percent of the PEG were lost to follow-up compared with 23% of the UCG, primarily as a result of disease progression. Seventy-eight PEG and 85 UCG patients completed the intervention. Analyses showed no significant between-group effects in PF. However, clinically and statistically significant between-group effects were found for the SWT and HGS test.

Interpretation. Fatigue was not reduced but physical performance (SWT and HGS test) was significantly improved after 8 weeks of physical exercise. Physical exercise might therefore be a suitable approach for maintaining physical capacity in cancer patients with incurable and advanced disease.