Leana Wen: A Treatment That Could Transform Cancer Care

The results were remarkable. During the follow-up period of approximately eight years, 131 participants in the health education group had a recurrence in colon cancer compared to 93 in the structured exercise group. The exercise group had a 28 percent lower risk of cancer recurrence or developing new cancers compared to the education-only group. Crucially, they had a 37 percent lower overall mortality rate.

While previous research had suggested that exercise and cancer survival were linked, causation was unclear, partly because those who self-reported more physical activity also tended to adopt other healthy behaviors. This is the first randomized study that establishes a clear causal relationship. Notably, the two groups had no significant differences in terms of smoking status or medical problems such as diabetes or depression. And while the exercise group improved overall fitness, participants did not lose weight, indicating that the benefits were independent of obesity-related cancer risks.

The finding should prompt oncologists to revisit treatment strategies. Melinda Irwin, a Yale epidemiology professor and author of an accompanying NEJM editorial, told me that while some medical organizations generally recommend exercise for cancer patients, there is no standard of care that requires counseling patients on exercise, much less referring them to a structured exercise program. Her own institution — a world-renowned cancer center — offers a cancer survivorship program where patients can consult a physical therapist and nutritionist — but only a minority of patients participate, and the visits are not covered by insurance.

Irwin’s research has demonstrated that lifestyle interventions including exercise, healthy eating and weight management can improve the biological markers of inflammation and cell proliferation, thereby slowing cancer progression. She likens this to the transformation that occurred in care for people recovering from heart attacks. For many years, these patients were advised bed rest, Irwin said. “And then the research showed, no, that actually is the worst thing that’s going to increase your risk of a second heart attack.”

“We are not at all there with cancer,” Irwin said. She believes many patients would embrace a holistic approach to cancer care, especially as mounting research shows that lifestyle changes can improve disease-free survival. Although most of her work had been in posttreatment settings, she changed her focus after hearing from clinical trial participants who questioned why they had to wait so long. Why, they asked, weren’t they told about the benefits of exercise and nutrition at the time of diagnosis so they could incorporate these changes throughout treatment?

Changing clinical practice and influencing insurance coverage depends on large-scale randomized trials such as this NEJM study, which can clearly demonstrate survival benefits. Regrettably, obtaining this level of evidence is about to become far more challenging. President Donald Trump’s budget, which has just been approved by the Senate, would slash the National Cancer Institute’s budget by nearly 40 percent. Such a dramatic cut would not only prevent new research from getting off the ground but also imperil promising work already underway.