Study Population
This study included 184 patients with 23 different tumor types who received 1 of 20 chemotherapy regimens. Characteristics of the study population are displayed in Table 1. Table 2 presents the standard chemotherapy regimens according to cancer type.
Table 1. Characteristics of Study Population. Values are Means + SE
N
|
184
|
Age, mean (SE), y
|
61.8 (3.4)
|
BMI (SE), kg/m2
|
28.1 (2.1)
|
Age Group, %, y
|
|
18-49
|
15.8
|
50-64
|
42.4
|
65-74
|
25.4
|
> 75
|
16.4
|
Male, %
|
36.4
|
Performance Status, %
|
|
ECOG=0
|
39.5
|
ECOG=1
|
27.7
|
ECOG>2
|
13.6
|
Unknown
|
19.2
|
Cancer Type, N (%)
|
|
Brain
|
12 (6.5)
|
Breast
|
66 (35.9)
|
Colorectal
|
16 (8.7)
|
Non-Hodgkins Lymphoma
|
14 (7.6)
|
Hodgkins Lymphoma
|
21 (11.4)
|
Non-Small Cell Lung
|
31 (16.8)
|
Ovarian
|
20 (10.9)
|
Pancreatic
|
4 (2.2)
|
Table 2. Standard Chemotherapy Regimens According to Cancer Type.
Breast Cancer Regimen
|
N
|
TC (4 cycle)
|
23
|
TAC
|
10
|
DD-AC + Paclitaxel
|
12
|
TC (6 cycle)
|
7
|
TCH
|
7
|
AC + Paclitaxel
|
6
|
AC + Docetaxel
|
1
|
Ovarian Cancer Regimen
|
N
|
Carboplatin, paclitaxel
|
18
|
Avastin, Carboplatin, Gemcitabine
|
1
|
BEP - 4 cycle
|
1
|
NSCLC Regimen
|
N
|
Carboplatin, Paclitaxel
|
20
|
Cicplatin, Vinorelbine
|
11
|
Colorectal Cancer Regimen
|
N
|
FOLFOX4
|
2
|
mFOLFOX6
|
13
|
5-FU
|
1
|
Hodgkins Lymphoma
|
N
|
ABVD
|
21
|
Non-Hodgkins Lymphoma
|
N
|
R-CHOP/CHOP
|
11
|
RCVP/CVP
|
3
|
Pancreatic
|
N
|
FOLFORNOX/Gemcitabine/Abraxane
|
2
|
Gemcitabine
|
1
|
Capecitabine (XELODA)
|
1
|
Brain Cancer Regimen
|
N
|
Temodar, Lomustine, Camtosar/Avastin
|
8
|
Temodar, Avastin, Lomustine
|
4
|
Abbreviations: TC, docetaxel, cyclophosphamide; TAC, docetaxel, doxorubicin, cyclophosphamide; DD, Dose Dense; AC, doxorubicin, cyclophosphamide; TCH, docetaxel, carboplatin, trastuzumab; BEP, bleomycin, etoposide, cisplatin; FOLFOX/mFOLFOX, folinic acid, 5-fluorouracil; 5-fu, 5-fluorouracil.
Exercise Adherence
Overall, exercise adherence was 84.3%. In general, as ECOG scores worsened, exercise adherence dropped. For those who had a baseline ECOG score of 1 or 0, exercise adherence was 92%. Conversely, those with a baseline ECOG score of 2 or greater had an exercise adherence of 72.8%.
Dose Delays, Dose Reductions, and RDI
As shown in Table 3, a considerable proportion of patients across regimens had dose delays (18.3%-74.3%) and dose reductions (18.1%-84.6%). Further between 12% and 83.9% of patients missed at least one dose of a myelosuppressive agent that was part of their standard regimen.
Table 4 presents RDI, which ranged from 12.8% for patients with breast cancer treated with dose-dense AC followed by paclitaxel every 2 weeks to 79.3 for patients with pancreatic cancer treated with folinic acid, 5-fluorouracil, oxaliplatin, followed by gemcitabine and abraxane. Overall, 50.8% of patients received less than 85% of the RDI. The incidence of reduced RDI was higher among patients with worse physical performance scores, as measured by ECOG scores. This data is presented in Table 5.
Table 3. Incidence of Dose Delays, Dose Reductions, and Missing Doses. Values are Means. Abbreviations: TC, docetaxel, cyclophosphamide; TAC, docetaxel, doxorubicin, cyclophosphamide; DD, Dose Dense; AC, doxorubicin, cyclophosphamide; TCH, docetaxel, carboplatin, trastuzumab; BEP, bleomycin, etoposide, cisplatin; FOLFOX/mFOLFOX, folinic acid, 5-fluorouracil; 5-fu, 5-fluorouracil.
Breast Cancer Regimen
|
Dose Delay > 7 days, %
|
Dose Reduction > 15%, %
|
Missing Dose, %
|
TC (4 cycle)
|
18.3
|
18.1
|
12
|
TAC
|
32.9
|
27.9
|
21.6
|
DD-AC + Paclitaxel
|
27.1
|
21.4
|
14.8
|
TC (6 cycle)
|
21.9
|
21
|
27.6
|
TCH
|
22
|
18.3
|
29.1
|
AC + Paclitaxel
|
38
|
32.8
|
27.9
|
Ovarian Cancer Regimen
|
|
|
|
Carboplatin, paclitaxel
|
51.5
|
58.2
|
42.5
|
NSCLC Regimen
|
|
|
|
Carboplatin, Paclitaxel
|
60.8
|
72.3
|
46.4
|
Cicplatin, Vinorelbine
|
59.1
|
84.6
|
41.3
|
Colorectal Cancer Regimen
|
|
|
|
FOLFOX4
|
50
|
47.9
|
64.6
|
mFOLFOX6
|
54.6
|
51.4
|
61.7
|
Hodgkins Lymphoma
|
|
|
|
ABVD
|
69.8
|
67.4
|
75.7
|
Non-Hodgkins Lymphoma
|
|
|
|
R-CHOP/CHOP
|
42.7
|
40.6
|
51.6
|
RCVP/CVP
|
47.6
|
43.8
|
43.6
|
Pancreatic
|
|
|
|
FOLFORNOX/Gemcitabine/Abraxane
|
74.3
|
68.4
|
83.9
|
Brain Cancer Regimen
|
|
|
|
Temodar, Lomustine, Camtosar/Avastin
|
70.8
|
51.8
|
75.9
|
Temodar, Avastin, Lomustine
|
51.2
|
76.8
|
72.3
|
Table 4. Incidence of Reduced RDI. Values are means. Parentheses indicate 95% Confidence Interval. Abbreviations: TC, docetaxel, cyclophosphamide; TAC, docetaxel, doxorubicin, cyclophosphamide; DD, Dose Dense; AC, doxorubicin, cyclophosphamide; TCH, docetaxel, carboplatin, trastuzumab; BEP, bleomycin, etoposide, cisplatin; FOLFOX/mFOLFOX, folinic acid, 5-fluorouracil; 5-fu, 5-fluorouracil.
Breast Cancer Regimen
|
RDI <85%, % (95% CI)
|
TC (4 cycle)
|
17.2 (16.8-20.4)
|
TAC
|
26.4 (24.3-30.2)
|
DD-AC + Paclitaxel
|
12.8 (11.7-16.2)
|
TC (6 cycle)
|
29.6 (27.4-33.2)
|
TCH
|
39.0 (37.2-43.8)
|
AC + Paclitaxel
|
21.2 (17.8-24.1)
|
Ovarian Cancer Regimen
|
|
Carboplatin, paclitaxel
|
64.5 (59.3-72.9)
|
NSCLC Regimen
|
|
Carboplatin, Paclitaxel
|
74.3 (72.1-82.4)
|
Cicplatin, Vinorelbine
|
82.0 (75.7-84.3)
|
Colorectal Cancer Regimen
|
|
FOLFOX4
|
71.4 (68.4-81.3)
|
mFOLFOX6
|
65.6 (64.3-69.4)
|
Hodgkins Lymphoma
|
|
ABVD
|
61.4 (58.6-64.8)
|
Non-Hodgkins Lymphoma
|
|
R-CHOP/CHOP
|
47.0 (46.2-50.1)
|
RCVP/CVP
|
45.7 (43.6-48.1)
|
Pancreatic
|
|
FOLFORNOX/Gemcitabine/Abraxane
|
79.3 (72.6-83.0)
|
Brain Cancer Regimen
|
|
Temodar, Lomustine, Camtosar/Avastin
|
65.4 (63.9-68.4)
|
Temodar, Avastin, Lomustine
|
62.4 (58.0-64.7)
|
Table 5. Performance Status and Reduced RDI. Values are means. Abbreviations: TC, docetaxel, cyclophosphamide; TAC, docetaxel, doxorubicin, cyclophosphamide; DD, Dose Dense; AC, doxorubicin, cyclophosphamide; TCH, docetaxel, carboplatin, trastuzumab; BEP, bleomycin, etoposide, cisplatin; FOLFOX/mFOLFOX, folinic acid, 5-fluorouracil; 5-fu, 5-fluorouracil.
|
Breast Cancer
|
Ovarian Cancer
|
NSCLC
|
CRC
|
Hodgkin Lymphoma
|
NHL
|
Pancreatic
|
Brain
|
|
(N=66)
|
(N=20)
|
(N=31)
|
(N=16)
|
(N=21)
|
(N=14)
|
(N=4)
|
(N=12)
|
ECOG=0
|
16.2
|
58.4
|
74.7
|
64.5
|
57.4
|
41.5
|
74.3
|
59.6
|
ECOG=1
|
24.9
|
62.8
|
78
|
68.2
|
58.7
|
44.7
|
79.6
|
63.4
|
ECOG>2
|
32.4
|
72.1
|
82.4
|
74.1
|
65.8
|
51.3
|
83.4
|
66.8
|