Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

The effect of exercise interventions on hospital length of stay and admissions during cancer treatment: a systematic review and meta-analysis (#377)

David Mizrahi 1 , Jonathan Lai 2 , Hayley Wareing 2 , Yi Ren 2 , Tong Li 1 , Christopher Swain 3 , David Smith 1 , Diana Adams 4 , Alexandra Martiniuk 1 , Michael David 1
  1. The Daffodil Centre, a joint venture with Cancer Council NSW, The University of Sydney, Sydney, NSW, Australia
  2. University of Sydney, Sydney, Australia
  3. Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
  4. Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney

Background: Exercise during cancer treatment is safe, reduces side-effects, and can potentially reduce hospital length of stay. This systematic review and meta-analysis of randomized controlled trials is the first to investigate whether participating in an exercise intervention during chemotherapy, radiotherapy or stem cell transplant cancer treatment regimens reduced the duration and frequency of hospital admissions.

Methods: Four electronic databases (Medline, EMBASE, PEDro and Cochrane Central Registry of Randomized Controlled Trials) were systematically searched from inception until March 2023. Eligible studies included randomized controlled trials which evaluated exercise interventions implemented during chemotherapy, radiotherapy or stem cell transplant regimens compared with usual care, and which assessed hospital admissions. Study selection and data extraction were dual-screened. Study quality was assessed using the Cochrane Risk-of-Bias tool (RoB 2) and GRADE assessment. Meta-analyses were conducted by pooling the data using random-effects models.

Results: Of 3918 screened abstracts, 20 studies met inclusion criteria, including 2635 participants (1383 intervention, 1252 control, 62% female, mean age=52.2±10.9 years from 18 adult studies and 11.2±3.5 years from two paediatric studies). Twelve studies were conducted during hematopoietic stem cell transplantation and eight during chemotherapy regimens. There was a small effect size in a pooled analysis that exercise during treatment reduced hospital length of stay by 1.40 days (95% CI: -2.26 to -0.54 days; low-quality evidence), and an 8% lower rate of hospital admission (difference in proportions = -0.08, 95% CI: -0.13 to -0.03, low-quality evidence). Most interventions reporting safety reported no adverse events, with three adverse events reported in two studies.

Conclusion: Exercise during cancer treatment can decrease both hospital length of stay and admissions. A small effect size and high heterogeneity limits the certainty. While exercise is factored into some multidisciplinary care plans, its inclusion as standard practice for most patients who would benefit should be considered as cancer care pathways evolve.