Association of Exercise Behavior with Overall Survival in Stage I-IIIA Lung Cancer

Rationale: Exercise assessments may help predict outcomes for patients with diagnosed lung cancer. Objectives: We examined the relationship between prediagnosis exercise behavior and clinical outcomes among patients with stage I-IIIA lung cancer. Methods: In a retrospective cohort study of patients with stage I-IIIA lung cancer at Kaiser Permanente Colorado who had at least one Exercise Vital Sign assessment-a questionnaire tool to help promote exercise in chronic disease management-within the year before diagnosis, we defined exercise behavior as active (any min/wk of moderate-to-vigorous-intensity physical activity) or inactive (no moderate-to-vigorous physical activity). The outcomes were 1) overall survival (OS) and 2) acute healthcare use (AHCU). We used the Kaplan-Meier method, Cox proportional hazard model, and negative binomial regression model to analyze the effects of exercise on outcomes, adjusting for demographic, socioeconomic, clinical, and lung-cancer characteristics. Results: Among 552 patients with lung cancer, 230 (42%) were identified as physically active before their diagnosis of cancer. There was no significant difference in the stage distribution between active and inactive patients. The median survival times were 2.4 years for the active group and 1.8 years for inactive patients (P < 0.001). The mean rates (standard deviations) of AHCU were 1.09 (1.55) and 2.31 (5.61) per person-year for active and inactive groups, respectively (P < 0.01). Active exercise, compared with inactivity, was associated with better OS (hazard ratio, 0.52 [0.39-0.69]) and lower AHCU (rate ratio, 0.63 [0.49-0.80]) in unadjusted analyses; in adjusted analyses, active exercise was associated with better OS (hazard ratio, 0.62 [0.45-0.86]), but AHCU was not lower by a statistically significant amount (rate ratio, 0.82 [0.65-1.04]). Conclusions: Prediagnosis active exercise was associated with better OS after diagnosis of stage I-IIIA lung cancer. Exercise assessments may help predict outcomes, risk-stratify patients for curative-intent therapy, and identify those who would benefit from increased physical activity and exercise.