Physical activity and systemic treatment outcomes in advanced thyroid cancer

Introduction Physical activity interventions could play a critical role in tolerance and outcome during anti-neoplastic therapy. Aim This study aims to evaluate the role of physical activity and its maintenance on treatment safety and efficacy in patients with advanced thyroid cancer. Methods We enrolled 28 patients with advanced thyroid cancer, treated with kinase inhibitor therapy for a median follow-up of 26 months. Three modified long-form International Physical Activity Questionnaires were administered before treatment, at an intermediate follow-up point and at the last follow-up point. Metabolic equivalents were calculated at each time point. Tumour response was evaluated according to RECIST, version 1.1. Results Patients inactive at baseline experienced more treatment interruptions during both the first (85 vs 30%, P = 0.01) and second half of the follow-up period (85 vs 47%, P = 0.08) and had more frequently a progressive disease (42 vs 14%, P = 0.15), compared to those who were mildly or highly active. Patients who declined their physical activity during treatment had more treatment interruptions (100 vs 31%, P = 0.006), more adverse events considering both the number (>5) and the grade (≥3) (100 vs 31%, P = 0.006 and 100 vs 38%, P = 0.01), more hospitalization due to toxicities (66 vs 8%, P = 0.008) and a more progressive disease (40 vs 8%, P = 0.09). The number of toxicities was inversely correlated with metabolic equivalents lost (r = −0.15, P = 0.04). Conclusion This is the first study showing that maintaining adequate physical activity levels is associated with better treatment tolerance and outcomes in advanced thyroid cancer patients on kinase inhibitor therapy, supporting the need for prospective prehabilitation trials.