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作者：ioncology
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编者按：既往，多项研究探索了运动对早期癌症患者的影响，但我们很少看到运动对晚期癌症患者影响的研究。PREFERABLE-EFFECT是一项探索运动对转移性乳腺癌患者生活质量和疲劳影响的研究，肿瘤瞭望特邀请PREFERABLE-EFFECT研究PI——乌得勒支大学Julius医学中心Anouk Hiensch教授对PREFERABLE-EFFECT研究数据及对患者的影响进行介绍。
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肿瘤瞭望：请您为我们简要介绍一下PREFERABLE-EFFECT研究的背景。
Anouk Hiensch教授：我是Anouk Hiensch，在乌得勒支大学Julius医学中心担任助理教授，主要研究方向是探索运动对肿瘤患者的影响。
过去几十年中，运动肿瘤学领域开展了大量研究，多个相关指南也得以制定，如ASCO指南和ACSM指南等。这些都表明运动对患者的心肺适应能力、疲劳和生活质量改善有益。然而，这些研究主要集中在可治愈性肿瘤的前提下。这也是为什么会强调在转移性乳腺癌患者中进行更多研究的原因，同时也是PREFERABLE-EFFECT研究的重要性所在。PREFERABLE-EFFECT研究的主要目标是探究运动对转移性乳腺癌患者生活质量和疲劳的影响。
Oncology Frontier：Please give us a brief introduction to the background of the PREFERABLE-EFFECT study.
Anouk Hiensch：Hi,I'm Anouk Hiensch. I'm working as an assistant professor at the Julius Center at the University Medical Center Utrecht. And I'm mainly doing research on the effects of exercise in patients with cancer.
So the last couple of decades, a lot of research has been done in the field of exercise oncology, which has led to several guidelines, including the ASCO and ACSM guidelines, showing that exercise has beneficial effects on cardiorespiratory fitness, fatigue and quality of life. But this research has mainly been conducted in the curative cancer setting. So that's also why they highlighted that more research needs to be done in patients with metastatic breast cancer. And that's where the PREFERABLE-EFFECT study came in. The primary aim of the PREFERABLE-EFFECT study was to investigate the effects of exercise in patients with metastatic breast cancer on quality of life and fatigue.
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肿瘤瞭望：PREFERABLE-EFFECT研究取得了什么结果？对于乳腺癌患者来说有何重要意义？
Anouk Hiensch教授：在PREFERABLE-EFFECT研究中，我们将患者随机分配到运动干预组和对照组。对照组接受常规护理并接受一般性的体育活动建议。而干预组则接受了为期九个月的结构化个体化运动计划，并由专业运动人员监督。我们监测了多项指标，包括患者报告的疲劳和生活质量等，在基线、三个月、六个月和九个月这几个时间点进行监测。结果显示，运动干预对患者的生活质量和疲劳有益。该研究的主要发现是，相较于对照组，干预组患者报告的生活质量更好，疲劳水平更低。
此外，我们还观察到干预组在疼痛、角色功能、身体功能和社交功能方面表现更好，这意味着他们能够更好的参与日常活动，与朋友和家人进行社交互动。这些较好的研究结果让我们思考运动锻炼效果是否适用于我们研究中的所有患者。因此，我们对入组患者的亚组进行了进一步研究。
我们发现，运动对生活质量的干预效果在年龄50岁以下的患者中更为显著。在年龄≥50岁的患者人群中我们也观察到运动的益处，但效果不及年龄小于50岁的患者。此外，我们发现基线时疲劳水平较高的患者对运动干预后的生活质量改善效果更明显。基于此，我们得出结论，对转移性乳腺癌患者进行监督运动是有益的，能够改善其生活质量、减轻体力疲劳，并对其他临床相关终点产生积极影响。我们的研究效果在各个亚组中基本一致，但我们也确认了两个重要的亚组：基线时报告疼痛的患者更加受益于运动干预，而年龄≥50岁的患者同样受益于运动，但可能需要更多个性化的措施，才能达到与年轻患者同样的获益。
Oncology Frontier：What are the results of the PREFERABLE-EFFECT study? What is the significance for breast cancer patients?
Anouk Hiensch：So what we did in the PREFERABLE-EFFECT study is that we randomized patients to either an exercise intervention or a control group. And the control group received care as usual, and it was supplemented with a general physical activity advice. And the intervention group received a nine-month structured and individualized exercise program, which was supervised by an exercise professional. And we measured several things, patients reported outcomes, including fatigue and quality of life. And we measured them at baseline, at three months, six and nine months. And what we found is that the exercise intervention had beneficial effects on quality of life and also physical fatigue, our primary endpoints. Meaning that the patients in the intervention group reported higher levels of quality of life and lower levels of fatigue compared to the control group.
And in addition, we measured a lot of other clinically relevant outcomes for these patients. And we saw that they did better, the intervention group did better in terms of pain, role functioning, physical functioning, and also social functioning. Meaning that they could better engage in daily activities in their lives and meet with their friends and family. We found these nice results, and we wondered whether these effects apply to all patients in our study, so we also looked into subgroups of our population.
And what we found is that patients who are younger than 50 years old, have higher or larger effects of the exercise intervention on quality of life. Also in the older population, so people above 50 years or older, we also saw beneficial effects of exercise, but they were not as large as in the patients under 50 years of age. And we also saw that patients who have high levels of fatigue at baseline also have larger effects of the exercise intervention on quality of life. So based on that, we concluded that supervised exercise is beneficial for patients with metastatic breast cancer in terms of quality of life, physical fatigue, and also other clinically relevant endpoints. And we also concluded that our effects are more or less consistent across subgroups, but that we could define two important subgroups. So the patients who report pain at baseline do benefit more from the exercise intervention. And that patients who are older than 50 years of age also benefit from exercise, but more tailoring might be needed for them to benefit as much from the exercise intervention as the younger patients do.
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肿瘤瞭望：您认为锻炼会缓解乳腺癌患者的疲劳吗，是否所有的晚期乳腺癌患者都应该进行运动锻炼？
Anouk Hiensch教授：既往研究显示运动能改善早期乳腺癌患者的疲劳状况。PREFERABLE-EFFECT研究数据也显示运动锻炼改善了患者的身体功能，并且对转移性乳腺癌患者同样有益。我们还观察到他们能够积极参与体育活动。因此，我们对患者参加运动课程的情况进行了调查。77%的人群能够在九个月的时间内参加相关运动课程。不能参加的主要原因可能是因为度假，可以料到在九个月的时间内确实会发生这种情况。或者，他们可能因为身体状况太差或正在接受治疗而无法参加。
除此之外，我认为我们研究中的运动计划实际上相当全面和密集，这意味着患者参与了高强度的间歇训练，而且患者也确实做到了。我认为我们的确可以让患者以中等到高强度进行训练，但需要更详细地了解患者的遵循情况，并且根据他们的健康状况来及时调整训练计划。这是我们未来需要进行的工作。
Oncology Frontier：Do you think exercise can reduce fatigue in breast cancer patients, and should all patients with advanced breast cancer be physically active?
Anouk Hiensch：The PREFERABLE-EFFECT study led to improvements in physical functioning. And also from earlier research, we know that exercise has beneficial effects on fatigue in early stage breast cancer patients. But now with the PREFERABLE-EFFECT study, we also show that it's also beneficial for patients with metastatic breast cancer. And we also saw that they could be physically active. So we looked into the attendance to the exercise sessions. And in 77% of the cases, they were able to attend the exercise sessions over the nine month period. And the main reasons for not being there were, for example, that they were on holidays, which you can imagine during a nine month period. Or that they were, for example, too sick or just had treatment.
Other than that, I think that our exercise program was actually quite extensive and also intensive. So meaning that they did high intensity interval training. And patients were doing that. And I think we can really train our patients and they can also do it on a moderate to high intensity. But we need to dive more into detail about the compliance and see how often we needed to adapt the program to the fitness levels of the patients. And that is something that we will do in the future.
Anouk Hiensch
乌得勒支大学Julius医学中心
（来源：《肿瘤瞭望》编辑部）
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