The ECHO-R Exercise Trial For Recurrent Ovarian Cancer: Robust Evidence In An Understudied Population

PURPOSE: It is unclear whether international exercise oncology guidelines are fit-for-purpose for people with rare cancers, poor survival prospects, and high morbidity. The ECHO-R trial evaluates the safety, feasibility and potential efficacy of a 6-month exercise intervention in women with recurrent ovarian cancer. METHODS: 50 women receiving chemotherapy for recurrent ovarian cancer were recruited to this pre-post, mixed-method exercise trial. The intervention included 12 telephone sessions and five in-person sessions with Accredited Exercise Physiologists. The weekly exercise target was consistent with international guidelines - 150 minutes of moderate-intensity, multimodal exercise per week. Primary outcomes were feasibility (minutes exercise completed) and harms profile (exercise-related adverse outcomes) of the intervention. Secondary outcomes included quality of life (QoL; FACT-O), fatigue (FACT-Fatigue), anxiety and depression (HADS), and neurotoxicity (FACT-GOG-NTX) which were assessed pre- and post-intervention. 13 women participated in post-intervention qualitative interviews providing a deeper understanding of factors influencing exercise participation. RESULTS: The average minutes of weekly exercise completed did not meet the target (median 142 min/week, min: 0; max 533). 38% of the sample reported ≥1 harm (range 0-7 harms/person; no serious harms reported), with 71% of harms impacting exercise participation (11% moderate-major impact). There was no meaningful change in health outcomes observed between pre- and post-intervention. The importance of social support and the physical environment, the hurdles of side effects, the power of advice from health professionals, a “yearning” for the outdoors and a tendency to “resort” to walking emerged as qualitative themes influencing physical activity participation. CONCLUSION: Exercise was deemed safe, but weekly exercise targets were typically unachievable and benefit not guaranteed. To help patients overcome changing exercise barriers, exercise professionals need clinical skill in behavior change. Those delivering exercise therapy to people with recurrent ovarian cancer should focus on each person’s “why” and that factors influencing exercise participation may be more psychosocial than physical. National Health and Medical Research Centre, Medical Research Future Fund—Emerging Priorities and Consumer-Driven Research Initiative (Grant ID: MRF1200120)