Impact of exercise on sexual health, body image, and therapy-related symptoms in women with metastatic breast cancer: The randomized controlled PREFERABLE-EFFECT trial

Abstract

The understanding and treatment of sexual health problems, impaired body image, and other non-life threatening but burdensome symptoms of women with metastatic breast cancer (mBC) is still insufficient. We studied the factors associated with such symptoms and investigated whether these problems could be alleviated by a structured exercise intervention. In the multinational PREFERABLE-EFFECT study, 355 women with mBC were randomly assigned to usual care (n = 178) or a 9-month supervised exercise program (n = 177). Breast cancer-specific functions and symptoms (EORTC QLQ-BR42) were assessed at baseline, 3, 6 (primary timepoint), and 9 months. Linear regression models and linear mixed models for repeated measures were calculated. At baseline, participants were 55.4 ± 11.2 years old, 52.4% were undergoing endocrine therapy, and 25.4% chemotherapy. Baseline sexual functioning was low, with 94.3% reporting no or little sexual activity. Age and depressive symptoms were negatively associated with sexual functioning. Among sexually active women, 46.2% felt no or little sexual enjoyment and 37.3% suffered from vaginal dryness. Body image was reported as low by 23.7%. Exercise significantly improved sexual functioning (6-months between-group difference (BGD) = 5.6, 95% CI [1.9, 9.4], effect size (ES) = 0.28) and vaginal symptoms (BGD = -7.1 [-11.7, -2.5], ES = 0.25), compared to usual care. Effects on body image were marginal (BGD = 4.0 [-0.2, 8.3], ES = 0.14). Among participants undergoing chemotherapy (n = 90), exercise reduced chemotherapy side-effects (BGD = -8.2 [-15.4, -1.0], ES = 0.48). In conclusion, women with mBC often experience sexual and vaginal problems and other treatment-related side-effects. A 9-month supervised exercise program vs. control was effective in improving sexual functioning and vaginal symptoms among women with mBC.