Exercise boosts sexual health in metastatic breast cancer patients

Working out can improve sexual function as well as reduce endocrine sexual symptoms in patients with metastatic breast cancer (mBC), according to data from the PREFERABLE-EFFECT trial.

In an intent-to-treat analysis with mixed models for repeated measures, a 9-month supervised exercise intervention conferred sustained improvements in sexual function compared with usual care (control), reported Dr Martina Schmidt from the German Cancer Research Center in Heidelberg, Germany.

The mean between-group difference in sexual function was 5.6 (95 percent CI, 1.9–9.4; effect size [ES], 0.28; p=0.0031) at 6 months and 4.5 (95 percent CI, 0.7–8.3; ES, 0.23; p=0.020) at 9 months. [Schmidt M, et al, ESMO Breast Cancer 2024, abstract 269MO]

Furthermore, exercise was associated with a substantial reduction in endocrine sexual symptoms at 6 months (mean between-group difference, –7.1, 95 percent CI, –11.6 to –2.5; ES, 0.25; p=0.0026), Schmidt said.

In terms of sexual enjoyment in the subgroup of participants who were sexually active, Schmidt noted an improvement with exercise but no change with control. However, she pointed out that the sample size was small, preventing a definitive conclusion about the effect.

Many patients with mBC undergo several courses of treatment, including surgery, radiation, and medications, which can take a toll on their emotional wellbeing, according to Schmidt. This can contribute to sexual problems, with patients experiencing decreased sexual satisfaction, difficulty achieving orgasm, and increased pain during intercourse—which can then have a negative ripple effect and impact the patients’ quality of life, she added.

In an earlier presentation, PREFERABLE-EFFECT already showed that exercise can help with cancer-related fatigue (EORTC QLQ-FA12) and health-related quality of life (EORTC QLQ-C30 summary score) in patients with mBC. And the present analysis indicated that exercise can also be beneficial for sexual health in this population, Schmidt said.

Commenting on the study, Dr Don Dizon from the Lifespan Cancer Institute, Providence, and Rhode Island Hospital, Providence, US, told the ESMO Daily Reporter: “These findings broadly describe what is known about sexual function and desire. If someone is not feeling well—they may be experiencing fatigue and nausea, for example, from their treatments—they are unlikely to have much sexual interest.

“By improving fatigue, exercise can improve quality of life, and this can have a knock-on effect on sexual health. And it is good to see that this is true, even in the metastatic breast cancer setting,” Dizon said.

PREFERABLE-EFFECT included 355 patients (mean age 55.4 years) with mBC from five European countries and Australia. Of these patients, 74.8 percent had received first- or second-line treatment at enrolment and 67.5 percent had bone metastases.

The patients were randomly assigned to undergo either usual care or a 9-month structured and personalized exercise program. All participants received an activity tracker and general exercise advice (exercise group: 30 mins per day for 5 days; control: 150 mins per week). The exercise program comprised supervised, twice-weekly hourly sessions focusing on balance, resistance training, and aerobic capacity. During the final 3 months of the study, one supervised session was replaced by unsupervised exercise.

At baseline, sexual functioning (17.1) was low, driven by older age and depressive symptoms. More than half of the patients showed no interest in sexual activities, 60 percent reported that they had not been sexually active in the past week, 24 percent had a poor body image, and 46 percent of sexually active patients reported experiencing little or no sexual enjoyment. In the subgroup of patients on endocrine therapy, 40 percent reported vaginal dryness and 27 percent reported vaginal pain during sexual activity, with both symptoms showing some correlation with sexual enjoyment.

Schmidt called for further research to determine the optimal role of exercise in addressing symptom burden, possibly in conjunction with additional support.