A new study has found that the survival rate of cervical cancer patients is closely associated not only with hospital treatment but also with the level of physical activity prior to diagnosis. The effect was found to be particularly pronounced among elderly patients aged 65 and older with early-stage disease.
A joint research team led by Professors Yoo Young Lee and Jun Hyeong Seo of the Department of Obstetrics and Gynecology at Samsung Medical Center, along with Professor Kyungdo Han of the Department of Statistics and Actuarial Science at Soongsil University, analyzed the association between pre-diagnosis physical activity and mortality in cervical cancer patients. The findings were published in a recent issue of the International Journal of Gynecological Cancer (IF=4.7).
Using national cancer big data (the Cancer Public Library Database based on K-CURE), the research team analyzed 8,833 women aged 19 to 79 who were diagnosed with cervical cancer between 2012 and 2017 and had undergone a health checkup within one year prior to diagnosis. Of these, 959 patients (10.9%) were under 40 years of age, 6,077 (68.8%) were between 40 and 64, and 1,797 (20.3%) were 65 or older. By SEER summary stage at diagnosis, localized disease accounted for the largest proportion at 5,728 patients (64.9%), followed by regional disease in 2,091 patients (23.7%) and distant metastasis in 439 patients (5.0%). Physical activity was assessed via self-reported questionnaires evaluating intensity, frequency, and duration, and weekly total energy expenditure (MET-min/wk) was calculated for analysis.
The results showed no association between pre-diagnosis physical activity level and mortality risk when the entire patient cohort was analyzed. However, among patients with localized (early-stage) disease, an association between physical activity level and mortality risk was observed. In this subgroup, engaging in high-intensity exercise was associated with a 36% reduction in mortality risk, while having a regular exercise habit was associated with a reduction of up to 38%.
In addition, across the entire cohort, higher weekly total energy expenditure was associated with a trend toward lower mortality risk. Notably, among early-stage patients, higher total energy expenditure—that is, a higher level of physical activity—was associated with a significant reduction in mortality risk of up to 43%. This effect was even more pronounced among elderly patients aged 65 and older. The research team explained that "because older patients tend to have lower physiologic reserve, their habitual exercise patterns are more strongly reflected in their prognosis after a cancer diagnosis."
In contrast, no significant association between physical activity and mortality was observed among patients with regionally advanced or metastatic disease. Likewise, no statistically significant correlation was found among younger patients under the age of 65.
Professor Jun Hyeong Seo stated, "This study provides evidence that physical activity prior to diagnosis may be associated with survival outcomes in cervical cancer patients," adding that "however, this effect was selectively observed among patients with early-stage disease who were also elderly."
Professor Yoo Young Lee, the principal investigator, emphasized, "Pre-diagnosis physical activity may be an important factor in understanding differences in survival among cervical cancer patients," and noted that "particularly for early-stage or elderly patients, maintaining regular physical activity may serve as an important pillar for improving prognosis."
This study is significant in that it demonstrates, through large-scale population-based data, the impact of lifestyle habits prior to a cervical cancer diagnosis on actual clinical outcomes. Given that survival analysis research focused on cervical cancer has been limited to date, this study is expected to serve as important clinical evidence for developing personalized patient management strategies going forward.