Post-diagnosis physical activity in relation to mortality among gynecological cancer survivors

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported in abstract; CIs for high activity comparisons exclude 1.0 (statistically significant); medium activity CI crosses 1.0 (non-significant)

• Effect Size: Pooled HR 0.65 (high vs. low physical activity); endometrial cancer HR 0.60; ovarian cancer HR 0.71; medium vs. low physical activity HR 0.88

• Primary Outcome: All-cause mortality in women with gynecological cancer (endometrial, ovarian, cervical) — high versus low post-diagnosis physical activity

• Nnt Or Sensitivity: Absolute risk reduction and NNT cannot be calculated from the abstract data alone; the HR of 0.65 represents a 35% relative reduction in all-cause mortality risk for high versus low physical activity; no hazard ratio for cancer-specific mortality reported

• Confidence Interval: Overall: 95% CI 0.54–0.78; endometrial: 95% CI 0.43–0.83; ovarian: 95% CI 0.58–0.86; medium activity: 95% CI 0.76–1.02

Clinical Application

Physical activity is a low-cost, widely accessible intervention with established safety in cancer survivors when appropriately supervised. Implementation requires integration into oncology survivorship care plans, referral pathways to exercise physiologists, and patient education. Barriers include cancer treatment-related fatigue, musculoskeletal side effects, and socioeconomic access constraints. Australia has established exercise oncology infrastructure through organisations such as Exercise & Sports Science Australia (ESSA) and Cancer Council Australia's survivorship programs. RACGP guidelines on cancer survivorship support lifestyle interventions including physical activity. Medicare-funded Chronic Disease Management plans (CDM/GP Management Plans) can facilitate referral to accredited exercise physiologists for eligible patients. The Gynecological Cancer Alliance of Australia and relevant state-based cancer services may benefit from incorporating these findings into survivorship care frameworks. No specific PBS or TGA implications arise from this review, as the intervention is behavioural rather than pharmacological. The findings align with existing Cancer Australia survivorship recommendations encouraging regular physical activity post-treatment. Adult women diagnosed with endometrial, ovarian, or cervical cancer who have completed or are undergoing primary treatment; results most applicable to endometrial and ovarian cancer survivors given available subgroup data

Abstract

PURPOSE: Physical activity may play a supportive role in cancer survivorship. However, evidence on the association between post-diagnosis physical activity and mortality among women with gynecological cancer remains limited and inconsistent. METHODS: We conducted a systematic review of the literature published between 1949 and January 2026. Eligible observational studies were identified, and random-effects meta-analyses were performed to estimate pooled hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between post-diagnosis physical activity and all-cause mortality among women diagnosed with gynecological cancer. RESULTS: A total of ten eligible studies on endometrial, ovarian, and cervical cancer were included, collectively reporting 3,867 deaths. High levels of post-diagnosis physical activity, compared with low levels, were associated with lower mortality (HR: 0.65; 95% CI 0.54-0.78). This inverse relationship was evident in both endometrial and ovarian cancer survivors (endometrial cancer: HR: 0.60; 95% CI 0.43-0.83; ovarian cancer: HR: 0.71; 95% CI 0.58-0.86). Medium levels of physical activity tended to be inversely associated with mortality (HR: 0.88; 95% CI 0.76-1.02). CONCLUSION: Higher levels of physical activity after a gynecological cancer diagnosis were associated with improved survival. The results suggest that physical activity may represent a modifiable lifestyle factor with the potential to improve long-term outcomes among gynecological cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: This supports the potential value of integrating physical activity into survivorship care, although further high-quality prospective studies are needed to strengthen causal inference.

References

1. 1.Hamann, A., Benker, P., Leitzmann, M. F., & Stein, M. J. (2026). Post-diagnosis physical activity in relation to mortality among gynecological cancer survivors. Cancer Causes & Control. https://doi.org/10.1007/s11764-023-01366-5