Dyadic exercise intervention for LGBTQ+ cancer survivors: Associations with health-related quality of life, fatigue, and inflammation biomarkers.

Abstract

12041 Background: Mixed training (aerobic/resistance) exercise is a key adjuvant therapy in exercise oncology; it decreases cancer mortality and improves patients' quality of life, in part by modulating the tumor microenvironment, regulating the HPA axis, and inflammatory pathways. LGBTQ cancer survivors and their partners frequently experience excessive fatigue, insomnia, impaired health-related quality of life (HRQOL), and relationship stress, yet remain underrepresented in exercise oncology research. Methods: We conducted an RCT with 70 LGBTQ+ cancer survivor-partner dyads (N = 140) to compare a 6-week home-based dyadic exercise program (EXCAP-PA) against a survivor-only intervention. Analyses focused on changes from baseline to post-intervention. Primary outcomes included the Survivor Profile of Mood States (POMS) Fatigue and PROMIS global health change to assess HRQOL. ANCOVA-style linear models regressed change scores on treatment arm and baseline values. Mediation analyses assessed whether changes in dyadic support, cortisol, and C-reactive protein (CRP) mediated the effect of treatment on fatigue and HRQOL. Results: Among 56 survivor–partner dyads with analyzable data, delivery of EXCAP-PA was feasible in this LGBTQ+ population. Both survivors and partners in each arm demonstrated improved HRQOL; however, the treatment arm did not significantly predict changes in PROMIS global health for survivors (survivors: B = 0.10, SE = 0.39, p = 0.80; partners: B = 0.03, SE = 0.41, p = 0.94). Baseline symptom burden strongly influenced outcomes: higher baseline fatigue was associated with greater reductions in POMS Fatigue–Inertia (B = −0.55, SE = 0.15, p < 0.001), indicating that participants with the highest fatigue experienced the largest improvements. In the CRP model (n ≈ 44), higher baseline CRP was significantly associated with greater subsequent decreases in log-transformed CRP (B = −0.37, SE = 0.17, p = 0.04). The model relating fatigue change to baseline fatigue, baseline CRP, and CRP change explained a substantial proportion of variance (R² = 0.29; F(3,40) = 5.42, p = 0.003), whereas baseline cortisol was not significantly related to fatigue change. Although mediation analyses using changes in dyadic support, log-transformed CRP, or log-transformed cortisol as mediators of treatment arm effects on fatigue or HRQOL yielded small, non-significant indirect effects, the outcomes are consistent with a beneficial effect in which dyadic processes and reduced inflammation improve symptoms and HRQOL. Conclusions: Dyadic EXCAP-PA proved feasible for LGBTQ+ survivor–partner dyads. Although this pilot is underpowered to detect significant effects on global health, fatigue, or inflammation, the findings highlight high-symptom/high-CRP survivors as a priority subgroup for future, larger dyadic exercise trials.