JAMA Oncology

The biggest drop in risk happens at the lower end of activity.

In an analysis published in JAMA Oncology, the benefit of exercise climbed steeply early on, and then it leveled off of it.

Roughly each extra hour or so of brisk walking per week was linked to about an 8% lower colon cancer risk.

And in a 32-year follow-up study, when researchers accounted for how consistently people exercised over the decades, meeting the guideline at a moderate level was enough to get the full benefit.

And there were some single-arm and retrospective series that were certainly encouraging, and total neuroadjuvant therapy with fulfirinox followed by individualized chemoradiation seemed to produce some impressive R0 results on some earlier studies.

But then came the study known as the Alliance A021501 study, which was published in JAMA Oncology in 2022.

And in this study, they randomized borderline resectable patients to eight cycles of modified fulfironox alone versus seven cycles of modified fulfironox followed by SBRT.

with surgery and adjuvant therapy in both arms and the result was the opposite of what you might have expected.

And here's the stat that honestly stopped me in my track.

A huge analysis in Jama Oncology looked at 113 studies and more than 11,000 people with cancer.

Exercise reduced cancer-related fatigue during and after cancer, and exercise worked significantly better than the medications they tested.

Better than the medications.

The median overall survival was roughly 54 months with modified FOLFIRINOX versus 35 months with gemcitabine monotherapy, and that median disease-free survival was 21.6 months versus 12.8 months.

And so this was one of the largest absolute survival gains we've ever seen in this disease, and five-year outcomes were published in Jama Oncology in 2022, and certainly this still held up.

The catch here, though, if you guys were listening carefully, is tolerability and eligibility.

So FOLFIRINOX is a very hard regimen.

So it's a lot of talk, little action, all right? And so what are the barriers? Language barrier is the number one.

So we published this in JAMA Oncology in which there was an analysis of alliance trials.

This is a competitive group.

And the number one group that consented but withdrew consent for a trial were Hispanics.

So why don't you dial that forward to 2020, where we now have so-called targeted therapy.

A paper published in JAMA Oncology, so this is oncology journal, looked at like 300 studies, um, performed really largely by the pharmaceutical industry, and the question was what was the impact? And it increased survival or overall survival by 3.4 months.

3.4 months.

So what if you-