Harnessing Exercise to Improve Outcomes in Black Prostate Cancer Patients - Dong-Woo (Derek) Kang

June 21, 2023

Derek Kang joins Alicia Morgans to discuss an ongoing exercise study focused on Black patients with prostate cancer undergoing Androgen Deprivation Therapy. This groundbreaking project is designed to study the potential effects of regular exercise on these patients' physical function, metabolic health, and prostate cancer outcomes. The study hopes to mitigate the higher risk of cardiovascular disease found among Black prostate cancer patients. Patients who enroll are provided with a four-month exercise regimen that blends aerobic and resistance training, all delivered virtually for ease of participation. This study aims to alleviate the higher incidence and mortality rates of prostate cancer within the Black community and has received positive feedback so far. With the trial currently underway, Dr. Kang and his team are excited to bring this crucial research to more communities.


Dong-Woo (Derek) Kang, PhD, Instructor, Division of Population Science, Department of Medical Oncology, Dana-Farber Cancer Institute I Harvard Medical School, Boston, Massachusetts

Alicia Morgans, MD, MPH, Genitourinary Medical Oncologist, Medical Director of Survivorship Program at Dana-Farber Cancer Institute, Boston, Massachusetts

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Alicia Morgans: Hi. I'm so excited to be here with Dr. Derek Kang, who's an instructor of medicine at Dana-Farber Cancer Institute. Thank you so much for being here with me today.

Derek Kang: Thank you so much for inviting me. It's a pleasure.

Alicia Morgans: Wonderful. So I know you gave a presentation at ASCO 2023 that was really a presentation for you and your lab. Tell me who's in your lab?

Derek Kang: So we are in a smaller lab compared to other labs. So I'm an instructor in the lab, and then we have a leader in our lab who's Dr. Christina Dieli-Conwright. And then in this particular study, we have doctors including Alicia Morgans and also Tim Rebbeck and Paul Nguyen, as well as David Einstein from BIDMC.

Alicia Morgans: Wonderful, wonderful. Now, one thing that I want to make sure that we acknowledge, too, is that this is an exercise study that's really focused on ensuring that patients with prostate cancer, black patients with prostate cancer, have an exercise study that we can understand outcomes and how this intervention can affect their health in terms of their physical function and metabolic health, prostate cancer outcomes as well. But I think that it's so important to acknowledge that this work is difficult to fund, and I know you have some really wonderful funders. Can you share who those are? And then tell me a little bit about how did you put this study together and what does that look like?

Derek Kang: So we are funded by Pfizer and Prostate Cancer Foundation and also CDMRP from DoD. So we are very graciously funded from those departments and organizations. So we are very lucky. So the study kind of started from the idea where black prostate cancer patients have higher risk of incidence and mortality, approximately twice higher than white counterparts. I think everyone probably is very aware of it.

And then even further, when we tease out those patients who are receiving ADT, black prostate cancer patients have about 65% higher risk of developing cardiovascular disease later on. So the idea of this exercise intervention trial is to kind of mitigate the risks of cardiovascular disease in these black men with prostate cancer on ADT.

So there are so many components in these trials, but the exercise intervention itself is very well-known. In the exercise, we call it the exercise oncology research field. We believe that exercise has been shown to improve cardiovascular health, as well as other patient-reported outcomes and other cardiometabolic outcomes as well. So exercise has intervened in this population to see the benefits of it. So we are very excited to have launched the study. It's ongoing. We have 11 participants so far and targeting 62 patients in total.

Alicia Morgans: Wonderful. So tell me, what does this exercise intervention look like? What are patients actually doing for this intervention?

Derek Kang: Sure. Once patients are interested in the study, we are providing four months of exercise intervention. It incorporates aerobic and resistance exercise together. So we are an exercise physiology lab as well. So we are really trying to target to improve their heart or target their heart function during the exercise, for example, increasing their heartbeats at a certain level based on their baseline fitness levels. We are doing metabolic testing and everything.

And then once they're on the study with randomized trials, once they're in the exercise group, the good thing about this study is virtual intervention. What it means is they are given their exercise equipment to their home. And we are sending it to their home. And they have their own bike and resistance equipment. And then we are providing one-on-one virtually supervised interventions. So we are technically making an appointment. So the patient joins the Zoom. We have an exercise oncologist and interventionist in our lab doing the Zoom, and then we are guiding and then supervising their interventions one-on-one. So one session probably takes about an hour or an hour and a half, doing high intensity interval training, particularly for the aerobic part. It's showing to be more beneficial in improving cardiac function and cardiac health.

Alicia Morgans: Wow, that's great. That's a long time to have an exercise session.

Derek Kang: Yeah.

Alicia Morgans: And patients seem to be able to engage and seem happy to do it, it sounds like.

Derek Kang: Of course, yes. So to be more specific, we have two patients so far that have completed four months of intervention, and they are absolutely loving the study and the aerobic exercise intervention, of course. So we are very happy that we have positive feedback so far. And then there are other participants as well. They've been doing a fantastic job. So those two patients, particularly, didn't miss any sessions. It was 100% adherence so far.

Alicia Morgans: Wow. Wow. It's great. It's nice, too, that this virtual intervention with the intensive exercise is in the home.

Derek Kang: Yes.

Alicia Morgans: And so those barriers to getting to the gym, whether it's weather or motivation or whatever it is, they're just not there in the same way.

Derek Kang: Right.

Alicia Morgans: As long as you can get them to join the Zoom, which it sounds like it has been pretty successful, you can get the intervention at least going, even if these barriers normally exist when we do try to exercise in the real world sometimes.

Derek Kang: Right. Right. That's a really good point, actually. When we were initially designing this study, one of the reasons that we adopted this virtual format is that many black prostate cancer patients or black people around this Dana-Farber catchment area are a little bit living outside of the main campus. So we thought that if exercise intervention can be done virtually, I think we could reach out to more cancer patients who are black and then living outside of the main city. So it has been very, very successful, I'll say so far, and very helpful in that setting.

Alicia Morgans: That makes a lot of sense. And I have to say, even when I am exercising at home, I do much better on my Peloton than when I have to go out to the gym to get that done.

Derek Kang: Right.

Alicia Morgans: That's great. So as you think about this and you're thinking about encouraging patients to participate in this trial that, of course, is a trial in progress, what would you say to patients in clinic and how do you find patients? How do get them to know about the study and hopefully engage?

Derek Kang: We are recruiting patients from Dana-Farber and then BIDMC, as I mentioned. So we are seeing more black patients at BIDMC. So David Einstein has been the champion in the particular institute referring patients to us, but I think eventually we'd like to reach out to broader black prostate cancer communities. And actually, we are working with Thomas Harrington from PHEN, Prostate Cancer Health Education Network, and we'd like to reach out to broader patients through different communities, different organizations, which is our ultimate goal.

Alicia Morgans: Wonderful. And what do you say to patients to encourage them to participate? It is a lot to sometimes think about moving from being someone who's relatively sedentary to being very active.

Derek Kang: Right. Right. We really want to highlight that exercise is beneficial in reducing their cardiovascular risk they might have, particularly in black prostate cancer patients. So when you think about doing exercise, when you're not doing it currently or doing it a little bit, you can think of what we are providing. What we can do is based on what you can do. And then we are providing a very individualized exercise program, so based on their current fitness levels and then their muscular fitness. And then we are providing from low intensity to higher intensity to a gradual progressive exercise program. So sometimes it may feel like it's a lot of work, but it can be starting slow and then a little bit of intervention. And very importantly, exercise can be also beneficial in other aspects of your health, not just only cardiovascular health, but also some metabolic health, as well as psychological health and quality of life. That's been really established in the exercise oncology research field. So we'd like to encourage patients to really participate in these types of studies.

Alicia Morgans: Absolutely. Absolutely. I would say that if exercise could be put into a bottle and taken as a pill, we would all prescribe it and we would all take it, right?

Derek Kang: Of course.

Alicia Morgans: We would all do it.

Derek Kang: Exactly. It's the $1 million medicine, as we say.

Alicia Morgans: Yes, yes, because it has so many good effects really ...

Derek Kang: Definitely.

Alicia Morgans: ... in function, in fitness, in ability to maintain independence, hopefully prevent falls, and due to the development of frailty and the psychological and cognitive effects that can be really enhanced because we are exercising our body, which also helps us keep our mind in shape.

Derek Kang: Of course, yes.

Alicia Morgans: Yeah.

Derek Kang: Yeah. Yeah. I really agree with that.

Alicia Morgans: Yeah. So I really commend you and the team for doing this work and really focusing on a population of patients that may benefit even more, particularly as it comes to cardiovascular risk, in a population that needs to be enhanced and enriched in clinical trials so we understand how to best support outcomes for all of our patients, for our black patients, for all of our patients.

Derek Kang: Right. Right.

Alicia Morgans: But these patients do suffer some of the most pronounced complications, have a higher risk of mortality, and it's fantastic that you and the team are really seeking them out to help them as a specific and unique community.

Derek Kang: Yes. Thank you so much. I mean, ultimately, right, we .... Sorry. Thank you. Ultimately, this is more like phase 2. We'd like to see the effect of exercise in a smaller catchment patient group as a smaller pilot study, but we'd like to expand the study, if possible, with the virtual interventions. Or we'll reach out to the larger communities eventually so that more patients can benefit from it. Yeah.

Alicia Morgans: Fantastic. Well, we'll make sure that the clinical trials.gov information is next to this recording, and I really wish you and the team continued success and rapid enrollment to help these patients get healthy. Your next study has got to be an exercise study for the doctors so that we can be as healthy as these patients are going to be.

Derek Kang: Of course.

Alicia Morgans: And congratulations and good luck to you and the team. Congratulations on your ASCO 2023 poster presentation.

Derek Kang: Thank you so much, Alicia.