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Coughlin SS, Kapuku G. Physical Activity, Weight Control, and Biomarkers of Prognosis and Survival among Breast Cancer Survivors. ARCHIVES OF EPIDEMIOLOGY 2018; 3:10.29011/2257-2252.100027. [PMID: 31179439 PMCID: PMC6550489 DOI: 10.29011/2257-2252.100027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Physical inactivity and obesity may increase risk of poor prognosis in breast cancer through effects on insulin or insulin-like growth factors or their binding proteins, insulin resistance, glucose metabolism, sex hormones, leptin and other adipokines, immunologic or inflammatory factors, oxidative stress, and Deoxyribonucleic acid (DNA) damage or repair capacity. The present review is based upon bibliographic searches in PubMed and relevant search terms. Articles published in English from January 1, 1980 through October 1, 2018 were identified using the following MeSH search terms and Boolean algebra commands: breast cancer survivors AND (insulin-like growth factor OR insulin resistance OR glucose metabolism OR sex hormones OR leptin OR adipokines OR immunologic OR inflammatory factors OR oxidative stress OR DNA repair capacity). After screening the abstracts or full texts of these articles and reviewing the references of previous review articles, a total of 66 studies met the eligibility criteria. Based upon published studies, it is difficult to determine the type or dose of exercise that affects inflammatory markers among breast cancer survivors. The optimal type of exercise, dose, and timing of physical activity needed to improve the inflammatory profile following a breast cancer diagnosis is unknown. Studies have used a range of physical activity types including aerobic, resistance training, yoga, and Tai Chi. A further issue is that existing studies of physical activity and biomarkers have included a range of disease stages. There is a need for a better understanding of the biological pathways through which physical activity and weight management increase survival in order to design targeted weight loss and exercise interventions for breast cancer survivors.
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Affiliation(s)
- Steven Scott Coughlin
- Department of Population Health Sciences, Augusta University, USA
- Research Service, Charlie Norwood Veterans Administration Medical Center, USA
| | - Gaston Kapuku
- Department of Population Health Sciences, Augusta University, USA
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Zhu ZY, Xue JX, Yu LX, Bian WH, Zhang YF, Sohn KC, Shin IH, Yao C. Reducing postsurgical exudate in breast cancer patients by using San Huang decoction to ameliorate inflammatory status: a prospective clinical trial. ACTA ACUST UNITED AC 2018; 25:e507-e515. [PMID: 30607117 DOI: 10.3747/co.25.4108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Reducing inflammatory factors in wound exudate is a promising treatment approach for healing wounds in postsurgical breast cancer patients. Traditional Chinese Medicine (tcm) treatments have been shown to be beneficial and safe for optimal regulation of oxidative stress during the postoperative period. In the present clinical trial, we evaluated the effectiveness of a promising Chinese herbal formula, San Huang decoction [shd (Radix astragali, Radix et rhizoma rhei, and Rhizoma curcuma longa, 3:1:1; supplemental Table 1)], on wound inflammatory response after mastectomy. Methods The study randomized 30 patients with breast cancer who fulfilled the inclusion and exclusion criteria to either a treatment (n = 15) or a control group (n = 15). Patients in the treatment group received liquid shd, taken twice daily with or without food. Treatment was given for 1 day before surgery and for 7 days postoperatively. Participants in the control group received a placebo on the same schedule as the treatment group. Outcomes measured in every subject included clinical tcm and wound inflammation symptom scores, daily and total amounts of drainage fluid, and levels of inflammatory factors in the exudate [tumour necrosis factor α (tnf-α), interleukins 6 (il-6), 8 (il-8), and 2R (il-2R), human C-reactive protein (crp)] at 2 hours and on days 1, 3, and 7 postoperatively. Results The total amount of drainage fluid over 7 days was significantly lower in the treatment group (572.20 ± 93.95 mL) than in the control group (700.40 ± 107.38 mL). The tcm symptom score was also lower in treatment group (day 7: 1.87 ± 0.83 vs. 4.80 ± 3.61, p = 0.049), as was the inflammatory symptom score (day 7: 0.67 ± 0.72 vs. 3.67 ± 2.50, p = 0.001). Levels of tnf-α, il-6, il-8, il-2R, and crp in drainage fluid were significantly lower with shd treatment. Conclusions Perioperative treatment with shd effectively lessened postoperative exudate and ameliorated inflammatory symptoms in patients who underwent surgery for breast cancer.
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Affiliation(s)
- Z Y Zhu
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, P.R.C
| | - J X Xue
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, P.R.C
| | - L X Yu
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, P.R.C
| | - W H Bian
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, P.R.C
| | - Y F Zhang
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, P.R.C
| | - K C Sohn
- Hospital of Catholic University of Daegu, Daegu, Republic of Korea
| | - I H Shin
- Hospital of Catholic University of Daegu, Daegu, Republic of Korea
| | - C Yao
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, P.R.C
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Abstract
Purpose Accurate evaluation of patients’ health status is a key component of the workup, treatment, and follow-up of cancer patients. Assessments by clinicians (eg, performance status, toxicity grade) and patients (eg, quality of life) play a critical role in current practice but have significant limitations. Technological advances now provide an opportunity to track a new class of objective measures of patient activity, such as daily step counts. Here, we describe recent efforts to incorporate this technology into the field of oncology. Design We conducted a structured literature search using MEDLINE electronic database to identify published observational studies of tracking steps in cancer patients and trials of exercise programs for cancer survivors incorporating pedometers until February 2016. Results Data indicate that physical activity information may supplant existing scales for the assessment of cancer patients’ functional capacity. Conclusion Objective activity monitoring is poised to revolutionize the way health care providers assess cancer patients at the time of diagnosis, during treatment, and in the survivorship setting.
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Affiliation(s)
- Juhi M Purswani
- Department of Radiation Oncology, New York University School of Medicine, New York, NY, USA
| | - Nitin Ohri
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA,
| | - Colin Champ
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Department of Integrative Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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LoConte NK, Gershenwald JE, Thomson CA, Crane TE, Harmon GE, Rechis R. Lifestyle Modifications and Policy Implications for Primary and Secondary Cancer Prevention: Diet, Exercise, Sun Safety, and Alcohol Reduction. Am Soc Clin Oncol Educ Book 2018; 38:88-100. [PMID: 30231343 DOI: 10.1200/edbk_200093] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Improved cancer treatments and cancer detection methods are not likely to completely eradicate the burden of cancer. Primary prevention of cancer is a logical strategy to use to control cancer while also seeking novel treatments and earlier detection. Lifestyle modification strategies to improve primary prevention and risk reduction for the development of cancer include choosing a healthy diet with an emphasis on plant sources, maintaining a healthy weight throughout life, being physically active, regularly using sunscreen and wearing protective clothing, limiting sun exposure during the hours of 10 AM to 2 PM, avoiding indoor tanning, and reducing or eliminating alcohol use. In addition to continued use of ongoing education of the public, health care providers, and cancer support communities, other policy and public health efforts should be pursued as well. Examples of supported and successful policy approaches are included in this article, including efforts to limit indoor tanning and improve community-wide interventions to reduce ultraviolet radiation exposure as well as to formally support various alcohol policy strategies including increasing alcohol taxes, reducing alcohol outlet density, improving clinical screening for alcohol use disorders, and limiting youth exposure to alcohol marketing and advertising. These prevention strategies are expected to have the largest impact on the development of melanoma as well as breast, colorectal, head and neck, liver, and esophageal cancers. The impact of these strategies as secondary prevention is less well understood. Areas of additional needed research and implementation are also highlighted. Future areas of needed research are the effects of these modifications after the diagnosis of cancer (as secondary prevention).
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Affiliation(s)
- Noelle K LoConte
- From the Carbone Cancer Center and University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Surgical Oncology, Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona Cancer Center, Tucson, AZ; Biobehavioral Health Sciences Division, College of Nursing, University of Arizona Cancer Center, Tucson, AZ; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; Be Well Communities, Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey E Gershenwald
- From the Carbone Cancer Center and University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Surgical Oncology, Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona Cancer Center, Tucson, AZ; Biobehavioral Health Sciences Division, College of Nursing, University of Arizona Cancer Center, Tucson, AZ; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; Be Well Communities, Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cynthia A Thomson
- From the Carbone Cancer Center and University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Surgical Oncology, Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona Cancer Center, Tucson, AZ; Biobehavioral Health Sciences Division, College of Nursing, University of Arizona Cancer Center, Tucson, AZ; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; Be Well Communities, Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tracy E Crane
- From the Carbone Cancer Center and University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Surgical Oncology, Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona Cancer Center, Tucson, AZ; Biobehavioral Health Sciences Division, College of Nursing, University of Arizona Cancer Center, Tucson, AZ; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; Be Well Communities, Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gil E Harmon
- From the Carbone Cancer Center and University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Surgical Oncology, Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona Cancer Center, Tucson, AZ; Biobehavioral Health Sciences Division, College of Nursing, University of Arizona Cancer Center, Tucson, AZ; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; Be Well Communities, Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ruth Rechis
- From the Carbone Cancer Center and University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Surgical Oncology, Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona Cancer Center, Tucson, AZ; Biobehavioral Health Sciences Division, College of Nursing, University of Arizona Cancer Center, Tucson, AZ; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; Be Well Communities, Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX
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Ricci JM, Flores V, Kuroyama I, Asher A, Tarleton HP. Pilot Study of Dose-Response Effects of Exercise on Change in C-Reactive Protein, Cortisol, and Health-Related Quality of Life Among Cancer Survivors. Biores Open Access 2018; 7:52-62. [PMID: 29789774 PMCID: PMC5961455 DOI: 10.1089/biores.2018.0003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Fatigue, stress, and depression contribute to poor health-related quality of life (HRQoL) among cancer survivors. This study examined the effects of combined aerobic and resistance training (CART) on HRQoL and biomarkers of stress. Cancer survivors (n = 76, 91% female, 39% breast cancer, 32% gynecologic cancer) were enrolled in CART for three 60-min sessions, weekly, for 26 weeks. Participants completed the National Institutes of Health's Patient Reported Outcomes Measurement Information System (NIH PROMIS) fatigue assessment and the SF-36. Cortisol and c-reactive protein (CRP) were assessed using volunteered blood specimens. Baseline fatigue scores were worse for participants completing treatment within the last year, compared to long-term survivors [F = (2, 59) = 3.470, p = 0.038]. After 26 weeks, fatigue scores improved by a noteworthy two points [M = 52.72, standard deviation, SD = 10.10 vs. M = 50.67, SD = 10.14; t(48) = 1.7145, p = 0.092]. Pre- to postintervention improvements in bodily pain [M = 50.54, SD = 9.51 vs. M = 48.20, SD = 10.07; t(33) = 2.913, p = 0.006] and limitations in social functioning [M = 50.60, SD = 9.17 vs. M = 47.75, SD = 11.66; t(33) = 2.206, p = 0.034], as well as a mean decrease of 1.64 ± 10.11 mg/L in CRP levels [t(107) = 1.261, p = 5.965], were observed. Participants within 1 year of treatment completion experienced greater improvements in post CRP levels compared to those who had treatment 1–4 years (p = 0.030) and 5 or more years ago (p = 0.023). Physical functioning, fatigue, fear/anxiety, social role satisfaction, and CRP levels improved following participation in this exercise intervention. Oncologists should consider recommending CART as soon as medically feasible following the cessation of cancer treatment.
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Affiliation(s)
- Jeanette M Ricci
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, California
| | - Victoria Flores
- Department of Kinesiology, California State University, Long Beach, California
| | - Isabela Kuroyama
- Department of Psychology, Loyola Marymount University, Los Angeles, California
| | - Arash Asher
- Cancer Survivorship and Rehabilitation, Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
| | - Heather P Tarleton
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, California
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Owusu C, Schluchter M, Koroukian SM, Schmitz KH, Berger NA. Black-white disparity in physical performance among older women with newly diagnosed non-metastatic breast cancer: Exploring the role of inflammation and physical activity. J Geriatr Oncol 2018; 9:613-619. [PMID: 29699938 DOI: 10.1016/j.jgo.2018.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/14/2018] [Accepted: 04/10/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine racial differences in physical performance among older women with newly diagnosed non-metastatic breast cancer and identify clinical, behavioral and biological factors that might contribute to such disparities. METHODS This is a cross-sectional study of women aged ≥65 years with newly diagnosed stage I-III breast cancer recruited from ambulatory oncology clinics at an academic center, between September 2010 and August 2015. Participants completed a Comprehensive Geriatric Assessment and laboratory testing for biomarkers of inflammation [interleukin-6 (IL6)] prior to receiving systemic treatment for cancer. The primary outcome was poor physical performance, defined as scoring ≤7 on the Short Physical Performance Battery, Yes or No. Logistic regression analyses were undertaken. RESULTS Among 135 women with mean age of 74.8 years (SD = 6.9), 31% were African-American (AA), and 33% had poor physical performance. Controlling for age, education, comorbidities and geriatric syndromes, participants with poor physical performance were more likely to be AA [versus (vs.) Non-Hispanic Whites (NHW)], odds ratio (OR) = 3.10, 95% confidence interval (CI) = 1.18-8.15. Controlling further for physical activity (PA) attenuated the racial disparity in physical performance (OR = 2.50, CI = 0.91-6.84). Lastly, controlling for IL6 further diminished the racial disparity in physical performance (OR = 1.93, CI = 0.67-5.56). In adjusted models, PA and IL6 explained 29% and 38%, respectively, of the racial disparity in poor physical performance. CONCLUSION Among older women with newly diagnosed non-metastatic breast cancer, poor physical performance was prevalent and AA were disproportionately affected. Less engagement in physical activity and subclinical inflammation partly contributed to this disparity.
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Affiliation(s)
- Cynthia Owusu
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, United States; Case Comprehensive Cancer Center, Cleveland, Ohio, United States.
| | - Mark Schluchter
- Case Comprehensive Cancer Center, Cleveland, Ohio, United States; Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, United States
| | - Siran M Koroukian
- Case Comprehensive Cancer Center, Cleveland, Ohio, United States; Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, United States
| | | | - Nathan A Berger
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, United States; Case Comprehensive Cancer Center, Cleveland, Ohio, United States
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Adams BD, Arem H, Hubal MJ, Cartmel B, Li F, Harrigan M, Sanft T, Cheng CJ, Pusztai L, Irwin ML. Exercise and weight loss interventions and miRNA expression in women with breast cancer. Breast Cancer Res Treat 2018; 170:55-67. [PMID: 29511965 DOI: 10.1007/s10549-018-4738-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/26/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Obesity and weight gain are associated with comorbidities including a higher risk of tumor recurrence and cancer-related deaths among breast cancer (BC) survivors; however, the underlying mechanisms linking obesity and cancer are poorly understood. Given the lack of clinically validated BC biomarkers, obesity and weight-loss studies utilize serum biomarkers as the intermediary outcomes of tumor recurrence. Studies have indicated microRNAs (miRNA)s are reliable biomarkers for cancer. We hypothesized that miRNA expression correlates with obesity and weight loss amongst BC survivors. This would yield insight into the biological pathways by which this association occurs, enabling more precise development of therapeutics. PATIENTS AND METHODS We correlated baseline body mass index (BMI) with serum miRNA expression in 121 BC survivors enrolled in the Hormones and Physical Exercise (HOPE) trial. We then analyzed expression of the 35 most abundant miRNAs from HOPE in a six-month randomized controlled weight-loss trial (Lifestyle, Exercise, and Nutrition; LEAN) in 100 BC survivors. Ingenuity pathway analysis (IPA) software was used to identify biological pathway targets of the BMI-associated and intervention-responsive miRNAs using predictive biomarkers. RESULTS Pearson correlations in HOPE identified eight miRNAs associated with BMI, including miR-191-5p (r = - 0.22, p = 0.016) and miR-122-5p (r = 0.25, p = 0.0048). In the LEAN validation study, levels of miR-191-5p significantly increased during the six-month intervention (p = 0.082). Ingenuity Pathway Analysis identified "Estrogen-mediated S-phase entry" (HOPE p = 0.003; LEAN p < 0.001) and "Molecular mechanisms of cancer" (HOPE p = 0.02; LEAN p < 0.001) as the top canonical pathways that significantly correlated with BMI-associated and intervention-responsive miRNAs and contain obesity and cancer-relevant genes including the E2F family of transcription factors and CCND1, which have been implicated in sporadic BC. CONCLUSION While the association between obesity and BC recurrence and mortality has been demonstrated in the literature, mechanisms underlying the link between weight gain and cancer are unclear. Using two independent clinical trials, we identified novel miRNAs associative to BMI and weight loss that contribute to the development of cancer. Predictive modeling of miRNA targets identified multiple canonical pathways associated with cancer, highlighting potential mechanisms explaining the link between BMI and increased cancer risk.
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Affiliation(s)
- Brian D Adams
- The RNA Institute, University at Albany State University of New York, Albany, NY, 12222, USA.,Investigative Medicine Program, Yale University Medical School, New Haven, CT, 06520, USA.,Department of RNA Sciences, The Brain Institute of America, Groton, CT, 06340, USA
| | - Hannah Arem
- Department of Epidemiology and Biostatistics, Milken Institute of Public Health George Washington University, Washington, DC, 20052, USA
| | - Monica J Hubal
- Department of Exercise and Nutrition Sciences, Milken Institute of Public Health George Washington University, Washington, DC, 20052, USA
| | | | - Fangyong Li
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, 06510, USA
| | | | - Tara Sanft
- Yale Medical Oncology, Smilow Cancer Center at Yale New Haven Hospital, New Haven, CT, 06511, USA
| | - Christopher J Cheng
- Division of Nucleic Acid Technology, Alexion Pharmaceuticals, Cheshire, CT, 06410, USA
| | - Lajos Pusztai
- Yale Medical Oncology, Smilow Cancer Center at Yale New Haven Hospital, New Haven, CT, 06511, USA
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Effects of combined and resistance training on the inflammatory profile in breast cancer survivors: A systematic review. Complement Ther Med 2018; 36:73-81. [DOI: 10.1016/j.ctim.2017.11.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/14/2017] [Accepted: 11/29/2017] [Indexed: 12/18/2022] Open
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Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity for women with breast cancer after adjuvant therapy. Cochrane Database Syst Rev 2018; 1:CD011292. [PMID: 29376559 PMCID: PMC6491330 DOI: 10.1002/14651858.cd011292.pub2] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Women with a diagnosis of breast cancer may experience short- and long-term disease and treatment-related adverse physiological and psychosocial outcomes. These outcomes can negatively impact prognosis, health-related quality of life (HRQoL), and psychosocial and physical function. Physical activity may help to improve prognosis and may alleviate the adverse effects of adjuvant therapy. OBJECTIVES To assess effects of physical activity interventions after adjuvant therapy for women with breast cancer. SEARCH METHODS We searched the Cochrane Breast Cancer Group (CBCG) Specialised Registry, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Physiotherapy Evidence Database (PEDro), SPORTDiscus, PsycINFO, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform, on 18 September 2015. We also searched OpenGrey and Healthcare Management Information Consortium databases. SELECTION CRITERIA We searched for randomised and quasi-randomised trials comparing physical activity interventions versus control (e.g. usual or standard care, no physical activity, no exercise, attention control, placebo) after adjuvant therapy (i.e. after completion of chemotherapy and/or radiation therapy, but not hormone therapy) in women with breast cancer. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed risk of bias, and extracted data. We contacted trial authors to ask for additional information when needed. We calculated an overall effect size with 95% confidence intervals (CIs) for each outcome and used GRADE to assess the quality of evidence for the most important outcomes. MAIN RESULTS We included 63 trials that randomised 5761 women to a physical activity intervention (n = 3239) or to a control (n = 2524). The duration of interventions ranged from 4 to 24 months, with most lasting 8 or 12 weeks (37 studies). Twenty-eight studies included aerobic exercise only, 21 involved aerobic exercise and resistance training, and seven used resistance training only. Thirty studies described the comparison group as usual or standard care, no intervention, or control. One-fifth of studies reported at least 20% intervention attrition and the average physical activity adherence was approximately 77%.No data were available on effects of physical activity on breast cancer-related and all-cause mortality, or on breast cancer recurrence. Analysis of immediately postintervention follow-up values and change from baseline to end of intervention scores revealed that physical activity interventions resulted in significant small-to-moderate improvements in HRQoL (standardised mean difference (SMD) 0.39, 95% CI 0.21 to 0.57, 22 studies, 1996 women; SMD 0.78, 95% CI 0.39 to 1.17, 14 studies, 1459 women, respectively; low-quality evidence), emotional function (SMD 0.21, 95% CI 0.10 to 0.32, 26 studies, 2102 women, moderate-quality evidence; SMD 0.31, 95% CI 0.09 to 0.53, 15 studies, 1579 women, respectively; low-quality evidence), perceived physical function (SMD 0.33, 95% CI 0.18 to 0.49, 25 studies, 2129 women; SMD 0.60, 95% CI 0.23 to 0.97, 13 studies, 1433 women, respectively; moderate-quality evidence), anxiety (SMD -0.57, 95% CI -0.95 to -0.19, 7 studies, 326 women; SMD -0.37, 95% CI -0.63 to -0.12, 4 studies, 235 women, respectively; low-quality evidence), and cardiorespiratory fitness (SMD 0.44, 95% CI 0.30 to 0.58, 23 studies, 1265 women, moderate-quality evidence; SMD 0.83, 95% CI 0.40 to 1.27, 9 studies, 863 women, respectively; very low-quality evidence).Investigators reported few minor adverse events.Small improvements in physical activity interventions were sustained for three months or longer postintervention in fatigue (SMD -0.43, 95% CI -0.60 to -0.26; SMD -0.47, 95% CI -0.84 to -0.11, respectively), cardiorespiratory fitness (SMD 0.36, 95% CI 0.03 to 0.69; SMD 0.42, 95% CI 0.05 to 0.79, respectively), and self-reported physical activity (SMD 0.44, 95% CI 0.17 to 0.72; SMD 0.51, 95% CI 0.08 to 0.93, respectively) for both follow-up values and change from baseline scores.However, evidence of heterogeneity across trials was due to variation in intervention components (i.e. mode, frequency, intensity, duration of intervention and sessions) and measures used to assess outcomes. All trials reviewed were at high risk of performance bias, and most were also at high risk of detection, attrition, and selection bias. In light of the aforementioned issues, we determined that the evidence was of very low, low, or moderate quality. AUTHORS' CONCLUSIONS No conclusions regarding breast cancer-related and all-cause mortality or breast cancer recurrence were possible. However, physical activity interventions may have small-to-moderate beneficial effects on HRQoL, and on emotional or perceived physical and social function, anxiety, cardiorespiratory fitness, and self-reported and objectively measured physical activity. The positive results reported in the current review must be interpreted cautiously owing to very low-to-moderate quality of evidence, heterogeneity of interventions and outcome measures, imprecision of some estimates, and risk of bias in many trials. Future studies with low risk of bias are required to determine the optimal combination of physical activity modes, frequencies, intensities, and durations needed to improve specific outcomes among women who have undergone adjuvant therapy.
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Affiliation(s)
- Ian M Lahart
- University of WolverhamptonFaculty of Education, Health and WellbeingGorway RoadWalsallWest MidlandsUKWS1 3BD
| | - George S Metsios
- University of WolverhamptonFaculty of Education, Health and WellbeingGorway RoadWalsallWest MidlandsUKWS1 3BD
| | - Alan M Nevill
- University of WolverhamptonFaculty of Education, Health and WellbeingGorway RoadWalsallWest MidlandsUKWS1 3BD
| | - Amtul R Carmichael
- Queen's HospitalDepartment of SurgeryBelvedere RoadBurton on TrentStaffordshireUK
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Molecular Mechanisms Linking Exercise to Cancer Prevention and Treatment. Cell Metab 2018; 27:10-21. [PMID: 29056514 DOI: 10.1016/j.cmet.2017.09.015] [Citation(s) in RCA: 291] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/09/2017] [Accepted: 09/19/2017] [Indexed: 12/14/2022]
Abstract
The benefits of exercise training for cancer patients are becoming increasingly evident. Physical exercise has been shown to reduce cancer incidence and inhibit tumor growth. Here we provide the status of the current molecular understanding of the effect of exercise on cancer. We propose that exercise has a role in controlling cancer progression through a direct effect on tumor-intrinsic factors, interplay with whole-body exercise effects, alleviation of cancer-related adverse events, and improvement of anti-cancer treatment efficacy. These findings have wide-ranging societal implications, as this understanding may lead to changes in cancer treatment strategies.
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Mills RC. Breast Cancer Survivors, Common Markers of Inflammation, and Exercise: A Narrative Review. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2017; 11:1178223417743976. [PMID: 29434469 PMCID: PMC5802700 DOI: 10.1177/1178223417743976] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/23/2017] [Indexed: 12/29/2022]
Abstract
Exercise may help positively improve inflammatory marker levels, therefore promoting better outcomes in breast cancer survivors. This narrative review is intended to provide an overview between inflammation and breast cancer, in addition to the effects exercise may have on common inflammatory markers that have been examined in both healthy populations and breast cancer survivors throughout the literature. The inconsistencies and gaps in the literature addressed may be important for future research to further understand the relationship between exercise and inflammation, as well as the underlying biological mechanisms that are responsible for these changes. For the purpose of organization, this review is structured into the following sections: (1) Breast Cancer Facts, Treatment-Related Side Effects, and General Exercise Benefits; (2) Effects of Exercise on Markers of Inflammation in Cancer-Free Populations; (3) Cancer and Markers of Inflammation; (4) Effects of Exercise on Markers of Inflammation in Breast Cancer Survivors; and (5) Conclusions.
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Affiliation(s)
- Robert Coleman Mills
- Robert Coleman Mills III, Duke University Medical Center, Box 2714, Durham, NC 27710, USA.
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Gresham G, Schrack J, Gresham LM, Shinde AM, Hendifar AE, Tuli R, Rimel BJ, Figlin R, Meinert CL, Piantadosi S. Wearable activity monitors in oncology trials: Current use of an emerging technology. Contemp Clin Trials 2017; 64:13-21. [PMID: 29129704 DOI: 10.1016/j.cct.2017.11.002] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/16/2017] [Accepted: 11/01/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Physical activity is an important outcome in oncology trials. Physical activity is commonly assessed using self-reported questionnaires, which are limited by recall and response biases. Recent advancements in wearable technology have provided oncologists with new opportunities to obtain real-time, objective physical activity data. The purpose of this review was to describe current uses of wearable activity monitors in oncology trials. METHODS We searched Pubmed, Embase, and the Cochrane Central Register of Controlled Trials for oncology trials involving wearable activity monitors published between 2005 and 2016. We extracted details on study design, types of activity monitors used, and purpose for their use. We summarized activity monitor metrics including step counts, sleep and sedentary time, and time spent in moderate-to-vigorous activity. RESULTS We identified 41 trials of which 26 (63%) involved cancer survivors (post-treatment) and 15 trials (37%) involved patients with active cancer. Most trials (65%) involved breast cancer patients. Wearable activity monitors were commonly used in exercise (54%) or behavioral (29%) trials. Cancer survivors take between 4660 and 11,000 steps/day and those undergoing treatment take 2885 to 8300steps/day. CONCLUSION Wearable activity monitors are increasingly being used to obtain objective measures of physical activity in oncology trials. There is potential for their use to expand to evaluate and predict clinical outcomes such as survival, quality of life, and treatment tolerance in future studies. Currently, there remains a lack of standardization in the types of monitors being used and how their data are being collected, analyzed, and interpreted. PRECIS Recent advancements in wearable activity monitor technology have provided oncologists with new opportunities to monitor their patients' daily activity in real-world settings. The integration of wearable activity monitors into cancer care will help increase our understanding of the associations between physical activity and the prevention and management of the disease, in addition to other important cancer outcomes.
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Affiliation(s)
- Gillian Gresham
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, United States; Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States.
| | - Jennifer Schrack
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, United States
| | | | - Arvind M Shinde
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States
| | - Andrew E Hendifar
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States
| | - Richard Tuli
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States
| | - B J Rimel
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States
| | - Robert Figlin
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States
| | - Curtis L Meinert
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, United States
| | - Steven Piantadosi
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States
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Lee MK, Kim JY, Kim DI, Kang DW, Park JH, Ahn KY, Yang HI, Lee DH, Roh YH, Lee JW, Chu SH, Meyerhardt JA, Jones LW, Kim NK, Jeon JY. Effect of home-based exercise intervention on fasting insulin and Adipocytokines in colorectal cancer survivors: a randomized controlled trial. Metabolism 2017; 76:23-31. [PMID: 28987237 DOI: 10.1016/j.metabol.2017.07.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/13/2017] [Accepted: 07/12/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIMS Elevated circulating insulin is associated with increased risk of recurrence and cancer mortality in early-stage colorectal cancer (CRC). We conducted a randomized controlled trial to determine the effect of a 12-week home-based exercise program on fasting insulin, adipocytokines, and physical function in CRC survivors. METHODS One hundred and twenty-three stage II-III CRC patients were randomly assigned to either a home-based exercise (n=62) or standard care control group (n=61) for 12weeks. Home-based exercise consisted of aerobic and resistance training, with a goal of obtaining ≥18 metabolic equivalent task (MET)-h/wk. Participants in the exercise group were instructed to participate in >18MET-h/wk. of aerobic and resistance exercise while the participants in the control group were asked to maintain their usual daily activity. The primary outcome was fasting insulin levels. Secondary outcomes were adiponectin, TNF-α levels and 6min walk distance from baseline to post-intervention. RESULTS After the 12-weeks, moderate-vigorous physical activity participation increased from 9.1±14.7MET-h/wk. to 26.6±21.7MET-h/wk. in the exercise group, with no change in the control group (p<0.01 for group and time interaction). Circulating insulin level decreased by 1μU/ml (6.0±3.9 vs. 5.0±3.5, p=0.009) in the exercise group with no change in the control group (p=0.022 for group and time interaction). A similar trend was observed in TNF-α (p=0.030 for group and time interaction). Six minute walk distance increased by 25.2m in the exercise group with no change in the control group (p=0.061 for group and time interaction). CONCLUSIONS The 12week home-based exercise program increased level of physical activity and decreased circulating insulin levels in CRC survivors.
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Affiliation(s)
- Mi Kyung Lee
- Department of Sport Industry Studies, Exercise Medicine and Rehabilitation Laboratory, Yonsei University, Republic of Korea; Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Republic of Korea
| | - Ji-Young Kim
- Department of Sport Industry Studies, Exercise Medicine and Rehabilitation Laboratory, Yonsei University, Republic of Korea
| | - Dong-Il Kim
- Department of Sport Industry Studies, Exercise Medicine and Rehabilitation Laboratory, Yonsei University, Republic of Korea
| | - Dong-Woo Kang
- Department of Sport Industry Studies, Exercise Medicine and Rehabilitation Laboratory, Yonsei University, Republic of Korea; Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Ji-Hye Park
- Department of Sport Industry Studies, Exercise Medicine and Rehabilitation Laboratory, Yonsei University, Republic of Korea
| | - Ki-Yong Ahn
- Department of Sport Industry Studies, Exercise Medicine and Rehabilitation Laboratory, Yonsei University, Republic of Korea
| | - Hyuk In Yang
- Department of Sport Industry Studies, Exercise Medicine and Rehabilitation Laboratory, Yonsei University, Republic of Korea
| | - Dong Hoon Lee
- Department of Sport Industry Studies, Exercise Medicine and Rehabilitation Laboratory, Yonsei University, Republic of Korea; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Republic of Korea
| | - Ji-Won Lee
- Department of Family Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Republic of Korea
| | - Sang-Hui Chu
- Department of Clinical Nursing Science, Yonsei University College of Nursing, Nursing Policy Research Institute, Biobehavioural Research Center, Republic of Korea
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Lee W Jones
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nam-Kyu Kim
- Department of Surgery, Yonsei University College of Medicine, Republic of Korea; Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Republic of Korea; Cancer Prevention Center, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Justin Y Jeon
- Department of Sport Industry Studies, Exercise Medicine and Rehabilitation Laboratory, Yonsei University, Republic of Korea; Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Republic of Korea; Cancer Prevention Center, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Law W, Johnson C, Rushton M, Dent S. The Framingham risk score underestimates the risk of cardiovascular events in the HER2-positive breast cancer population. ACTA ACUST UNITED AC 2017; 24:e348-e353. [PMID: 29089804 DOI: 10.3747/co.24.3684] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Patients with breast cancer (bca) who overexpress her2 (the human epidermal growth factor receptor 2) are at risk for cardiotoxicity when treated with anthracycline-based chemotherapy and her2-targeted agents. The Framingham risk score (frs) is a validated tool that stratifies patients into high-, intermediate-, or low-risk groups and calculates their 10-year risk of developing cardiovascular disease (cvd) based on past medical history, systolic blood pressure, and measurement of serum lipids. We retrospectively analyzed patients with her2-positive bca to determine whether the frs predicts adverse cardiovascular (CV) events or cardiotoxicity in patients treated using anthracyclines or her2-targeted therapy, or both. METHODS The frs was determined for patients with bca referred to The Ottawa Hospital Cardiology-Oncology Clinic from October 2008 to August 2014. The patients were stratified into high (≥20%), intermediate (10%-20%), and low (<10%) 10-year cv risk groups. Primary outcomes included cvd-related hospitalizations and deaths, and cardiotoxicity [drop in left ventricular ejection fraction (lvef) of >10% to a lvef ≤50%]. RESULTS Of the 152 patients included in the analysis (median follow-up: 40.7 months; range: 3.5-263 months), 47 (31%) were classified as high risk; 36 (24%), as intermediate risk; and 69 (45%), as low-risk. The number of cvd-related hospitalizations and deaths was 22, for an overall prevalence of 14%, with significantly more events occurring in high-risk than in low-risk patients (odds ratio: 4.18; 95% confidence limits: 1.47, 11.89). The frs predicted a 10-year risk of any cv event of 11.2% and underestimated the actual rate of cv events in the entire cohort. High frs was not associated with cardiotoxicity (p = 0.82). CONCLUSIONS In a population of patients with her2-positive bca referred to a cardiology-oncology clinic, the frs does not accurately predict the risk of cv events or cardiotoxicity.
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Affiliation(s)
| | - C Johnson
- Division of Cardiology, Department of Medicine, and
| | | | - S Dent
- Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, ON
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Enhancing an oncologist's recommendation to exercise to manage fatigue levels in breast cancer patients: a randomized controlled trial. Support Care Cancer 2017; 26:905-912. [PMID: 28965138 DOI: 10.1007/s00520-017-3909-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/25/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Fatigue is a troublesome symptom for breast cancer patients, which might be mitigated with exercise. Cancer patients often prefer their oncologist recommend an exercise program, yet a recommendation alone may not be enough to change behavior. Our study determined whether adding an exercise DVD to an oncologist's recommendation to exercise led to better outcomes than a recommendation alone. METHODS Ninety breast cancer patients, at varying phases of treatment and stages of disease, were randomized to receive the following: an oncologist verbal recommendation to exercise (REC; n = 43) or REC plus a cancer-specific yoga DVD (REC + DVD; n = 47). Fatigue, vigor, and depression subscales of the Profile of Mood States, and physical activity levels (MET-min/week), exercise readiness, and self-efficacy were assessed at baseline, 4, and 8 weeks. Analyses controlled for age, time since diagnosis, and metastatic disease. RESULTS Over 8 weeks, women in REC + DVD used the DVD an average of twice per week. The REC + DVD group had greater reductions in fatigue (- 1.9 ± 5.0 vs. - 1.0 ± 3.5, p = 0.02), maintained exercise readiness (- 0.1 ± 1.1 vs. - 0.3 ± 1.3; p = 0.03), and reported less of a decrease in physical activity (- 420 ± 3075 vs. - 427 ± 5060 MET-min/week, p = 0.06) compared to REC only. CONCLUSIONS A low-cost, easily distributed, and scalable yoga-based DVD could be a simple booster to an oncologist's advice that motivates breast cancer patients, even those with advanced disease and/or in treatment, to engage in self-care, e.g., exercise, to manage fatigue. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03120819.
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Kim TH, Chang JS, Kong ID. Effects of Exercise Training on Physical Fitness and Biomarker Levels in Breast Cancer Survivors. J Lifestyle Med 2017; 7:55-62. [PMID: 29026725 PMCID: PMC5618735 DOI: 10.15280/jlm.2017.7.2.55] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 06/13/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Exercise has been identified as a beneficial intervention to enhance quality of life in breast cancer survivors. In addition, there has been a noteworthy increase in studies emphasizing the benefits of exercise in cancer. We sought to summarize the empirical literature concerning the effects of exercise on physical fitness and biomarker levels in breast cancer survivors according to the type of exercise. METHODS We searched PubMed and PubMed Central for studies on the association of exercise with the levels of various biomarkers and physical fitness in breast cancer survivors. We investigated the effects of different types of exercise (aerobic, resistance, or combined) on breast cancer survivors, with changes in physical fitness and biomarker levels as the primary outcomes. RESULTS In total, 118 research papers published from 2012 to July 2016 were retrieved from PubMed and PubMed Central. Of these, 24 papers met our inclusion criteria. All types of exercise were found to improve physical fitness in breast cancer survivors. However, the results with regard to biomarkers were controversial. CONCLUSION The findings of this review suggest that combined exercise is associated with better outcomes than aerobic or resistance exercise alone in breast cancer survivors.
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Affiliation(s)
- Tae Ho Kim
- Department of Physiology, Yonsei University Wonju College of Medicine, Yonsei Institute of Sports Science & Exercise Medicine, Wonju, Korea
| | - Jae Seung Chang
- Department of Physiology, Yonsei University Wonju College of Medicine, Yonsei Institute of Sports Science & Exercise Medicine, Wonju, Korea
| | - In Deok Kong
- Department of Physiology, Yonsei University Wonju College of Medicine, Yonsei Institute of Sports Science & Exercise Medicine, Wonju, Korea
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Exercise protects from cancer through regulation of immune function and inflammation. Biochem Soc Trans 2017; 45:905-11. [PMID: 28673937 DOI: 10.1042/bst20160466] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/29/2017] [Accepted: 06/01/2017] [Indexed: 02/07/2023]
Abstract
Exercise training has been extensively studied in cancer settings as part of prevention or rehabilitation strategies, yet emerging evidence suggests that exercise training can also directly affect tumor-specific outcomes. The underlying mechanisms for this exercise-dependent cancer protection are just starting to be elucidated. To this end, evasion of immune surveillance and tumor-associated inflammation are established as hallmarks of cancer, and exercise may target cancer incidence and progression through regulation of these mechanisms. Here, I review the role of exercise in protection from cancer through mobilization and activation of cytotoxic immune cells, restriction of inflammatory signaling pathways in myeloid immune cells, and regulation of acute and chronic systemic inflammatory responses. In conclusion, I propose that exercise has the potential to target tumor growth through regulation of immune and inflammatory functions, and exercise may be pursued as anticancer treatment through incorporation into standard oncological therapy to the benefit of the cancer patients.
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Kang DW, Lee J, Suh SH, Ligibel J, Courneya KS, Jeon JY. Effects of Exercise on Insulin, IGF Axis, Adipocytokines, and Inflammatory Markers in Breast Cancer Survivors: A Systematic Review and Meta-analysis. Cancer Epidemiol Biomarkers Prev 2017; 26:355-365. [PMID: 27742668 DOI: 10.1158/1055-9965.epi-16-0602] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/04/2016] [Accepted: 10/04/2016] [Indexed: 12/11/2022] Open
Abstract
Background: Insulin, IGF axis, adiponectin, and inflammatory markers are associated with breast cancer. Given that physical activity improves prognosis of breast cancer survivors, we investigated the effects of exercise on these markers as potential mediators between physical activity and breast cancer.Methods: PubMed, EMBASE, CENTRAL, CINAHL, and SportDiscus were searched up to December 3, 2015, to identify randomized controlled trials (RCT) that investigated the effect of exercise on insulin, IGF axis, and cytokines in breast cancer survivors. Weighted mean difference (WMD) was calculated using either fixed- or random-effects models on the basis of the heterogeneity of the studies.Results: A total of 18 studies involving 681 breast cancer survivors were included, and these numbers were reduced for individual biomarker analyses. We found that exercise significantly reduced fasting insulin levels [WMD, -3.46 μU/mL; 95% confidence interval (CI), -5.97 to -0.95; P = 0.007]. Furthermore, potentially meaningful but statistically nonsignificant changes were observed in insulin resistance (WMD, -0.73; 95% CI, -0.54 to 0.13; P = 0.23), adiponectin (WMD, 1.17 μg/mL; 95% CI, -0.87 to 3.20; P = 0.26), and C-reactive protein (WMD, -1.10 mg/L; 95% CI, -2.39 to 0.20; P = 0.10). Subgroup analyses showed that fasting insulin levels were significantly more impacted in studies in which intervention participants experienced a weight reduction (WMD, -7.10 μU/mL; 95% CI, -10.31 to -3.90; P < 0.001).Conclusions: Exercise reduces fasting insulin levels in breast cancer survivors. This may be due to exercise-induced reductions in body weight.Impact: Practitioners and clinicians may better help breast cancer prognosis be improved through exercise, anticipating physiological effects on cancer. Cancer Epidemiol Biomarkers Prev; 26(3); 355-65. ©2016 AACR.
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Affiliation(s)
- Dong-Woo Kang
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Junga Lee
- Department of Sport and Leisure Studies, Yonsei University, Seoul, Korea.,Exercise Medicine Center for Diabetes and Cancer Patients, Institute of Convergence of Science (ICONS), Yonsei University, Seoul, Korea
| | - Sang-Hoon Suh
- Department of Physical Education, Yonsei University, Seoul, Korea
| | - Jennifer Ligibel
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Kerry S Courneya
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Justin Y Jeon
- Department of Sport and Leisure Studies, Yonsei University, Seoul, Korea. .,Exercise Medicine Center for Diabetes and Cancer Patients, Institute of Convergence of Science (ICONS), Yonsei University, Seoul, Korea.,Cancer Prevention Center, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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Fairman CM, Hyde PN, Focht BC. Resistance training interventions across the cancer control continuum: a systematic review of the implementation of resistance training principles. Br J Sports Med 2016; 51:677-685. [DOI: 10.1136/bjsports-2016-096537] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 11/03/2022]
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Tizdast N, Ghazalian F, Gholami M. The Effect of Exercise Type on Inflammatory Markers in Obese Survivors With Breast Cancer: Randomized Control Trial. HEALTH SCOPE 2016. [DOI: 10.17795/jhealthscope-33421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Meneses-Echávez JF, Correa-Bautista JE, González-Jiménez E, Schmidt Río-Valle J, Elkins MR, Lobelo F, Ramírez-Vélez R. The Effect of Exercise Training on Mediators of Inflammation in Breast Cancer Survivors: A Systematic Review with Meta-analysis. Cancer Epidemiol Biomarkers Prev 2016; 25:1009-17. [PMID: 27197276 DOI: 10.1158/1055-9965.epi-15-1061] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 03/30/2016] [Indexed: 11/16/2022] Open
Abstract
Several sources of evidence indicate that exercise during and after breast cancer could positively modulate the tumor microenvironment. This meta-analysis aimed to determine the effects of exercise training on mediators of inflammation in breast cancer survivors. We searched for randomized controlled trials published from January 1990 to March 2014. An inverse variance method of meta-analysis was performed using a random effects model in the presence of statistical heterogeneity. Eight high-quality trials (n = 478) were included. Exercise improved the serum concentrations of IL6 [weighted mean difference (WMD) = -0.55 pg/mL; 95% confidence interval (CI), -1.02 to -0.09], TNFα (WMD = -0.64 pg/mL; 95% CI, -1.21 to -0.06), IL8 (MD = -0.49 pg/mL; 95% CI, -0.89 to -0.09), and IL2 (WMD = 1.03 pg/mL; 95% CI, 0.40 to 1.67). No significant differences were found in the serum concentrations of C-reactive protein (WMD = -0.15; 95% CI, -0.56 to 0.25) or IL10 (WMD = 0.41; 95% CI, -0.18 to 1.02). Exercise training positively modulates chronic low-grade inflammation in women with breast cancer, which may impact upon carcinogenic mechanisms and the tumor microenvironment. These findings align with the other positive effects of exercise for breast cancer survivors, reinforcing the appropriateness of exercise prescription in this population. Cancer Epidemiol Biomarkers Prev; 25(7); 1009-17. ©2016 AACR.
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Affiliation(s)
- Jose F Meneses-Echávez
- Norwegian Knowledge Centre for the Health Services in the Norwegian Institute of Public Health, Oslo, Norway.
| | - Jorge E Correa-Bautista
- Centro de Estudios en Medición de la Actividad Física (CEMA), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | | | | | - Mark R Elkins
- Sydney Medical School, University of Sydney, Sydney, Australia. Centre for Education and Workforce Development, Sydney Local Health District, Sydney, Australia
| | - Felipe Lobelo
- Hubert Department of Global Health, Emory University, Rollins School of Public Health, Atlanta, Georgia. Exercise is Medicine Global Research and Collaboration Center, Atlanta, Georgia
| | - Robinson Ramírez-Vélez
- Centro de Estudios en Medición de la Actividad Física (CEMA), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
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Dennett AM, Peiris CL, Shields N, Prendergast LA, Taylor NF. Moderate-intensity exercise reduces fatigue and improves mobility in cancer survivors: a systematic review and meta-regression. J Physiother 2016; 62:68-82. [PMID: 26996098 DOI: 10.1016/j.jphys.2016.02.012] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/05/2016] [Accepted: 02/25/2016] [Indexed: 12/15/2022] Open
Abstract
QUESTION Is there a dose-response effect of exercise on inflammation, fatigue and activity in cancer survivors? DESIGN Systematic review with meta-regression analysis of randomised trials. PARTICIPANTS Adults diagnosed with cancer, regardless of specific diagnosis or treatment. INTERVENTION Exercise interventions including aerobic and/or resistance as a key component. OUTCOME MEASURES The primary outcome measures were markers of inflammation (including C-reactive protein and interleukins) and various measures of fatigue. The secondary outcomes were: measures of activity, as defined by the World Health Organization's International Classification of Functioning, Disability and Health, including activities of daily living and measures of functional mobility (eg, 6-minute walk test, timed sit-to-stand and stair-climb tests). Risk of bias was evaluated using the PEDro scale, and overall quality of evidence was assessed using the Grades of Research, Assessment, Development and Evaluation (GRADE) approach. RESULTS Forty-two trials involving 3816 participants were included. There was very low-quality to moderate-quality evidence that exercise results in significant reductions in fatigue (SMD 0.32, 95% CI 0.13 to 0.52) and increased walking endurance (SMD 0.77, 95% CI 0.26 to 1.28). A significant negative association was found between aerobic exercise intensity and fatigue reduction. A peak effect was found for moderate-intensity aerobic exercise for improving walking endurance. No dose-response relationship was found between exercise and markers of inflammation or exercise duration and outcomes. Rates of adherence were typically high and few adverse events were reported. CONCLUSIONS Exercise is safe, reduces fatigue and increases endurance in cancer survivors. The results support the recommendation of prescribing moderate-intensity aerobic exercise to reduce fatigue and improve activity in people with cancer. REVIEW REGISTRATION PROSPERO CRD42015019164.
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Affiliation(s)
- Amy M Dennett
- School of Allied Health, La Trobe University and Allied Health Clinical Research Office, Eastern Health
| | - Casey L Peiris
- School of Allied Health, La Trobe University and Northern Health
| | - Nora Shields
- School of Allied Health, La Trobe University and Northern Health
| | - Luke A Prendergast
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia
| | - Nicholas F Taylor
- School of Allied Health, La Trobe University and Allied Health Clinical Research Office, Eastern Health
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Ma LX, Bulsara MK, Tan SY, Vardy J. Body weight management in overweight and obese breast cancer survivors. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Li Xin Ma
- Concord Repatriation General Hospital; Concord Cancer Centre; Hospital Rd, Concord, Sydney New South Wales Australia 2139
- Hebei University; Nutrition and Food Hygiene Department; No. 342 East Yuhua Rd Baoding Hebei Province China 071000
| | - Max K Bulsara
- The University of Notre Dame Australia; Institute for Health Research; 19 Mouat Street PO Box 1125 Fremantle WA Australia 6959
| | - Sim Yee Tan
- Concord Repatriation General Hospital; Concord Cancer Centre; Hospital Rd, Concord, Sydney New South Wales Australia 2139
- Concord Repatriation General Hospital; Nutrition and Dietetics Department; Building 38 Hospital Road Concord NSW Australia 2139
- University of Sydney; Sydney Medical School; Sydney Australia
| | - Janette Vardy
- Concord Repatriation General Hospital; Concord Cancer Centre; Hospital Rd, Concord, Sydney New South Wales Australia 2139
- University of Sydney; Sydney Medical School; Sydney Australia
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Schmidt ME, Meynköhn A, Habermann N, Wiskemann J, Oelmann J, Hof H, Wessels S, Klassen O, Debus J, Potthoff K, Steindorf K, Ulrich CM. Resistance Exercise and Inflammation in Breast Cancer Patients Undergoing Adjuvant Radiation Therapy: Mediation Analysis From a Randomized, Controlled Intervention Trial. Int J Radiat Oncol Biol Phys 2016; 94:329-37. [DOI: 10.1016/j.ijrobp.2015.10.058] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/08/2015] [Accepted: 10/26/2015] [Indexed: 12/20/2022]
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LaVoy EC, Fagundes CP, Dantzer R. Exercise, inflammation, and fatigue in cancer survivors. EXERCISE IMMUNOLOGY REVIEW 2016; 22:82-93. [PMID: 26853557 PMCID: PMC4755327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cancer-related fatigue significantly disrupts normal functioning and quality of life for a substantial portion of cancer survivors, and may persist for years following cancer treatment. While the causes of persistent fatigue among cancer survivors are not yet fully understood, accumulating evidence suggests that several pathways, including chronic inflammation, autonomic imbalance, HPA-axis dysfunction, and/or mitochondrial damage, could contribute towards the disruption of normal neuronal function and result in the symptom of cancer-related fatigue. Exercise training interventions have been shown to be some of the more successful treatment options to address cancer-related fatigue. In this review, we discuss the literature regarding the causes of persistent fatigue in cancer survivors and the mechanisms by which exercise may relieve this symptom. There is still much work to be done until the prescription of exercise becomes standard practice for cancer survivors. With improvements in the quality of studies, evidenced-based exercise interventions will allow exercise scientists and oncologists to work together to treat cancer-related fatigue.
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Affiliation(s)
- Emily C.P. LaVoy
- Laboratory of Integrated Physiology, Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Christopher P. Fagundes
- Department of Symptoms Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Psychology, Rice University, Houston, TX, USA
| | - Robert Dantzer
- Department of Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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76
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Murphy EA, Enos RT, Velázquez KT. Influence of Exercise on Inflammation in Cancer: Direct Effect or Innocent Bystander? Exerc Sport Sci Rev 2015; 43:134-42. [PMID: 25906430 DOI: 10.1249/jes.0000000000000054] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We propose the hypothesis that the benefits of exercise on inflammation in cancer are a result of a direct effect on inflammatory cytokines, including interleukin-6, tumor necrosis factor-α, and monocyte chemoattractant protein 1, that are critical for cancer growth as well as a bystander effect of the established relationship between exercise and cancer.
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Affiliation(s)
- E Angela Murphy
- Department of Pathology, Microbiology and Immunology, School of Medicine, University of South Carolina, Columbia, SC
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77
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Møller T, Lillelund C, Andersen C, Bloomquist K, Christensen KB, Ejlertsen B, Nørgaard L, Wiedenbein L, Oturai P, Breitenstein U, Adamsen L. The challenge of preserving cardiorespiratory fitness in physically inactive patients with colon or breast cancer during adjuvant chemotherapy: a randomised feasibility study. BMJ Open Sport Exerc Med 2015; 1:e000021. [PMID: 27900123 PMCID: PMC5117008 DOI: 10.1136/bmjsem-2015-000021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 12/11/2022] Open
Abstract
Introduction Anti-neoplastic treatment is synonymous with an inactive daily life for a substantial number of patients. It remains unclear what is the optimal setting, dosage and combination of exercise and health promoting components that best facilitate patient adherence and symptom management in order to support cardio-respiratory fitness and lifestyle changes in an at-risk population of pre-illness physically inactive cancer patients. Methods Patients with breast or colon cancer referred to adjuvant chemotherapy and by the oncologists pre-screening verified as physically inactive were eligible to enter a randomised three-armed feasibility study comparing a 12-week supervised hospital-based moderate to high intensity exercise intervention or alternate an instructive home-based12-week pedometer intervention, with usual care. Results Using a recommendation based physical activity screening instrument in order to correspond with cardio-respiratory fitness (VO2 peak) proved to be an applicable method to identify pre-illness physically inactive breast and colon cancer patients. The study demonstrated convincing recruitment (67%), safety and intervention adherence among breast cancer patients; while the attendance rate for colon cancer patients was notably lower (33%). VO2-peak declined on average 12% across study groups from baseline to 12 weeks though indices towards sustaining watt performance and reduce fat mass favoured the hospital-based intervention. Pedometer use was well adapted in both breast and colon cancer patients. Conclusions Despite a fair adherence and safety, the current study calls into question whether aerobic exercise, regardless of intensity, is able to increase VO2-peak during texane-based chemotherapy in combination with Neulasta in physically inactive breast cancer patients. Trial Registration: ISRCTN24901641
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Affiliation(s)
- Tom Møller
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Christian Lillelund
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Christina Andersen
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Kira Bloomquist
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Karl Bang Christensen
- Faculty of Health and Medical Sciences, Section of Biostatistics , University of Copenhagen , Copenhagen , Denmark
| | - Bent Ejlertsen
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Lone Nørgaard
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Liza Wiedenbein
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Peter Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Ulla Breitenstein
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Lis Adamsen
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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78
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Lucius K, Trukova K. Integrative Therapies and Cardiovascular Disease in the Breast Cancer Population: A Review, Part 2. Integr Med (Encinitas) 2015; 14:33-40. [PMID: 26770165 PMCID: PMC4712867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In Part 1 of the current review, the cardiotoxicity of standard breast cancer treatment was reviewed. Part 2 presents a comprehensive review of the current evidence for lifestyle factors, including nutrition and exercise. Part 2 describes the results of several dietary interventions in breast cancer survivors. Specific dietary factors that may promote cardiovascular health in this population, including essential fatty acids and plant phytosterols, are also reviewed. In addition, the mechanisms by which exercise may provide a benefit are discussed, and evidence for the important role of attainment and maintenance of a healthy weight is outlined. Finally, recommendations for lifestyle changes in the survivor population are discussed, and opportunities for future research in this population are identified.
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Affiliation(s)
- Khara Lucius
- Khara Lucius, nd, fabno, is a naturopathic doctor in the Department of Naturopathic Medicine; and Kristen Trukova, ms, rd, cso, cnsc, ldn, is lead oncology dietitian in the Nutrition Department. Both are located at the Cancer Treatment Centers of America, Midwestern Regional Medical Center, in Zion, Illinois
| | - Kristen Trukova
- Khara Lucius, nd, fabno, is a naturopathic doctor in the Department of Naturopathic Medicine; and Kristen Trukova, ms, rd, cso, cnsc, ldn, is lead oncology dietitian in the Nutrition Department. Both are located at the Cancer Treatment Centers of America, Midwestern Regional Medical Center, in Zion, Illinois
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79
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Swisher AK, Abraham J, Bonner D, Gilleland D, Hobbs G, Kurian S, Yanosik MA, Vona-Davis L. Exercise and dietary advice intervention for survivors of triple-negative breast cancer: effects on body fat, physical function, quality of life, and adipokine profile. Support Care Cancer 2015; 23:2995-3003. [PMID: 25724409 PMCID: PMC4624214 DOI: 10.1007/s00520-015-2667-z] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 02/15/2015] [Indexed: 01/19/2023]
Abstract
PURPOSE Regular exercise and healthy eating are routinely recommended for breast cancer survivors, and past studies show benefits in quality of life and decreased inflammation. However, this has not been tested specifically in triple-negative breast cancer survivors. Increasing physical activity and losing body fat are thought to positively affect inflammatory biomarkers that have been associated with breast cancer. Therefore, the primary purpose of this study was to determine if participation in an exercise and dietary counseling program can improve body fat, physical function, and quality of life in survivors of this aggressive breast cancer. Secondarily, we sought to determine if participation in the program had beneficial effects on obesity-related markers of the adipokine profile. METHODS Sixty-six survivors of triple-negative breast cancer with BMI >25 were invited to participate. Twenty-eight enrolled and 23 completed the randomized, controlled trial (13 intervention, 10 control). Moderate-intensity aerobic exercise (150 min per week, for 12 weeks) and diet counseling were compared to usual care, education only. The primary outcome of interest was weight loss (body mass, BMI, % fat), and secondary outcomes included physical function (exercise capacity), quality of life (Function After Cancer Therapy-Breast (FACT-B)), cytokines (C-reactive protein (CRP), TNF-α, IL-6), and adipokine profile (leptin, adiponectin, insulin). RESULTS Participants in the program lost more body fat (2.4 % loss vs. 0.4 % gain, p < 0.05) than the control group. The intervention group also improved quality of life (FACT-B total score +14 pts) and decreased sedentary time but did not improve peak exercise capacity. The intervention had no effect on serum cytokines and adipokines after 12 weeks in the program. However, serum leptin and adiponectin and their ratio were significantly correlated with BMI in the intervention group (p < 0.05). CONCLUSIONS Exercise and dietary counseling led to loss of body fat and improved quality of life in survivors of triple-negative breast cancer. BMI was associated with favorable changes in leptin and adiponectin which may reflect a change in adiposity with intervention. Exercise and healthy eating may be equally effective in this high-risk population as in other breast cancer survivors and should be encouraged as a part of a cancer survivorship program.
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Affiliation(s)
- Anne K Swisher
- Division of Physical Therapy, West Virginia University, PO Box 9226, Morgantown, WV, 26506-9226, USA,
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80
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Long Parma D, Hughes DC, Ghosh S, Li R, Treviño-Whitaker RA, Ogden SM, Ramirez AG. Effects of six months of Yoga on inflammatory serum markers prognostic of recurrence risk in breast cancer survivors. SPRINGERPLUS 2015; 4:143. [PMID: 25853030 PMCID: PMC4383749 DOI: 10.1186/s40064-015-0912-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/03/2015] [Indexed: 02/01/2023]
Abstract
Yoga-based exercise has proven to be beneficial for practitioners, including cancer survivors. This study reports on the effect on inflammatory biological markers for 20 breast cancer survivors who participated in a six-month yoga-based (YE) exercise program. Results are compared to a comprehensive exercise (CE) program group and a comparison (C) exercise group who chose their own exercises. "Pre" and "post" assessments included measures of anthropometrics, cardiorespiratory capacity, and inflammatory markers interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor alpha (TNFα) and C-reactive protein (CRP). Descriptive statistics, effect size (d), and dependent sample 't' tests for all outcome measures were calculated for the YE group. Significant improvements were seen in decreased % body fat, (-3.00%, d = -0.44, p = <.001) but not in cardiorespiratory capacity or in inflammatory serum markers. To compare YE outcomes with the other two groups, a one-way analysis of co-variance (ANCOVA) was used, controlling for age, BMI, cardiorespiratory capacity and serum marker baseline values. We found no differences between groups. Moreover, we did not see significant changes in any inflammatory marker for any group. Our results support the effectiveness of yoga-based exercise modified for breast cancer survivors for improving body composition. Larger studies are needed to determine if there are significant changes in inflammatory serum markers as a result of specific exercise modalities.
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Affiliation(s)
- Dorothy Long Parma
- />Department of Epidemiology and Biostatistics, Institute for Health Promotion Research, University of Texas Health Science Center at San Antonio, 7411 John Smith Drive Suite 1000, San Antonio, TX USA
| | - Daniel C Hughes
- />Department of Epidemiology and Biostatistics, Institute for Health Promotion Research, University of Texas Health Science Center at San Antonio, 7411 John Smith Drive Suite 1000, San Antonio, TX USA
| | | | - Rong Li
- />Department of Molecular Medicine, Institute of Biotechnology, University of Texas Health Science Center at San Antonio, San Antonio, TX USA
| | - Rose A Treviño-Whitaker
- />Department of Epidemiology and Biostatistics, Institute for Health Promotion Research, University of Texas Health Science Center at San Antonio, 7411 John Smith Drive Suite 1000, San Antonio, TX USA
| | - Susan M Ogden
- />Department of Epidemiology and Biostatistics, Institute for Health Promotion Research, University of Texas Health Science Center at San Antonio, 7411 John Smith Drive Suite 1000, San Antonio, TX USA
| | - Amelie G Ramirez
- />Department of Epidemiology and Biostatistics, Institute for Health Promotion Research, University of Texas Health Science Center at San Antonio, 7411 John Smith Drive Suite 1000, San Antonio, TX USA
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81
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Block KI, Block PB, Gyllenhaal C. Integrative therapies in cancer: modulating a broad spectrum of targets for cancer management. Integr Cancer Ther 2015; 14:113-8. [PMID: 25601968 DOI: 10.1177/1534735414567473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Integrative medicine is an approach to health and healing that "makes use of all appropriate therapeutic approaches, health care professionals, and disciplines to achieve optimal health and healing." A comprehensive integrative medicine intervention for cancer patients typically includes nutritional counseling, biobehavioral strategies, and promotion of physical activity, as well as dietary supplements including herbs, nutraceuticals, and phytochemicals. A broad-spectrum intervention of this type may contribute uniquely to improvement in cancer outcomes through its impact on a wide variety of relevant molecular targets, including effects on multiple cancer hallmarks. Hallmarks that may be particularly affected include genetic instability, tumor-promoting inflammation, deregulated metabolism, and immune system evasion. Because of their susceptibility to manipulation by diet, exercise, and supplementation, these may be characterized as metabolic hallmarks. Research on the use of comprehensive integrative approaches can contribute to the development of systems of multitargeted treatment regimens and would help clarify the combined effect of these approaches on cancer outcomes.
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Affiliation(s)
- Keith I Block
- Block Center for Integrative Cancer Treatment, Skokie, IL, USA
| | - Penny B Block
- Block Center for Integrative Cancer Treatment, Skokie, IL, USA
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82
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Glass OK, Inman BA, Broadwater G, Courneya KS, Mackey JR, Goruk S, Nelson ER, Jasper J, Field CJ, Bain JR, Muehlbauer M, Stevens RD, Hirschey MD, Jones LW. Effect of aerobic training on the host systemic milieu in patients with solid tumours: an exploratory correlative study. Br J Cancer 2015; 112:825-31. [PMID: 25584487 PMCID: PMC4453949 DOI: 10.1038/bjc.2014.662] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/01/2014] [Accepted: 12/17/2014] [Indexed: 12/18/2022] Open
Abstract
Background: Few studies have investigated the effects of exercise on modulation of host factors in cancer patients. We investigated the efficacy of chronic aerobic training on multiple host-related effector pathways in patients with solid tumours. Patients and Methods: Paired peripheral blood samples were obtained from 44 patients with solid tumours receiving cytotoxic therapy and synthetic erythropoietin (usual care; n=21) or usual care plus supervised aerobic training (n=23) for 12 weeks. Samples were characterised for changes in immune, cytokine and angiogenic factors, and metabolic intermediates. Aerobic training consisted of three supervised cycle ergometry sessions per week at 60% to 100% of peak oxygen consumption (VO2peak), 30–45 min per session, for 12 weeks following a nonlinear prescription. Results: The between-group delta change in cardiopulmonary function was +4.1 ml kg −1 min−1, favouring aerobic training (P<0.05). Significant pre–post between-group differences for five cytokine and angiogenic factors (HGF, IL-4, macrophage inflammatory protein-1β (MIP-1β), vascular endothelial growth factor (VEGF), and TNF-α) also favour the aerobic training group (P's<0.05). These reductions occurred in conjunction with nonsignificant group differences for T lymphocytes CD4+, CD8+, and CD8+/CD45RA (P<0.10). For these factors, circulating concentrations generally increased from baseline to week 12 in the aerobic training group compared with decreases or no change in the usual care group. No significant changes in any metabolic intermediates were observed. Conclusions: Aerobic training alters host availability of select immune–inflammatory effectors in patients with solid tumours; larger confirmatory studies in more homogenous samples are warranted.
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Affiliation(s)
- O K Glass
- Duke University Medical Center, Durham, NC, USA
| | - B A Inman
- Duke University Medical Center, Durham, NC, USA
| | | | - K S Courneya
- University of Alberta, Edmonton, Alberta, Canada
| | - J R Mackey
- University of Alberta, Edmonton, Alberta, Canada
| | - S Goruk
- University of Alberta, Edmonton, Alberta, Canada
| | - E R Nelson
- Duke University Medical Center, Durham, NC, USA
| | - J Jasper
- Duke University Medical Center, Durham, NC, USA
| | - C J Field
- University of Alberta, Edmonton, Alberta, Canada
| | - J R Bain
- Duke University Medical Center, Durham, NC, USA
| | | | - R D Stevens
- Duke University Medical Center, Durham, NC, USA
| | | | - L W Jones
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
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83
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Abstract
UNLABELLED There has been an increase in the cancer survivor population in the United States over the past several decades primarily due to improvements in early detection of first malignancies and effective treatment modalities. A wealth of evidence has demonstrated that regular physical activity is associated with a lower risk of death, all-cause mortality, cancer recurrence, and several chronic diseases, including type 2 diabetes and cardiovascular disease, common comorbid conditions in people who have survived cancer. Physical activity also is a central component of weight management. METHODS This review summarizes the current physical activity recommendations and the evidence linking physical activity to improvements in weight management, physiological effects, and psychological health outcomes for cancer survivors. RESULTS The available literature suggests physical activity is safe and is positively associated with weight management, cardiorespiratory fitness, muscular strength and endurance, quality of life, fatigue, and other psychosocial factors in cancer survivors. Yet relationships related to specific cancer diagnoses, treatments, and underlying cardiometabolic mechanisms associated with survival have not been thoroughly examined in randomized controlled trials. Furthermore, factors that influence adherence to physical activity behaviors must be identified to develop effective exercise programs. The use of objective measures of physical activity and the standardization of reporting outcome measures within intervention trials are needed to complement this effort. CONCLUSIONS Healthcare providers should consider individual differences among cancer survivors and tailor physical activity programs to meet the individual needs of the patient to assist in the adoption and maintenance of a physically active lifestyle.
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Affiliation(s)
- David O Garcia
- Canyon Ranch Center for Prevention and Health Promotion, Mel & Enid Zuckerman College of Public Health, Division of Health Promotion Sciences, University of Arizona, Tucson, Arizona
| | - Cynthia A Thomson
- Canyon Ranch Center for Prevention and Health Promotion, Mel & Enid Zuckerman College of Public Health, Division of Health Promotion Sciences, University of Arizona, Tucson, Arizona
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84
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Goh J, Niksirat N, Campbell KL. Exercise training and immune crosstalk in breast cancer microenvironment: exploring the paradigms of exercise-induced immune modulation and exercise-induced myokines. Am J Transl Res 2014; 6:422-438. [PMID: 25360210 PMCID: PMC4212920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 06/16/2014] [Indexed: 06/04/2023]
Abstract
Observational research suggests that exercise may reduce the risk of breast cancer and improve survival. One proposed mechanism for the protective effect of aerobic exercise related to cancer risk and outcomes, but has not been examined definitively, is the immune response to aerobic exercise. Two prevailing paradigms are proposed. The first considers the host immune response as modifiable by aerobic exercise training. This exercise-modulated immune-tumor crosstalk in the mammary microenvironment may alter the balance between tumor initiation and progression versus tumor suppression. The second paradigm considers the beneficial role of exercise-induced, skeletal muscle-derived cytokines, termed "myokines". These myokines exert endocrine-like effects on multiple organs, including the mammary glands. In this systematic review, we i) define the role of macrophages and T-cells in breast cancer initiation and progression; ii) address the two paradigms that support exercise-induced immunomodulation; iii) systematically assessed the literature for exercise intervention that assessed biomarkers relevant to both paradigms in human intervention trials of aerobic exercise training, in healthy women and women with breast cancer; iv) incorporated pre-clinical animal studies and non-RCTs for background discussion of putative mechanisms, through which aerobic exercise training modulates the immunological crosstalk, or the myokine-tumor interaction in the tumor microenvironment; and v) speculated on the potential biomarkers and mechanisms that define an exercise-induced, anti-tumor "signature", with a view toward developing relevant biomarkers for future aerobic exercise intervention trials.
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Affiliation(s)
- Jorming Goh
- Screening & Diagnostics Technologies Laboratory, Defence Medical and Environmental Research Institute, DSO National LaboratoriesRepublic of Singapore
| | - Negin Niksirat
- Rehabilitation Sciences, University of British ColumbiaVancouver B.C., Canada
| | - Kristin L Campbell
- Rehabilitation Sciences, University of British ColumbiaVancouver B.C., Canada
- Cancer Prevention Center, University of British ColumbiaVancouver B.C., Canada
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85
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Euteneuer F, Schwarz MJ, Schmidmaier R, Hennings A, Riemer S, Stapf TM, Selberdinger VB, Süssenbach P, Dannehl K, Rief W. Blunted exercise-induced mobilization of monocytes in somatization syndromes and major depression. J Affect Disord 2014; 166:156-64. [PMID: 25012425 DOI: 10.1016/j.jad.2014.04.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/23/2014] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Previous research indicates that physical activity may alter the number of immune cells. We examined whether increasing or decreasing the level of physical activity affects circulating lymphocyte and monocyte counts in patients with somatization syndromes and patients with major depression. METHODS Thirty-eight participants with major depression, 26 participants with somatization syndromes and 47 healthy controls participated in the study. Using an experimental within-subject design, participants were involved in 1 week of increased physical activity (daily exercise sessions) and 1 week of reduced physical activity. Counts of total lymphocytes, lymphocyte subsets and monocytes were determined before and after each trial. Linear mixed models adjusted for sex, body mass index, age, fitness status and the order of trials were used for longitudinal data analysis. RESULTS One week of exercise increases the number of monocytes in healthy controls (p<.05), but not in patients with somatization syndromes or patients with major depression. In addition, after 1 week of exercise, depressive symptoms were reduced in patients with major depression (p<.05) while somatoform symptoms were reduced (p<.05) in both clinical groups. Baseline comparisons and mixed models indicated reduced T helper cell counts in patients with somatization syndromes. LIMITATIONS Relatively small sample size. The time of physical activity was relatively short and restricted to low-graded exercise. CONCLUSIONS This study demonstrates a blunted mobilization of monocytes by exercise in both patients with somatization syndromes and patients with major depression. In addition, even one week of exercise reduces somatoform and depressive symptoms.
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Affiliation(s)
- Frank Euteneuer
- Division of Clinical Psychology and Psychotherapy, Philipps Universität, Marburg, Germany.
| | - Markus J Schwarz
- Institute for Laboratory Medicine, Ludwig-Maximilian-Universität, Munich, Germany
| | - Ralf Schmidmaier
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilian Universität, Munich, Germany
| | - Anika Hennings
- Division of Clinical Psychology and Psychotherapy, Philipps Universität, Marburg, Germany
| | - Sabine Riemer
- Division of Clinical Psychology and Psychotherapy, Philipps Universität, Marburg, Germany
| | - Theresa M Stapf
- Department of Psychiatry, Ludwig-Maximilian-Universität, Munich, Germany
| | | | - Philipp Süssenbach
- Division of Psychological Methods, Philipps Universität, Marburg, Germany
| | - Katharina Dannehl
- Division of Clinical Psychology and Psychotherapy, Philipps Universität, Marburg, Germany
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, Philipps Universität, Marburg, Germany
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86
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Running away from side effects: physical exercise as a complementary intervention for breast cancer patients. Clin Transl Oncol 2014; 17:180-96. [PMID: 24894838 DOI: 10.1007/s12094-014-1184-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/11/2014] [Indexed: 10/25/2022]
Abstract
The number of breast cancer survivors increases every year, thanks to the development of new treatments and screening techniques. However, patients present with numerous side effects that may affect their quality of life. Exercise has been demonstrated to reduce some of these side effects, but in spite of this, few breast cancer patients know and follow the exercise recommendations needed to remain healthy. In this review, we describe the different breast cancer treatments and the related side effects and implications of exercise in relation to these. We propose that exercise could be an integrative complementary intervention to improve physiological, physical and psychological factors that affect survival and quality of life of these patients. For that reason, the main objective of this review is to provide a general overview of exercise benefits in breast cancer patients and recommendations of how to design exercise interventions in patients with different side effects.
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87
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Schmidt ME, Wiskemann J, Steindorf K. Exercise in breast cancer patients: impact on health. BREAST CANCER MANAGEMENT 2014. [DOI: 10.2217/bmt.14.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY As a consequence of breast cancer diagnosis and treatment side effects, many patients reduce their physical activity, resulting in physical deconditioning. However, it has been shown that both aerobic and resistance exercise are feasible and safe throughout the breast cancer continuum. Exercise can reduce fatigue, depression and anxiety, improve quality of life and self-esteem, as well as cardiorespiratory fitness, muscle strength, physical functioning and body composition. In addition, as early-stage breast cancer patients may be at higher risk for cardiac events owing to cardiotoxic therapy, exercise can mitigate cardiovascular impairments. There is increasing evidence that higher physical activity levels are associated with improved overall survival after breast cancer; therefore, patients should receive support and be encouraged to engage in exercise training during and after cancer treatment.
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Affiliation(s)
- Martina E Schmidt
- Division of Preventive Oncology, Working Group 'Physical Activity & Cancer', National Center for Tumor Diseases Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Joachim Wiskemann
- Division of Preventive Oncology, Working Group 'Physical Activity & Cancer', National Center for Tumor Diseases Heidelberg, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Karen Steindorf
- Division of Preventive Oncology, Working Group 'Physical Activity & Cancer', National Center for Tumor Diseases Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
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88
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Loprinzi PD, Lee H. Rationale for Promoting Physical Activity Among Cancer Survivors: Literature Review and Epidemiologic Examination. Oncol Nurs Forum 2014; 41:117-25. [DOI: 10.1188/14.onf.117-125] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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89
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Barsevick AM, Irwin MR, Hinds P, Miller A, Berger A, Jacobsen P, Ancoli-Israel S, Reeve BB, Mustian K, O'Mara A, Lai JS, Fisch M, Cella D. Recommendations for high-priority research on cancer-related fatigue in children and adults. J Natl Cancer Inst 2013; 105:1432-40. [PMID: 24047960 DOI: 10.1093/jnci/djt242] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Over the past decades, some scientific progress has been made in understanding and treating cancer-related fatigue (CRF). However, three major problems have limited further progress: lack of agreement about measurement, inadequate understanding of the underlying biology, and problems in the conduct of clinical trials for CRF. This commentary reports the recommendations of a National Cancer Institute Clinical Trials Planning Meeting and an ongoing National Cancer Institute working group to address these problems so that high-priority research and clinical trials can be conducted to advance the science of CRF and its treatment. Recommendations to address measurement issues included revising the current case definition to reflect more rigorous criteria, adopting the Patient Reported Outcomes Measurement Information System fatigue scales as standard measures of CRF, and linking legacy measures to the scales. With regard to the biology of CRF, the group identified the need for longitudinal research to examine biobehavioral mechanisms underlying CRF and testing mechanistic hypotheses within the context of intervention research. To address clinical trial issues, recommendations included using only placebo-controlled trial designs. setting eligibility to minimize sample heterogeneity or enable subgroup analysis, establishing a CRF severity threshold for participation in clinical trials, conducting dissemination trials of efficacious interventions (such as exercise), and combining nonpharmacologic and pharmacologic interventions to exploit the potential synergy between these approaches. Accomplishing these goals has the potential to advance the science of CRF and improve the clinical management of this troubling symptom.
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Affiliation(s)
- Andrea M Barsevick
- Affiliations of authors: Thomas Jefferson University, Philadelphia, PA (AMB); University of California-Los Angeles, Los Angeles, CA (MRI); Children's National Medical Center, Washington, DC (PH); Emory University, Atlanta, GA (AM); University of Nebraska Medical Center, Omaha, NE (AB); Moffitt Cancer Center, Tampa, FL (PJ); University of California-San Diego, San Diego, CA (SA-I); University of North Carolina at Chapel Hill, Chapel Hill, NC (RBR); University of Rochester, Rochester, NY (KM); National Cancer Institute, Bethesda, MD (AOM); Northwestern University, Chicago, IL (J-SL, DC); M.D. Anderson Cancer Center, Houston, TX (MF)
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90
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Zimmer P, Jäger E, Bloch W, Zopf EM, Baumann FT. Influence of a six month endurance exercise program on the immune function of prostate cancer patients undergoing Antiandrogen- or Chemotherapy: design and rationale of the ProImmun study. BMC Cancer 2013; 13:272. [PMID: 23731674 PMCID: PMC3681550 DOI: 10.1186/1471-2407-13-272] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/29/2013] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Exercise seems to minimize prostate cancer specific mortality risk and treatment related side effects like fatigue and incontinence. However the influence of physical activity on the immunological level remains uncertain. Even prostate cancer patients undergoing palliative treatment often have a relatively long life span compared to other cancer entities. To optimize exercise programs and their outcomes it is essential to investigate the underlying mechanisms. Further, it is important to discriminate between different exercise protocols and therapy regimes. METHODS/DESIGN The ProImmun study is a prospective multicenter patient preference randomized controlled trial investigating the influence of a 24 week endurance exercise program in 80-100 prostate cancer patients by comparing patients undergoing Antiandrogen therapy combined with exercise (AE), Antiandrogen therapy without exercise (A), Chemotherapy with exercise(CE) or Chemotherapy without exercise (C). The primary outcome of the study is a change in prostate cancer relevant cytokines and hormones (IL-6, MIF, IGF-1, Testosterone). Secondary endpoints are immune cell ratios, oxidative stress and antioxidative capacity levels, VO2 peak, fatigue and quality of life. Patients of the intervention group exercise five times per week, while two sessions are supervised. During the supervised sessions patients (AE and CE) exercise for 33 minutes on a bicycle ergometer at 70-75% of their VO2 peak. To assess long term effects and sustainability of the intervention two follow-up assessments are arranged 12 and 18 month after the intervention. DISCUSSION The ProImmun study is the first trial which primarily investigates immunological effects of a six month endurance exercise program in prostate cancer patients during palliative care. Separating patients treated with Antiandrogen therapy from those who are additionally treated with Chemotherapy might allow a more specific view on the influence of endurance training interventions and the impact of different therapy protocols on the immune function. TRIAL REGISTRATION German Clinical Trials Register: DRKS00004739.
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Affiliation(s)
- Philipp Zimmer
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Am Sportpark Müngersdorf 6, Köln 50933, Germany
| | - Elke Jäger
- Department for Oncology and Hematology, Clinic Northwest, Steinbacher Hohl 2-26, Frankfurt am Main 60488, Germany
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Am Sportpark Müngersdorf 6, Köln 50933, Germany
| | - Eva Maria Zopf
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Am Sportpark Müngersdorf 6, Köln 50933, Germany
| | - Freerk T Baumann
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Am Sportpark Müngersdorf 6, Köln 50933, Germany
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91
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Maître C. [Relation between physical activity, weight balance and breast cancer]. ANNALES D'ENDOCRINOLOGIE 2013; 74:148-53. [PMID: 23566614 DOI: 10.1016/j.ando.2013.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Many epidemiologic studies, with a good methodology, support the evidence of the positive role of regular physical activity on primary and tertiary prevention of breast cancer on the risk of recurrence and mortality. This relation depends on the level of total energy expenditure by week, which helps balance weight on lifetime, an essential part of benefit. The beneficial effects of physical activity are linked to many interrelated additional mechanisms: in a short-term, contraction of skeletal muscles involves aerobic metabolism which utilizes glucose and amino acids like glutamine, improves insulin sensitivity and lowers plasma insulin; in a long-term, physical activity produces favorable changes in body composition, decreasing body fat and increasing lean mass. That is a key point to reduce the intake of energy substrates stimulating carcinogenesis, to improve insulin sensitivity, to change the ratio of leptin and adiponectin, to enhance cellular immunity and to block cellular pathways of cell proliferation and angiogenesis. Maintaining a healthy weight through regular physical activity well balanced with energy intake is it a goal for prevention of breast cancer.
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Affiliation(s)
- Carole Maître
- Service médical de l'INSEP, 11, avenue du Tremblay, 75012 Paris, France.
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