Transcript JG belarus conf - survivorship 9

Maximizing Your
Health During and
After Breast Cancer
Treatment
Julie R. Gralow, M.D.
Associate Professor, Medical Oncology
University of Washington School of
Medicine
Fred Hutchinson Cancer Research Center
Seattle Cancer Care Alliance
Regular Physical Activity and
Good Nutrition Can Help Reduce:
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Heart disease
High cholesterol levels
High blood pressure
Obesity
Nicotine addiction
Diabetes
Depression
Cancer
Osteoporosis
Insomnia
Age-related declines in muscular strength
Exercise During Cancer
Treatment
Exercise During Cancer
Treatment
Maintaining an exercise
program throughout cancer
treatment is not only safe, but
also an effective way to manage
fatigue, depression, and
treatment side effects
Exercise Benefits Physical Health
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Improved healing and recovery from surgery
Decreased lymphedema
Higher energy levels, less fatigue
Weight loss/prevent weight gain
Decreased nausea
Less pain
Decreased heart disease and osteoporosis
Exercise Benefits Emotional Health
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Improved body and self-image
Decreased anxiety
Improved social interaction
Better sense of control
Improved depression and mood
Better sleep patterns
Fatigue and Quality of Life
Outcomes of Exercise During
Cancer Treatment
Mock V et al, Cancer Pract 9: 119-127 2001
• Patients: 52 breast cancer patients randomized
to home-based walking program or usual care
during adjuvant chemotherapy or radiation
therapy
• Results: Women who exercised > 90 minutes
per week (divided over 3 or more days)
reported significantly
– Less fatigue
– Less emotional distress
– Higher functional ability
– Better quality of life
Exercise and Breast Cancer PostTreatment
Exercise and Survival After
Breast Cancer Diagnosis
Holmes MD et al, JAMA 2005
• Prospective observational study
– 2987 nurses in the U.S. Nurses’ Health Study
diagnosed with stage I, II or III breast cancer
– Physical activity categories:
» < 3 MET hours (metabolic equivalent tasks)
per week
» 3-8.9 MET hours/week
» 9-14.9 MET hours/week
» > 24 MET hours/week
– 3 MET hours per week is equal to walking at an
average pace of 2-3 miles /hour for 1 hour
Exercise and Survival After
Breast Cancer Diagnosis
Holmes MD et al, JAMA 2005
• Results:
– Compared to women with < 3 MET hours/week,
risk of dying of breast cancer was:
» 20% less for 3-9 MET hours/week
» 40-50% less for > 9 MET hours/week of
exercise
• Conclusion:
– Physical activity after a breast cancer diagnosis
may reduce the risk of death from this disease
– The greatest benefit occurred in women who
performed the equivalent of walking 3-5
hours/week at an average pace
What About Lymphedema
(Arm Swelling After Lymph
Node Surgery)?
Weight Training and Lymphedema in
Breast Cancer Survivors
Ahmed RL et al, J Clin Oncol 2005
• Patients: 45 breast cancer survivors following axillary lymph
node dissection
• Study: Randomized to weight training program or not
– Weight training sessions 2x per week for 6 months
– For upper body, initially used no weights or only wrist
weights, weight gradually increased if no symptoms of
lymphedema developed
• Results:
– None of the women in the weight training program
experienced a noticeable change in arm swelling
– Frequency of new lymphedema, or worsening of existing
lymphedema, was similar in both groups
Nutrition, Body Weight and Breast
Cancer
-Maintain good
body weight
-Low fat diet
-High fiber
-Increase fruits
and vegetables
-Limit alcohol
Nutrition and Survival after the
Diagnosis of Breast Cancer: A
Review of the Evidence
Rock CL et al, JCO 20:3302-16, 2002
• Being overweight or obese is associated with
poorer prognosis in a majority of studies
• Treatment-related weight gain influences
survival, quality of life, other diseases
• Dietary fat: 5 of 12 studies showed inverse
relationship with survival
• Fruits and vegetables: majority of studies
showed favorable relationship with survival
Breast Cancer and Alcohol
More than 2 drinks/day associated with increased breast
cancer risk!
Women’s Intervention Nutrition Study
(WINS)
Chlebowski R et al, JNCI 98, 2006
• Patients: 2,437 postmenopausal women with early stage
breast cancer (age 48-79)
• Intervention: Randomized within 1 year of surgery to:
– dietary intervention (8 biweekly counseling sessions by
nutritionists and support throughout)
– versus control
• Results:
Intervention group
Control group
Fat intake/day at 12 months
33.3 gms (+/- 16.7)
51.3 gms (+/- 24.4)
Women’s Intervention Nutrition Study
(WINS)
Chlebowski R et al, JNCI 98, 2006
• Results (cont.):
Relapses (60 month follow-up)
Group
All pts
Diet
96/975 (9.8%)
Control
181/1462 (12.3%)
24% reduction in breast cancer recurrence in diet intervention group
Conclusion: Lifestyle interventions can reduce
recurrences in breast cancer patients
Optimizing Health After Breast
Cancer Diagnosis and Treatment
• Exercise regularly
• Avoid obesity, control weight
• Eat a healthy diet: low fat, high fiber, low
alcohol
• Avoid smoking
• Wear sunscreen
• Reduce stress
• Control known diseases: high blood pressure,
diabetes, high cholesterol, osteoporosis
Optimizing Health After Breast
Cancer Diagnosis and Treatment
• The majority of
breast cancer
patients can look
forward to a long
life after cancer
diagnosis and
treatment
• Cancer patients
should not forget
about all aspects
of health and wellbeing