Breast Cancer & Exercise

By: Morgan Ashley, Chloe Meltz, & Alicia Walker

Breast Cancer in the U.S. • 2nd most common cancer

among Women in the U.S.

• ~1 in 8 (12%) U.S. women will develop invasive breast cancer during their lifetime

• American Cancer Society estimates that in 2013 the U.S. will see:

~ 232,340 new cases of invasive breast cancer in women ~39,620 women will die from breast cancer

• Incidence rate of breast cancer is slowly decreasing accompanied by a slight drop in the number of deaths due to breast cancer

Selection of Treatment Options

• Surgical Therapy

• Adjuvant Therapy

• Radiation Therapy

• Drug Therapy

• Selected based on stage of cancer

• American Joint Committee on Cancer’s TNM system:

T: tumor sizeN: node involvementM: metastasis

• All come with side effects

• Some chronic and incurable

Surgical Therapy• Mastectomy – removal of breast, pectoral muscles,

axillary lymph nodes, and all fat and adjacent tissues)

• Breast Conserving Surgery (Lumpectomy) – Removal of the entire tumor along with a margin of normal surrounding tissue. Followed by radiation or chemotherapy.

• Axillary Lymph Node Dissection – examination of the lymph nodes provide prognostic information and helps determine further treatment. Lymphedema may occur as a chronic side effect.

Treatment Related Side Effect: Lymphedema

•

Patient may experience heaviness, pain, impaired motor function in the arm, numbness in the fingers.

Radiation Therapy• Treatment of a defined area of the body to achieve local control of

disease

• Radiation only has an effect on tissues within the treatment field

• Can be used as:

A) Primary treatment following lumpectomy

B) Adjuvant therapy following mastectomy

C)Palliative treatment for pain

• ~ ½ cancer patients will receive radiation therapy at some point in their treatment

• Side effects: Fatigue & specific to tissue being targeted

Chemotherapy• Use of chemicals as a systemic therapy for cancer

• Can be used to:

A) Cure B) Control

C) Palliative relief when cure & control are no longer an option

• Most effective when therapy is not interrupted and patients receive intended doses

• Chemotherapeutic agents can not distinguish between normal cells and cancer cells, resulting in the destruction of normal cells

• Side effects: Fatigue, nausea, anorexia, taste alteration, weight loss, bone marrow suppression, alopecia

Treatment Related Side Effects: Fatigue

• Most common side effect of radiation therapy and chemotherapy

• “Universal Symptom”

• Affects 70-100% of cancer patients receiving treatment

• Origin is multi-factored & exact mechanisms still unclear

• Chronic, not relieved by sleep or rest

• Accumulation of muscle metabolites (lactate, hydrogen ions, and other end products from the destruction of cells) results in decreased muscle strength

• Weight loss, depression and nausea and medications can exacerbate fatigue

Exercise: An Intervention• For many years: Physician’s recommended that

cancer patients rest & avoid physical effort.

• Inactivity increases further muscular wasting and loss of cardiorespiratory fitness

• Today: Intervention for chronic, incurable cancer treatment related symptoms

• Clinicians should encourage patients with breast cancer to start exercise at the beginning of chemotherapy treatment and continue for as long as possible

Limiting Factors to Exercise• Fatigue

• Lymphedema

• Anxiety & Depression

• Fear

Benefits of ExerciseAcute Exercise Response Long Term Exercise

AdaptationsImprove mood

Hormone Regulation (estrogen)

Reduce fatigue intensity

Decreases treatment induced symptoms: swelling due to lymphedema, improve appetite, reduce sleep disturbances

Safer surgery

Easier/Faster Recovery

Preserve and improve aerobic fitness & strength

Improvements in body composition

Increase chemotherapy completion rates

Decrease Lymphedema exacerbation

Improve Self Esteem & QOL

Prevent the manifestation and reduce the intensity of fatigue

Acute Exercise Response• Hormones:

EstrogenEndorphinsSerotoninGrowth Factors

• Improves Appetite

• Improves Sleep Patterns

• Decreases lymphedema related swelling

Physiological Adaptations to TrainingCourneya K. & Segal R. (2007). Effects of Aerobic and Resistance Exercise in Breast Cancer Patients Receiving Adjuvant Chemotherapy. Journal of

Clinical Oncology. Volume 25, Issue 28.

Resistance Exercise Training

Preserve & improve strength*Lean Body Mass*5.7% higher RDI*Self Esteem*

Secondary:

QOLFatigueDepression

Aerobic Exercise Training

Preserve Aerobic FitnessPeak Oxygen Consumption*Maintain Percent Body Fat*3.3% higher RDISelf Esteem*

Secondary:

QOLFatigueDepressionAnxiety

Physiological Adaptations to Aerobic Training

• Preserve aerobic fitness: blunting the 8% decline in Vo2 max seen in usual care group

• O2 consumption superior to UC and RET groups

• Prevented Fat gain

• Improved RDI and chemotherapy completion rates

• Improved Self Esteem

• Improved aerobic fitness was associated with improved QOL, fatigue, depression, anxiety

Physiological Adaptations to Anaerobic Training

• Improve Strength: Upper and lower body strength superior to US and AET groups

• Increase lean body mass: Superior to UC group

• 5.7% increase in RDI

• Improve self esteem

• Decrease exacerbation of lymphedema symptoms (Control: 83% vs. PA group: 45%)

• Increased lean body mass was associated with improved QOL, fatigue, depression and anxiety

Cancer & Treatment Related Fatigue • Aerobic & Anaerobic can improve

• Oppose the physiological impairment resulting from cancer and treatment

• Resulting in a reduction of fatigue by normalizing physical performance

Decrease Risk & Prevention of Reoccurrence

• More research• Pre and Post-

menopausal effects• Used as Pre and Post-

breast cancer treatment

• Many positive outcomes with exercise other than cancer prevention for the individual

Find something you enjoy!

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