Challenge Your Expert: Supportive Care in

Breast CancerThe Significance of

Life Style

Alessandra Fabi

Bologna, 29-30 Marzo 2017

VOLONTA’

WILL

VOLUNTAD

WERDEN

VOLONTE’

Cause Prevenibili di Neoplasia

33%

33%

8%

5%

4% 17%Stili di Vita

Fumo

Infezioni Virali

FattorioccupazionaliCause ambientali

Altro/Non noto

Rapporto AIRTUM 2016Tutti i tipi di neoplasia

• Abuso di alcol• Obesità• Inattività fisica

Management of Comorbidities

The presence of cardiovascular disease, chronicobstructive pulmonary disease or diabetes increasedbreast cancer-specific mortality by between 10% and24%

Age and Comorbidities at the time of diagnosis:

the largest effects on mortality from causes other than breastcancer

1) Phisycal Exercise

2) Diet & Weight gain

1) Alcohol & Smoke

Nell’ambito della Prevenzione Primaria diversi studi hanno valutato la correlazione Attività Fisica/Incidenza per alcuni tumori.

Esercizio fisico e cancro

TIPO DI TUMORE Numero di studi

Trend di efficacia in base al livello di AF e grado di evidenza scientifica

TUMORE AL COLON +++ Buone evidenze di riduzione di incidenza di patologie

TUMORE AL RETTO +++ Nessuna differenza tra categorie di “fitness” e livelli di AF

TUMORE ALL’ENDOMETRIO +++ Buone evidenze di riduzione di incidenza di patologie

TUMORE ALLA MAMMELLA +++ Ottime evidenze di riduzione di incidenza di patologie

TUMORE ALLA PROSTATA +++ Alcune evidenze di riduzione di incidenza di patologie

TUMORE AI POLMONI +++ Nessuna differenza tra categorie di “fitness” e livelli di AF

TUMORE AL PANCREAS ++ Nessuna differenza tra categorie di “fitness” e livelli di AF

+ Pochi studi scientifici++ Tra 5 e 10 studi scientifici+++ Più di 10 studi scientifici

Mod. da: ACSM’s Guidelines for exercise testing and prescription, 7°

edition, 2005

Moore SC JAMA Intern Med 2016

A higher level of leisure-time physical activity was associated with lower risk for 13 of the 26 types of cancer

1. Che tipo di attività fisica?

Non esistono studi di confronto aerobica vs anaerobica

2. Come misurare l’attività fisica?

Equivalente Metabolico –o MET- cioè ml di O2 consumato per kg di massacorporea per minuto

Ma…

116.304 women

Stratified analysis

Prizot, Eur J Cancer 2016

highest versus lowest category of physical activityhours per week or in hours of metabolic equivalent per week (MET-h/week).

a physically inactive women engaging in at least 150 min per week of vigorous physicalactivity would reduce their lifetime risk of breast cancer by 9%, a reduction that might be

two times greater in women who never used HRT.

Physical activity and never use HRT: excellent double win

Pizot, Eur J Cancer 2016

Nessuna differenza fra gli stadi (II vs III)Maggiore beneficio per la malattia ER+

older/post-menopausal women; those engaging in at least 10 MET-hours of physical activity per week had a 27 % reduction in all-causemortality) and a 25 % reduction in breast cancer-specific mortality(compared with women per-forming \10 MET-hours/week

adhesion to the PA Guidelines may be animportant interventiontarget for reducingmortality among breastcancer survivors

Fatigue

HR-QoL

Yoga & Breast Cancer

Wheight gain (after BC diagnosis)

Weight gain after diagnosis has beenassociated with a higher rate of breastcancer recurrences and with worse OS

-Analysis in stage I to III BC, each 5-kg gain was associated with a 12% increasein all-cause mortality, a 13% increase in breast cancer specific mortality, and a19% increase in cardiovascular disease mortality (1).

- Weight gain of greater than 10% was associated with breast cancer–specificmortality (p=.05); but no amount of weight gain was associated with an increasein breast cancer recurrences. (2)

1. Nichols HB, Cancer Epidemiol Biomarkers Prev. 2009; 2. laydon MC, J Natl Cancer Inst 2015

Analysis 3993 pts

Quali sono le cause? Le basi fisiopatologiche sono da ricercarsi nella disregolazione metabolica ed

endocrinologica tipica dell’obesità.

Insulino resistenza (Insulina e IGF-1) Stato proinfiammatorio (IL-6, TNFα, PCR) Neoangiogenesi (PAI-1, VEGF) Incremento di Leptina ed Adiponectina

ProliferazioneSopravvivenzaInvasivitàMetastatizzazione

BMI and Breast Cancer

Guenancia, J Clin Oncol 2016

Obesity As a Risk Factor for Anthracyclines and TrastuzumabCardiotoxicity in Breast Cancer: Systematic Review and Meta-Analysis

Overweight=

BMI 25-29

Obesity=

BMI > 30

8745 pts

How to avoid or improve weight gain after BC?Interventions

✔ Avoid side effects from therapy….but…

✔ diet, physical activity, and behavior modification, personalized lifestyle telephonecounseling with face-to-face group-based education. Several studies used a commercial weight loss programs, such as Weight Watchers and/or Curves , teleconferencing forbreast cancer survivors in rural locations.

BUT

limited number of interventional studies, small sample sizes, and short duration offollow-up in many studies limit our ability to draw conclusions regarding the mostefficacious weight-loss intervention after a breast cancer diagnosis

Playdon M, Curr Breast Cancer Rep. 2013

SABCS 2016

The Intestinal Microbiome and ER+ BC

Kwa, JNCI 2016

Alcohol and BCLace Cohort

1867 pts early BCWhel Trial

3088 pts early BCAfter BC Pooling Project

9329 pts

The associationbetween alcohol

intake and recurrence may

depend on menopausal status

at BC diagnosis

Alcohol intake was notassociated with overall

mortality, possiblybecause of a

cardioprotective effectand a reduction in noncancer deaths

Light alcohol intakedid not increase the risk of BC recurrenceor all-cause mortality

in middle-agedwomen previouslydiagnosed with BC

Alcohol intake wasassociated with otherfavorable prognosticindicators that mayexplain its apparentprotective effect in non-obese women

Alcohol increasedrisk of breast

cancer and deathas a result of BC

The increased riskof recurrence wasmost pronounced

in postmenopausaland

overweight/obese women

Sternfeld, 2009Kwan, 2013 Flatt, 2010

Smokers pack-yr

20 -> 34.9 35 -> more current

Recurrence 22% 37% 41%All cause-mortality 26% 54% 60%

Pierce et al, JNCI 2014

“Autostima, volersi bene, rispettare i propri tempi, e le

priorità….”

By Anna Paola

GRAZIE