Patient preference and timing for exercise in breast cancer care

Exercise is recommended following cancer diagnosis and may be particularly valuable for women receiving cardiotoxic chemotherapy treatments. We investigated breast cancer patient preference on exercise programming in a prospective manner and retrospectively assessed length of time between diagnosis and chemotherapy initiation. Sixty-seven newly diagnosed breast cancer patients responded to questions regarding exercise programming related to cancer treatment and surveys on current activity level. Additionally, a retrospective chart review was conducted on 500 random breast cancer patients. Age, cancer stage, treatment, and treatment dates were extracted. Women were interested in, or, absolutely wanted to, participate in an exercise program before treatment (76.2%). There was uncertainty regarding willingness to delay treatment; 49.2% were willing to delay their treatment if the program was recommended by their doctors, 41.8% would not, and 9.0% were too unsure to respond. However, women would like to hear information about an exercise program for cancer patients when they are first diagnosed (61.9%). We observed that 64.6% of women were below recommended levels of physical activity; yet, current activity was not associated with an interest in an exercise program or willingness to delay treatment. Retrospectively, we observed an average interval of 72.6 ± 34.6 days between cancer diagnosis and initiation of anthracycline-based chemotherapy treatment, with younger women with more advanced cancer receiving anthracycline-based chemotherapy. Based on patient preference and length of time to chemotherapy initiation, a reasonable next step to promote the current recommendations for exercise could be to integrate exercise into breast cancer care earlier in treatment.

[1]  D. Forman,et al.  Long-term health outcomes in a British cohort of breast, colorectal and prostate cancer survivors: a database study , 2011, British Journal of Cancer.

[2]  L. Steinherz Early breast cancer therapy and cardiovascular injury. , 2008, Journal of the American College of Cardiology.

[3]  D. Hydock,et al.  Acute Exercise Protects Against Doxorubicin Cardiotoxicity , 2008, Integrative cancer therapies.

[4]  P. Douglas,et al.  Safety and efficacy of aerobic training in operable breast cancer patients receiving neoadjuvant chemotherapy: A phase II randomized trial , 2014, Acta oncologica.

[5]  A. Chicco,et al.  Voluntary exercise protects against acute doxorubicin cardiotoxicity in the isolated perfused rat heart. , 2005, American journal of physiology. Regulatory, integrative and comparative physiology.

[6]  E. Clipp,et al.  Current health behaviors and readiness to pursue life‐style changes among men and women diagnosed with early stage prostate and breast carcinomas , 2000, Cancer.

[7]  T. Byers,et al.  Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study , 2011, Breast Cancer Research.

[8]  C. Friedenreich,et al.  Effects of exercise dose and type during breast cancer chemotherapy: multicenter randomized trial. , 2013, Journal of the National Cancer Institute.

[9]  J. Broderick,et al.  Testing the ‘teachable moment’ premise: does physical activity increase in the early survivorship phase? , 2014, Supportive Care in Cancer.

[10]  Alejandro Martínez-Rodríguez,et al.  The impact of aerobic exercise training on arterial stiffness in pre- and hypertensive subjects: a systematic review and meta-analysis. , 2014, International journal of cardiology.

[11]  R. Shephard,et al.  A simple method to assess exercise behavior in the community. , 1969, Canadian journal of applied sport sciences. Journal canadien des sciences appliquees au sport.

[12]  H. Chung,et al.  Exercise, oxidative stress and hormesis , 2008, Ageing Research Reviews.

[13]  G. Schuler,et al.  Effect of Exercise on Coronary Endothelial Function in Patients With Coronary Artery Disease , 2000 .

[14]  K. Courneya,et al.  A Survey of Physical Activity Programming and Counseling Preferences in Young-Adult Cancer Survivors , 2012, Cancer nursing.

[15]  S. Flocke,et al.  Teachable moments for health behavior change: a concept analysis. , 2009, Patient education and counseling.

[16]  J. Viña,et al.  Moderate exercise is an antioxidant: upregulation of antioxidant genes by training. , 2008, Free radical biology & medicine.

[17]  K. Nordin,et al.  Perceived barriers to and facilitators of being physically active during adjuvant cancer treatment. , 2016, Patient education and counseling.

[18]  G. Godin,et al.  The use of the Godin-Shephard Leisure-Time Physical Activity Questionnaire in oncology research: a systematic review , 2015, BMC Medical Research Methodology.

[19]  Greg Yothers,et al.  Assessment of cardiac dysfunction in a randomized trial comparing doxorubicin and cyclophosphamide followed by paclitaxel, with or without trastuzumab as adjuvant therapy in node-positive, human epidermal growth factor receptor 2-overexpressing breast cancer: NSABP B-31. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[20]  E. Lindeman,et al.  [Guideline "Cancer rehabilitation"]. , 2011, Nederlands tijdschrift voor geneeskunde.

[21]  J. Prochaska,et al.  Stages and processes of self-change of smoking: toward an integrative model of change. , 1983, Journal of consulting and clinical psychology.

[22]  H. Kohl,et al.  Long-Term Effects of Changes in Cardiorespiratory Fitness and Body Mass Index on All-Cause and Cardiovascular Disease Mortality in Men: The Aerobics Center Longitudinal Study , 2012 .

[23]  G. Salles,et al.  Subclinical late cardiomyopathy after doxorubicin therapy for lymphoma in adults. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[24]  R. Newton,et al.  Australian Association for Exercise and Sport Science position stand: optimising cancer outcomes through exercise. , 2009, Journal of science and medicine in sport.

[25]  K. Courneya,et al.  American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. , 2010, Medicine and science in sports and exercise.

[26]  L. Gianni,et al.  Anthracyclines: Molecular Advances and Pharmacologic Developments in Antitumor Activity and Cardiotoxicity , 2004, Pharmacological Reviews.

[27]  A. Ascensão,et al.  Endurance training attenuates doxorubicin-induced cardiac oxidative damage in mice. , 2005, International journal of cardiology.

[28]  S. Berntsen,et al.  Comparison between logbook-reported and objectively-assessed physical activity and sedentary time in breast cancer patients: an agreement study , 2017, BMC Sports Science, Medicine and Rehabilitation.

[29]  A. Ascensão,et al.  Moderate endurance training prevents doxorubicin-induced in vivo mitochondriopathy and reduces the development of cardiac apoptosis. , 2005, American journal of physiology. Heart and circulatory physiology.

[30]  S. Powers,et al.  Short-term exercise training protects against doxorubicin-induced cardiac mitochondrial damage independent of HSP72. , 2010, American journal of physiology. Heart and circulatory physiology.

[31]  Effects of short-term exercise-training on aortic systolic pressure augmentation in overweight and obese individuals , 2013, European Journal of Applied Physiology.

[32]  N. Tubiana-Mathieu,et al.  Effects of a home-based walking training program on cardiorespiratory fitness in breast cancer patients receiving adjuvant chemotherapy: a pilot study. , 2013, European journal of physical and rehabilitation medicine.

[33]  K. Courneya,et al.  Cardiopulmonary function and age-related decline across the breast cancer survivorship continuum. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[34]  W. Kraus,et al.  Results of a diet/exercise feasibility trial to prevent adverse body composition change in breast cancer patients on adjuvant chemotherapy. , 2008, Clinical breast cancer.

[35]  J. Kampert,et al.  Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. , 1996, JAMA.

[36]  S. Colletta,et al.  Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[37]  H. Youn,et al.  Early Cardiac Function Monitoring for Detection of Subclinical Doxorubicin Cardiotoxicity in Young Adult Patients with Breast Cancer , 2013, Journal of breast cancer.

[38]  H. Naito,et al.  Exercise training decreases DNA damage and increases DNA repair and resistance against oxidative stress of proteins in aged rat skeletal muscle , 2002, Pflügers Archiv.

[39]  C. Ayers,et al.  Association of Cardiorespiratory Fitness With Total, Cardiovascular, and Noncardiovascular Mortality Across 3 Decades of Follow-Up in Men and Women , 2012, Circulation. Cardiovascular quality and outcomes.

[40]  K. Courneya,et al.  Exercise counseling and programming preferences of cancer survivors. , 2002, Cancer practice.

[41]  K. Schmitz,et al.  The effects of exercise on cardiovascular outcomes before, during, and after treatment for breast cancer , 2013, Breast Cancer Research and Treatment.

[42]  Karianne Vassbakk-Brovold,et al.  Individualized Comprehensive Lifestyle Intervention in Patients Undergoing Chemotherapy with Curative or Palliative Intent: Who Participates? , 2015, PloS one.

[43]  F. Roila,et al.  Cardiotoxicity of chemotherapeutic agents and radiotherapy-related heart disease: ESMO Clinical Practice Guidelines. , 2010, Annals of oncology : official journal of the European Society for Medical Oncology.

[44]  Lakshmi Pulakat,et al.  Mitochondrial biogenesis in the metabolic syndrome and cardiovascular disease , 2010, Journal of Molecular Medicine.

[45]  E. Yeh,et al.  Identification of the molecular basis of doxorubicin-induced cardiotoxicity , 2012, Nature Medicine.