Improving lifestyle behaviors during chemotherapy for breast cancer: The Lifestyle, Exercise, and Nutrition Early After Diagnosis (LEANer) Trial.
breast cancer
chemotherapy
diet
exercise
lifestyle intervention
nutrition
physical activity
treatment
Journal
Cancer
ISSN: 1097-0142
Titre abrégé: Cancer
Pays: United States
ID NLM: 0374236
Informations de publication
Date de publication:
12 Mar 2024
12 Mar 2024
Historique:
revised:
16
02
2024
received:
06
11
2023
accepted:
19
02
2024
medline:
12
3
2024
pubmed:
12
3
2024
entrez:
12
3
2024
Statut:
aheadofprint
Résumé
Little is known about improving physical activity (PA) and diet during and after chemotherapy for breast cancer. This secondary analysis examines changes in PA and diet quality during a yearlong intervention for patients with breast cancer undergoing chemotherapy and evaluates factors associated with these changes. Newly diagnosed patients with breast cancer (N = 173) undergoing chemotherapy were randomized to a year-long nutrition and exercise intervention (n = 87) or usual care (UC, n = 86). Mixed models compared 1-year changes in PA and diet quality via the Healthy Eating Index (HEI)-2015 by study arm. Among the intervention group, baseline factors associated with change in PA and diet were assessed with multivariable linear and logistic regression. At 1 year, compared with UC, the intervention arm increased PA more (mean difference = 136.1 minutes/week; 95% CI, 90.2-182.0), participated in more strength training (56% vs. 15%; p < .001), and had suggestive improvements in HEI-2015 (mean difference = 2.5; 95% CI, -0.3 to 5.3; p = .08). In the intervention arm, lower fatigue was associated with improved PA (p = .04) and higher education was associated with improved HEI-2015 (p = .001) at 1 year. Higher HEI-2015 (p = .04) and married/living with someone (p = .05) were associated with higher odds of participating in strength training at 1 year. This year-long lifestyle intervention for patients with breast cancer undergoing chemotherapy resulted in increases in PA and suggestive improvements in diet quality. Behavior change was associated with baseline fatigue, diet quality, education, and married/living with someone. Addressing these factors in interventions may improve uptake of lifestyle behaviors in trials during and after chemotherapy.
Sections du résumé
BACKGROUND
BACKGROUND
Little is known about improving physical activity (PA) and diet during and after chemotherapy for breast cancer. This secondary analysis examines changes in PA and diet quality during a yearlong intervention for patients with breast cancer undergoing chemotherapy and evaluates factors associated with these changes.
METHODS
METHODS
Newly diagnosed patients with breast cancer (N = 173) undergoing chemotherapy were randomized to a year-long nutrition and exercise intervention (n = 87) or usual care (UC, n = 86). Mixed models compared 1-year changes in PA and diet quality via the Healthy Eating Index (HEI)-2015 by study arm. Among the intervention group, baseline factors associated with change in PA and diet were assessed with multivariable linear and logistic regression.
RESULTS
RESULTS
At 1 year, compared with UC, the intervention arm increased PA more (mean difference = 136.1 minutes/week; 95% CI, 90.2-182.0), participated in more strength training (56% vs. 15%; p < .001), and had suggestive improvements in HEI-2015 (mean difference = 2.5; 95% CI, -0.3 to 5.3; p = .08). In the intervention arm, lower fatigue was associated with improved PA (p = .04) and higher education was associated with improved HEI-2015 (p = .001) at 1 year. Higher HEI-2015 (p = .04) and married/living with someone (p = .05) were associated with higher odds of participating in strength training at 1 year.
CONCLUSIONS
CONCLUSIONS
This year-long lifestyle intervention for patients with breast cancer undergoing chemotherapy resulted in increases in PA and suggestive improvements in diet quality. Behavior change was associated with baseline fatigue, diet quality, education, and married/living with someone. Addressing these factors in interventions may improve uptake of lifestyle behaviors in trials during and after chemotherapy.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NCI NIH HHS
ID : 5R01CA207753-04
Pays : United States
Informations de copyright
© 2024 American Cancer Society.
Références
Runowicz CD, Leach CR, Henry NL, et al. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. CA A Cancer J Clin. 2016;66(1):43-73. doi:10.3322/caac.21319
Rock CL, Thomson CA, Sullivan KR, et al. American Cancer Society nutrition and physical activity guideline for cancer survivors. CA A Cancer J Clin. 2022;72(3):230-262. doi:10.3322/caac.21719
Cifu G, Arem H. Adherence to lifestyle-related cancer prevention guidelines and breast cancer incidence and mortality. Ann Epidemiol. 2018;28(11):767-773.e1. doi:10.1016/j.annepidem.2018.09.002
Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA A Cancer J Clin. 2012;62(4):242-274. doi:10.3322/caac.21142
Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise guidelines for cancer survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc. 2019;51(11):2375-2390. doi:10.1249/mss.0000000000002116
Schmid D, Leitzmann MF. Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Ann Oncol. 2014;25(7):1293-1311. doi:10.1093/annonc/mdu012
Ligibel JA, Bohlke K, May AM, et al. Exercise, diet, and weight management during cancer treatment: ASCO Guideline. J Clin Oncol. 2022;40(22):2491-2507. doi:10.1200/jco.22.00687
Irwin ML, Crumley D, McTiernan A, et al. Physical activity levels before and after a diagnosis of breast carcinoma: the Health, Eating, Activity, and Lifestyle (HEAL) study. Cancer. 2003;97(7):1746-1757. doi:10.1002/cncr.11227
Irwin ML, McTiernan A, Baumgartner RN, et al. Changes in body fat and weight after a breast cancer diagnosis: influence of demographic, prognostic, and lifestyle factors. J Clin Oncol. 2005;23(4):774-782. doi:10.1200/jco.2005.04.036
Chan DSM, Vieira R, Abar L, et al. Postdiagnosis body fatness, weight change and breast cancer prognosis: Global Cancer Update Program (CUP global) systematic literature review and meta-analysis. Int J Cancer. 2023;152(4):600-615. doi:10.1002/ijc.34322
Clifford BK, Mizrahi D, Sandler CX, et al. Barriers and facilitators of exercise experienced by cancer survivors: a mixed methods systematic review. Support Care Cancer. 2018;26(3):685-700. doi:10.1007/s00520-017-3964-5
Courneya KS, McKenzie DC, Reid RD, et al. Barriers to supervised exercise training in a randomized controlled trial of breast cancer patients receiving chemotherapy. Ann Behav Med. 2008;35(1):116-122. doi:10.1007/s12160-007-9009-4
Ormel HL, van der Schoot GGF, Sluiter WJ, Jalving M, Gietema JA, Walenkamp AME. Predictors of adherence to exercise interventions during and after cancer treatment: a systematic review. Psycho Oncol. 2018;27(3):713-724. doi:10.1002/pon.4612
Courneya KS, Segal RJ, Reid RD, et al. Three independent factors predicted adherence in a randomized controlled trial of resistance exercise training among prostate cancer survivors. J Clin Epidemiol. 2004;57(6):571-579. doi:10.1016/j.jclinepi.2003.11.010
Courneya KS, Segal RJ, Gelmon K, et al. Predictors of supervised exercise adherence during breast cancer chemotherapy. Med Sci Sports Exerc. 2008;40(6):1180-1187. doi:10.1249/MSS.0b013e318168da45
Courneya KS, Segal RJ, Gelmon K, et al. Predictors of adherence to different types and doses of supervised exercise during breast cancer chemotherapy. Int J Behav Nutr Phys Activ. 2014;11(1):85. doi:10.1186/s12966-014-0085-0
Shang J, Wenzel J, Krumm S, Griffith K, Stewart K. Who will drop out and who will drop in: exercise adherence in a randomized clinical trial among patients receiving active cancer treatment. Cancer Nurs. 2012;35(4):312-322. doi:10.1097/NCC.0b013e318236a3b3
Beckenstein H, Slim M, Kim H, Plourde H, Kilgour R, Cohen TR. Acceptability of a structured diet and exercise weight loss intervention in breast cancer survivors living with an overweight condition or obesity: a qualitative analysis. Cancer Rep (Hoboken). 2021;4(3):e1337. doi:10.1002/cnr2.1337
Cho D, Park CL. Barriers to physical activity and healthy diet among breast cancer survivors: a multilevel perspective. Eur J Cancer Care. 2018;27(1):e12772, doi:10.1111/ecc.12772
Sanft T, Harrigan M, McGowan C, et al. Randomized trial of exercise and nutrition on chemotherapy completion and pathologic complete response in women with breast cancer: the Lifestyle, Exercise, and Nutrition Early After Diagnosis Study. J Clin Oncol. 2023;41(34):5285-5295. doi:10.1200/jco.23.00871
Sanft T, Harrigan M, Cartmel B, et al. Effect of healthy diet and exercise on chemotherapy completion rate in women with breast cancer: the Lifestyle, Exercise and Nutrition Early after Diagnosis (LEANer) study: study protocol for a randomized clinical trial. Contemp Clin Trials. 2021;109:106508. doi:10.1016/j.cct.2021.106508
Harrigan M, Cartmel B, Loftfield E, et al. Randomized trial comparing telephone versus in-person weight loss counseling on body composition and circulating biomarkers in women treated for breast cancer: the Lifestyle, Exercise, and Nutrition (LEAN) Study. J Clin Oncol. 2016;34(7):669-676. doi:10.1200/jco.2015.61.6375
The Diabetes Prevention Program (DPP). Description of lifestyle intervention. Diabetes Care. 2002;25(12):2165-2171. doi:10.2337/diacare.25.12.2165
Bandura A. Social cognitive theory in cultural context. Appl Psychol. 2002;51(2):269-290. doi:10.1111/1464-0597.00092
Kriska AM, Knowler WC, LaPorte RE, et al. Development of questionnaire to examine relationship of physical activity and diabetes in Pima Indians. Diabetes Care. 1990;13(4):401-411. doi:10.2337/diacare.13.4.401
Patterson RE, Kristal AR, Tinker LF, Carter RA, Bolton MP, Agurs-Collins T. Measurement characteristics of the Women’s Health Initiative Food Frequency Questionnaire. Ann Epidemiol. 1999;9(3):178-187. doi:10.1016/S1047-2797(98)00055-6
Shams-White MM, Pannucci TE, Lerman JL, et al. Healthy Eating Index-2020: review and update process to reflect the dietary guidelines for Americans, 2020-2025. J Acad Nutr Diet. 2023;123(9):1280-1288. doi:10.1016/j.jand.2023.05.015
Hays RD, Spritzer KL, Schalet BD, Cella D. PROMIS(®)-29 v2.0 profile physical and mental health summary scores. Qual Life Res. 2018;27(7):1885-1891. doi:10.1007/s11136-018-1842-3
Baglia ML, Lin IH, Cartmel B, et al. Endocrine-related quality of life in a randomized trial of exercise on aromatase inhibitor-induced arthralgias in breast cancer survivors. Cancer. 2019;125(13):2262-2271. doi:10.1002/cncr.32051
Kirkham AA, Van Patten CL, Gelmon KA, et al. Effectiveness of oncologist-referred exercise and healthy eating programming as a part of supportive adjuvant care for early breast cancer. Oncol. 2018;23(1):105-115. doi:10.1634/theoncologist.2017-0141
Courneya KS, Segal RJ, Mackey JR, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J Clin Oncol. 2007;25(28):4396-4404. doi:10.1200/jco.2006.08.2024
Irwin ML, Crumley D, McTiernan A, et al. Physical activity levels before and after a diagnosis of breast carcinoma. Cancer. 2003;97(7):1746-1757. doi:10.1002/cncr.11227
Swenson KK, Nissen MJ, Henly SJ. Physical activity in women receiving chemotherapy for breast cancer: adherence to a walking intervention. Oncol Nurs Forum. 2010;37(3):321-330. doi:10.1188/10.Onf.321-330
Meneses-Echávez JF, González-Jiménez E, Ramírez-Vélez R. Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: a systematic review and meta-analysis. BMC Cancer. 2015;15(1):77. doi:10.1186/s12885-015-1069-4
Mock V, Frangakis C, Davidson NE, et al. Exercise manages fatigue during breast cancer treatment: a randomized controlled trial. Psycho Oncol. 2005;14(6):464-477. doi:10.1002/pon.863
Kane K, Ilic S, Paden H, et al. An evaluation of factors predicting diet quality among cancer patients. Nutrients. 2018;10(8). doi:10.3390/nu10081019
Lee E, Zhu J, Velazquez J, et al. Evaluation of diet quality among American adult cancer survivors: results from 2005-2016 National Health and Nutrition Examination Survey. J Acad Nutr Diet. 2021;121(2):217-232. doi:10.1016/j.jand.2020.08.086
McCullough ML, Chantaprasopsuk S, Islami F, et al. Association of socioeconomic and geographic factors with diet quality in US adults. JAMA Netw Open. 2022;5(6):e2216406. doi:10.1001/jamanetworkopen.2022.16406
Heshmat R, Salehi F, Qorbani M, et al. Economic inequality in nutritional knowledge, attitude and practice of Iranian households: the NUTRI-KAP study. Med J Islam Repub Iran. 2016;30:426.
Pinto BM, Rabin C, Dunsiger S. Home-based exercise among cancer survivors: adherence and its predictors. Psycho Oncol. 2009;18(4):369-376. doi:10.1002/pon.1465
Husebø AML, Karlsen B, Allan H, Søreide JA, Bru E. Factors perceived to influence exercise adherence in women with breast cancer participating in an exercise programme during adjuvant chemotherapy: a focus group study. J Clin Nurs. 2015;24(3-4):500-510. doi:10.1111/jocn.12633
Kampshoff CS, van Mechelen W, Schep G, et al. Participation in and adherence to physical exercise after completion of primary cancer treatment. Int J Behav Nutr Phys Activ. 2016;13(1):100. doi:10.1186/s12966-016-0425-3
Pinto BM, Trunzo JJ, Reiss P, Shiu S-Y. Exercise participation after diagnosis of breast cancer: trends and effects on mood and quality of life. Psycho Oncol. 2002;11(5):389-400. doi:10.1002/pon.594
McGuire R, Waltman N, Zimmerman L. Intervention components promoting adherence to strength training exercise in breast cancer survivors with bone loss. West J Nurs Res. 2011;33(5):671-689. doi:10.1177/0193945910379004
Kampshoff CS, Jansen F, van Mechelen W, et al. Determinants of exercise adherence and maintenance among cancer survivors: a systematic review. Int J Behav Nutr Phys Activ. 2014;11(1):80. doi:10.1186/1479-5868-11-80
Klepin HD, Danhauer SC, Tooze JA, et al. Exercise for older adult inpatients with acute myelogenous leukemia: a pilot study. J Geriatr Oncol. 2011;2(1):11-17. doi:10.1016/j.jgo.2010.10.004