Rebecca Speck, MPH

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Exercise During Cancer Treatment an evolving
evidence base

• Rebecca Speck, MPH
• Department of Defense Breast Cancer Research
  Program Predoctoral Trainee
• University of Pennsylvania

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Overview

• Literature overview
• Results
• Where do we go from here?

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Literature Review

• 75 studies included in review
• 60 high quality studies
• 30 studies during treatment
• 23 high quality studies during treatment

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Description of interventions- During Tx
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Description of Studies
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Outcomes

• Self-esteem
• Physiological
• Pain
• Symptoms/side effects
• Relative dose intensity
• Night in hospital

• Physical fitness
• Body size
• Quality of life
• Psychosocial
• Fatigue
• Anxiety
• Depression

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Qualitative Review

• Strong evidence 3 studies, gt75 significant
• Some evidence 3 studies, 26-75 significant
• Not effective 3 studies, but lt25 significant
• Insufficient evidence lt3 high quality studies

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Some evidence
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Not Effective
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Insufficient evidence
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Conclusions

• Some positive effects
• No adverse effects
• No reason not to prescribe
• physical activity

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Gaps and Future Direction

• Needs assessment
• Who needs an intervention, what intervention, and
  why?
• Association between amenable behaviors and
  treatment side effects or long-term health
  outcomes
• Observational studies interventions
• Dissemination, implementation, and policy change
  in cancer care

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BALANCEAssociation of Energy Balance Factors
and Toxicities During Breast Cancer
Chemotherapy

• Broad Objective
• Enhance our understanding of whether energy
  balance factors amenable to intervention
  contribute to variability in experienced
  toxicities during adjuvant chemotherapy for
  breast cancer
• Energy balance
• -physical activity, diet, sleep and body
  composition

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Specific Aim 1

• To examine the association between experienced
  toxicities and energy balance factors during
  multiple cycles of adjuvant chemotherapy in
  breast cancer patients.
• Hypothesis The interindividual variability in
  baseline energy balance factors will be
  associated with variability in experienced
  toxicities.

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Specific Aim 2

• 2-To measure the changes in energy balance that
  occur during multiple cycles of adjuvant
  chemotherapy in a population of 60 breast cancer
  patients.
• Hypothesis Energy balance variables will change
  as follows

• Decrease
• Physical activity
• Energy intake
• Lean body mass

• Increase
• Dietary supplement use
• Body fat
• Alteration
• Sleep

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In other words

• Can baseline energy balance factors predict
  experienced side effects and toxicities?
• If grouped by baseline energy balance factor,
  will women experience varying degree and duration
  of side effects between groups?

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Methods-Design

• Prospective Longitudinal Observational Cohort
  Study
• 60-75 women
• Inclusion Criteria
• 18-71 years old
• Doxorubicin or taxol/taxotere chemo
• Exclusion Criteria
• Previous chemotherapy
• Pregnant, physical disability, HIV positive

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Methods-Measures

• EXPOSURES
• Physical Activity
• Diet
• Sleep
• Body Composition

• OUTCOMES
• Toxicities
• Blood Collection
• OTHER MEASURES
• Physical Functional Status
• Health history, medication use-comorbidities

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Baseline Demographics
AC/T doxirubicin (Adriamycin)
cyclophosphamide/paclitaxel (Taxol) TC
docetaxel (Taxotere) cyclophosphamide (Cytoxan)
TCHdocetaxel (Taxotere)/carboplatin
trastuzumab (Herceptin)
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ActivPAL output
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Baseline Physical Activity
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Baseline Sleep
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Physical Activity Groupings
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Changes in Side Effects
High score bad High possible Physical 28,
Social28, Emotion24, Function28, Breast40
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Funding Acknowledgements

• Transdiscliplinary Research in Energetics and
  Cancer (TREC)-Case Western, Fred Hutch, Univ of
  MN, USC.
• NCI funded initiative aiming to understand the
  effect of energy balance factors on cancer
  control
• DOD Breast Cancer Research Program
• Predoctoral Training Grant
• Mentors
• Kathryn Schmitz, PhD, MPH
• Angela DeMichele, MD, MSCE
• Michael Milone, MD, PhD

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Thank you!