Maximizing Your Health During and After Breast Cancer Treatment

1. Maximizing Your Health During and After Breast Cancer Treatment Julie R. Gralow, M.D. Associate Professor, Medical Oncology University of Washington School of Medicine Fred Hutchinson Cancer Research Center Seattle Cancer Care Alliance

2. Regular Physical Activity and Good Nutrition Can Help Reduce: • Heart disease • High cholesterol levels • High blood pressure • Obesity • Nicotine addiction • Diabetes • Depression • Cancer • Osteoporosis • Insomnia • Age-related declines in muscular strength

3. Exercise During Cancer Treatment

4. Exercise During Cancer Treatment Maintaining an exercise program throughout cancer treatment is not only safe, but also an effective way to manage fatigue, depression, and treatment side effects

5. Exercise Benefits Physical Health • Improved healing and recovery from surgery • Decreased lymphedema • Higher energy levels, less fatigue • Weight loss/prevent weight gain • Decreased nausea • Less pain • Decreased heart disease and osteoporosis

6. Exercise Benefits Emotional Health • Improved body and self-image • Decreased anxiety • Improved social interaction • Better sense of control • Improved depression and mood • Better sleep patterns

7. Fatigue and Quality of Life Outcomes of Exercise During Cancer TreatmentMock V et al, Cancer Pract 9: 119-127 2001 • Patients: 52 breast cancer patients randomized to home-based walking program or usual care during adjuvant chemotherapy or radiation therapy • Results: Women who exercised > 90 minutes per week (divided over 3 or more days) reported significantly • Less fatigue • Less emotional distress • Higher functional ability • Better quality of life

8. Exercise and Breast Cancer Post-Treatment

9. Exercise and Survival After Breast Cancer DiagnosisHolmes MD et al, JAMA 2005 • Prospective observational study • 2987 nurses in the U.S. Nurses’ Health Study diagnosed with stage I, II or III breast cancer • Physical activity categories: • < 3 MET hours (metabolic equivalent tasks) per week • 3-8.9 MET hours/week • 9-14.9 MET hours/week • > 24 MET hours/week • 3 MET hours per week is equal to walking at an average pace of 2-3 miles /hour for 1 hour

10. Exercise and Survival After Breast Cancer DiagnosisHolmes MD et al, JAMA 2005 • Results: • Compared to women with < 3 MET hours/week, risk of dying of breast cancer was: • 20% less for 3-9 MET hours/week • 40-50% less for > 9 MET hours/week of exercise • Conclusion: • Physical activity after a breast cancer diagnosis may reduce the risk of death from this disease • The greatest benefit occurred in women who performed the equivalent of walking 3-5 hours/week at an average pace

11. What About Lymphedema (Arm Swelling After Lymph Node Surgery)?

12. Weight Training and Lymphedema in Breast Cancer SurvivorsAhmed RL et al, J Clin Oncol 2005 • Patients: 45 breast cancer survivors following axillary lymph node dissection • Study: Randomized to weight training program or not • Weight training sessions 2x per week for 6 months • For upper body, initially used no weights or only wrist weights, weight gradually increased if no symptoms of lymphedema developed • Results: • None of the women in the weight training program experienced a noticeable change in arm swelling • Frequency of new lymphedema, or worsening of existing lymphedema, was similar in both groups

13. Nutrition, Body Weight and Breast Cancer -Maintain good body weight -Low fat diet -High fiber -Increase fruits and vegetables -Limit alcohol

14. Nutrition and Survival after the Diagnosis of Breast Cancer: A Review of the EvidenceRock CL et al, JCO 20:3302-16, 2002 • Being overweight or obese is associated with poorer prognosis in a majority of studies • Treatment-related weight gain influences survival, quality of life, other diseases • Dietary fat: 5 of 12 studies showed inverse relationship with survival • Fruits and vegetables: majority of studies showed favorable relationship with survival

15. Breast Cancer and Alcohol More than 2 drinks/day associated with increased breast cancer risk!

16. Women’s Intervention Nutrition Study (WINS)Chlebowski R et al, JNCI 98, 2006 • Patients: 2,437 postmenopausal women with early stage breast cancer (age 48-79) • Intervention: Randomized within 1 year of surgery to: • dietary intervention (8 biweekly counseling sessions by nutritionists and support throughout) • versus control • Results: Fat intake/day at 12 months Intervention group 33.3 gms (+/- 16.7) Control group 51.3 gms (+/- 24.4)

17. Women’s Intervention Nutrition Study (WINS)Chlebowski R et al, JNCI 98, 2006 • Results (cont.): Relapses (60 month follow-up) GroupDietControl All pts 96/975 (9.8%) 181/1462 (12.3%) 24% reduction in breast cancer recurrence in diet intervention group Conclusion: Lifestyle interventions can reduce recurrences in breast cancer patients

18. Optimizing Health After Breast Cancer Diagnosis and Treatment • Exercise regularly • Avoid obesity, control weight • Eat a healthy diet: low fat, high fiber, low alcohol • Avoid smoking • Wear sunscreen • Reduce stress • Control known diseases: high blood pressure, diabetes, high cholesterol, osteoporosis

19. Optimizing Health After Breast Cancer Diagnosis and Treatment • The majority of breast cancer patients can look forward to a long life after cancer diagnosis and treatment • Cancer patients should not forget about all aspects of health and well-being