Brief Hospital Supervision of Exercise and Diet During Adjuvant Breast Cancer Therapy Is Not Enough to Relieve Fatigue: A Multicenter Randomized Controlled Trial

Abstract

Supervised exercise dietary programs are recommended to relieve cancer-related fatigue and weight increase induced by adjuvant treatment of early breast cancer (EBC). As this recommendation lacks a high level of evidence, we designed a multicenter randomized trial to evaluate the impact of an Adapted Physical Activity Diet (APAD) education program on fatigue. We randomized 360 women with EBC who were receiving adjuvant chemotherapy and radiotherapy to APAD or usual care at eight French cancer institutions. Data were collected at baseline, end of chemotherapy, end of radiotherapy, and 6 months post-treatment. The primary endpoint was the general cancer-related fatigue score using the MFI-20 questionnaire. Fatigue correlated with the level of precariousness, but we found no significant difference between the two groups in terms of general fatigue (p = 0.274). The APAD arm has a smaller proportion of patients with confirmed depression at the end of follow-up (p = 0.052). A transient modification in physical activity levels and dietary intake was reported in the experimental arm. However, a mixed hospital- and home-based APAD education program is not enough to improve fatigue caused by adjuvant treatment of EBC. Cancer care centers should consider integrating more proactive diet–exercise supportive care in this population, focusing on precarious patients.

Effects of Combined Interventions of Exercise and Diet or Exercise and Supplementation on Breast Cancer Patients: A Systematic Review

“…After 171 duplicates had been removed, titles and abstracts from the remaining 919 records were screened and the full text of 568 was assessed for eligibility. Finally, 13 studies were included in this systematic review describing 12 interventions [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ] (i.e., one intervention published 2 studies showing its results). We were forced to discard one study conducted by Arikawa et al [ 38 ] because the p-values were not reported, even though some variable changes, body mass and fitness level, were listed as significant in the body of the article.…”

“…The average age of patients ranged from 49.0 [ 30 , 31 ] to 58.7 years [ 37 ]. Eight interventions included patients receiving exercise plus diet interventions [ 26 , 27 , 28 , 30 , 31 , 33 , 34 , 35 , 36 ], and four interventions included patients receiving exercise plus supplementation interventions [ 25 , 29 , 32 , 37 ]. Of the 12 interventions analysed, in 11 of them, participants had a body mass index (BMI) > 25 kg/m 2 [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 33 , 34 , 35 , 36 , 37 ].…”

“…Regarding menopausal status, 4 interventions did not report it [ 25 , 30 , 31 , 33 , 34 ], in 2 interventions all participants were postmenopausal [ 32 , 37 ] and in 6 interventions, postmenopausal participants were between 40.0% and 90.0% of the total participants [ 26 , 27 , 28 , 29 , 35 , 36 ]. Regarding hormone therapy (HT) intake by participants, in 6 interventions they were receiving tamoxifen and aromatase inhibitors [ 28 , 29 , 34 , 35 , 36 , 37 ], 1 intervention tamoxifen [ 30 , 31 ], 1 intervention aromatase inhibitors plus selective estrogen receptor modulator [ 32 ], in 1 intervention the type of HT was not specified [ 25 ] and in 3 interventions it was not specified whether they were on HT or not [ 26 , 27 , 33 ]. Among all interventions, there were two interventions where all participants were receiving HT [ 29 , 30 , 31 ].…”

“…Supervision: Exercise programs were supervised in 4 interventions (33%) [ 25 , 30 , 31 , 34 , 36 ], semi-supervised in 5 interventions (42%) [ 26 , 27 , 28 , 33 , 37 ], 2 interventions were not supervised (17%) [ 29 , 32 ] and 1 intervention did not report supervision (8%) [ 35 ].…”

MicroRNAs as Potential Biomarkers for Exercise-Based Cancer Rehabilitation in Cancer Survivors

“…In addition to a supervised exercise programme, home-based exercise also showed promising prospects in cancer rehabilitation. A multicentre randomized controlled trial suggested that home-based physical activity consisted of combined endurance (same as aerobic exercise) and resistance training during 27 weeks significantly increased VO 2 peak compared to a decrease in the usual care group [17]. In addition to endurance and resistance exercise, home-based walking training was also reported to benefit breast cancer patients for cardiorespiratory fitness [18].…”