Feasibility of an exercise and nutritional intervention for weight management during adjuvant treatment for localized breast cancer: the PASAPAS randomized controlled trial

Foucaut, Aude-Marie; Morelle, Magali; Kempf-Lépine, A.-S.; Baudinet, Cédric; Meyrand, Renaud; Guillemaut, S.; Metzger, Séverine; Bourne-Branchu, V.; Grinand, Elodie; Chabaud, Sylvie; Pérol, David; Carretier, Julien; Berthouze, Sophie E.; Reynes, Éric; Perrier, Lionel; Rebattu, P.; Heudel, Pierre; Bachelot, Thomas; Bachmann, Patrick; Fervers, Béatrice; Trédan, Olivier; Touillaud, Marina

doi:10.1007/s00520-019-4658-y

Cited by 22 publications

(30 citation statements)

References 40 publications

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“…Third, a selection bias toward women highly motivated for PA cannot be ruled out, although there was no recruitment bias with respect to age, BMI, and tumor grade. 15 While a ceiling effect cannot be excluded, a contamination in the control group, which can be expected in exercise oncology trials, 46 may also have further diluted the effect of the intervention. Fourth, the subjective assessment of PA through questionnaires may have induced an over- or under-estimation of actual PA level in each group.…”

Section: Discussionmentioning

confidence: 99%

“…Physical activity intensity and duration and type of exercise were individualized under the supervision of a certified adapted PA trainer according to initial PA level. 14,15 In addition to supervised sessions, participants were encouraged to perform non-supervised exercise sessions at home and to record sessions in a PA diary, collected at each follow-up visit. The total duration of participation for all patients was 12 months (ie, for the 6-month intervention program, then a 6-month follow-up).…”

Section: Methodsmentioning

confidence: 99%

“…First, the PASAPAS feasibility study had not been designed to study biomarkers as the primary endpoints. Although the sample size was sufficient to assess the primary objective (ie, feasibility of an exercise intervention), 15,20 the power to examine the secondary objectives including biological effects of exercise may be limited. Second, the relatively short follow-up prevented to study biomarkers evolution after completion of adjuvant treatment.…”

Section: Concentrations Of the Inflammatory Cytokines Il6mentioning

confidence: 99%

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Effects of an Exercise and Nutritional Intervention on Circulating Biomarkers and Metabolomic Profiling During Adjuvant Treatment for Localized Breast Cancer: Results From the PASAPAS Feasibility Randomized Controlled Trial

et al. 2021

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Purpose: Exercise has been shown to improve physical and psychological conditions during cancer therapy, but mechanisms remain poorly understood. The purpose of the present study was to report the results of cancer-related biomarkers and metabolomics outcomes from the PASAPAS feasibility study. Methods: In the PASAPAS randomized controlled trial, 61 women beginning adjuvant chemotherapy for localized breast cancer were randomized in a 6-month program of weekly aerobic exercises associated with nutritional counseling versus usual care with nutritional counseling. In the present analysis of 58 women for whom blood samples were available, first, circulating levels of biomarkers (ie, insulin, insulin-like growth factor 1, estradiol, adiponectin, leptin, interleukin-6, and tumor necrosis factor α) were measured at baseline and 6-month follow-up. Changes in biomarkers were compared between exercisers (n = 40) and controls (n = 18) using mixed-effect models. Second, serum metabolites were studied using an untargeted 1H nuclear magnetic resonance spectroscopy, and orthogonal partial least squares analyses were performed to discriminate exercisers and controls at baseline and at 6 months. Results: Over the 6-month intervention, no statistically significant differences were observed between exercisers and controls regarding changes in biomarkers and metabolomic profiles. Conclusion: The present analysis of the PASAPAS feasibility trial did not reveal any improvement in circulating biomarkers nor identified metabolic signatures in exercisers versus controls during adjuvant breast cancer treatment. Larger studies preferably in women with poor physical activity level to avoid ceiling effect, testing different doses and types of exercise on additional biological pathways, could allow to clarify the mechanisms mediating beneficial effects of physical exercise during cancer treatment. Trial registration: ClinicalTrials.gov Identifier: NCT01331772. Registered 8 April 2011, https://clinicaltrials.gov/ct2/show/NCT01331772?term=pasapas&rank=1

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Concentrations Of the Inflammatory Cytokines Il6mentioning

confidence: 99%

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Effects of an Exercise and Nutritional Intervention on Circulating Biomarkers and Metabolomic Profiling During Adjuvant Treatment for Localized Breast Cancer: Results From the PASAPAS Feasibility Randomized Controlled Trial

et al. 2021

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“…It is at this stage where patients need to adhere to their physical activity regimen, despite the fatigue, emotional burden, and decreased QOL and well-being, which invariably accompany chemotherapy and other oncology treatments. 25 The decision of patients to participate in physical activity during active cancer treatment may be related to a number of factors, such as an understanding regarding the health-related benefits (e.g., reducing cancer-related fatigue), or simply the enjoyment from participation in the activity itself. At the same time, physical activity during chemotherapy may reflect the patient's wish to be a more active participant in the therapeutic process-empowered, and in control.…”

Section: Discussionmentioning

confidence: 99%

Association Between Physical Activity and Use of Complementary Medicine by Female Oncology Patients in an Integrative Palliative Care Setting

Raz

Samuels

Levy

et al. 2020

The Journal of Alternative and Complementary Medicine

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Objective: To examine the association between physical activity and the reported use of complementary medicine by patients with breast and gynecological cancer referred or self-referred to a complementary/ integrative medicine (CIM) consultation within a palliative care context.Methods: Retrospective observational study analyzing the medical files of patients referred to a CIM consultation provided within a specialized integrative oncology clinic for demographic and cancer-related parameters; participation in physical exercise and activities; and current use of nonconventional medical practices. Quality of life (QoL) outcomes were assessed during the initial CIM consultation by using the Edmonton Symptom Assessment Scale (ESAS) tool.Results: Among the 162 patient files examined, participation in physical activities was reported in 152, of whom 83 were identified as active and 69 inactive according to the American Cancer Society guidelines. A logistic multivariate regression model showed that physical activity was associated with higher rates of herbal/dietary supplement use for noncancer-related outcomes (odds ratio = 7.21, 95% confidence interval [CI] 1.6-32.46, p = 0.01); more frequently reported use of acupuncture for cancer-related outcomes (odds ratio = 7.79, 95% CI 1.93-31.5, p = 0.004); and lower ESAS scores for well-being (odds ratio = 0.77, 95% CI 1.0.65-0.92, p = 0.004), indicating better QoL.Conclusion: Physical activity was found to be associated with a greater use of CIM (specifically herbal/ dietary supplement use and acupuncture) in patients with breast and gynecological cancer during oncology treatment. Further research is needed to explore whether CIM use and physical activity are influenced by patients' health-belief models of care, and whether the CIM consultation can promote physical activity among these patients.

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“…Numerous interventions to overcome malnutrition in patients with various cancers have been attempted [ 3 , 25 , 26 ]. Unfortunately, interventions to improve cancer patients’ malnutrition or muscle loss have been rare.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of an Interactive Health Coaching Mobile App to Prevent Malnutrition and Muscle Loss in Esophageal Cancer Patients Receiving Neoadjuvant Concurrent Chemoradiotherapy: Prospective Pilot Study

Yang¹,

Oh²,

Noh³

et al. 2021

J Med Internet Res

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Background Excessive muscle loss is an important prognostic factor in esophageal cancer patients undergoing neoadjuvant chemoradiotherapy (NACRT), as reported in our previous research. Objective In this pilot study, we prospectively tested the feasibility of a health coaching mobile app for preventing malnutrition and muscle loss in this patient population. Methods Between July 2019 and May 2020, we enrolled 38 male patients with esophageal cancer scheduled for NACRT. For 8 weeks from the start of radiotherapy (RT), the patients used Noom, a health coaching mobile app that interactively provided online advice about food intake, exercise, and weight changes. The skeletal muscle index (SMI) measured based on computed tomography and nutrition-related laboratory markers were assessed before and after RT. We evaluated the changes in the SMI, nutrition, and inflammatory factors between the patient group that used the mobile app (mHealth group) and our previous study cohort (usual care group). Additionally, we analyzed the factors associated with walk steps recorded in the app. Results Two patients dropped out of the study (no app usage; treatment changed to a definitive aim). The use (or activation) of the app was noted in approximately 70% (25/36) of the patients until the end of the trial. Compared to the 1:2 matched usual care group by propensity scores balanced with their age, primary tumor location, tumor stage, pre-RT BMI, and pre-RT SMI level, 30 operable patients showed less aggravation of the prognostic nutritional index (PNI) (–6.7 vs –9.8; P=.04). However, there was no significant difference in the SMI change or the number of patients with excessive muscle loss (∆SMI/50 days >10%). In patients with excessive muscle loss, the walk steps significantly decreased in the last 4 weeks compared to those in the first 4 weeks. Age affected the absolute number of walk steps (P=.01), whereas pre-RT sarcopenia was related to the recovery of the reduced walk steps (P=.03). Conclusions For esophageal cancer patients receiving NACRT, a health care mobile app helped nutritional self-care with less decrease in the PNI, although it did not prevent excessive muscle loss. An individualized care model with proper exercise as well as nutritional support may be required to reduce muscle loss and malnutrition.

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Feasibility of an exercise and nutritional intervention for weight management during adjuvant treatment for localized breast cancer: the PASAPAS randomized controlled trial

Cited by 22 publications

References 40 publications

Effects of an Exercise and Nutritional Intervention on Circulating Biomarkers and Metabolomic Profiling During Adjuvant Treatment for Localized Breast Cancer: Results From the PASAPAS Feasibility Randomized Controlled Trial

Effects of an Exercise and Nutritional Intervention on Circulating Biomarkers and Metabolomic Profiling During Adjuvant Treatment for Localized Breast Cancer: Results From the PASAPAS Feasibility Randomized Controlled Trial

Association Between Physical Activity and Use of Complementary Medicine by Female Oncology Patients in an Integrative Palliative Care Setting

Feasibility of an Interactive Health Coaching Mobile App to Prevent Malnutrition and Muscle Loss in Esophageal Cancer Patients Receiving Neoadjuvant Concurrent Chemoradiotherapy: Prospective Pilot Study

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