Physical activity and survival of postmenopausal, hormone receptor–positive breast cancer patients: Results of the Tamoxifen Exemestane Adjuvant Multicenter Lifestyle study

Abstract

BACKGROUND: Physical activity has been related to improved breast cancer outcomes. Especially in the older breast cancer population, physical activity may be important because old age is associated with comorbidities and decreased physical function. The purpose of this study was to investigate the relation between physical activity and overall survival, breast cancer-specific survival, and recurrence in several age groups of postmenopausal breast cancer patients. METHODS: The Tamoxifen Exemestane Adjuvant Multinational Lifestyle study was a side study of the Tamoxifen Exemestane Adjuvant Multinational trial and prospectively investigated lifestyle habits of postmenopausal, hormone receptor-positive breast cancer patients. The relations between prediagnosis and postdiagnosis physical activity and overall survival, breast cancer-specific survival, and recurrence-free survival were assessed with Cox regression and competing risk regression models. RESULTS: Among 521 patients, high levels of physical activity before and after the diagnosis were associated with better overall survival (the multivariate hazard ratios were 0.50 [95% confidence interval 5 0.26-0.98] and 0.57 (95% confidence interval 5 0.26-1.40] for patients who were very active before and after the diagnosis, respectively, in comparison with inactive patients). This was most evident in patients who were 65 years old or older. Physical activity was not significantly associated with breast cancer-specific survival or the relapse-free period. CONCLUSIONS: Overall survival was better for patients who were active before and after the diagnosis. In contrast with previous studies, breast cancer survival and the risk of recurrence were not significantly associated with physical activity. These findings confirmed the need for more studies investigating the use of physical activity to supplement breast cancer treatment in older patients. Cancer 2014;120:2847-54.

Women with abnormal screening mammography lost to follow-up

“…The incidence and mortality increased both in developed and developing countries, possibly due to a shift of lifestyle in the population toward industrialized countries. [2,3] …”

Predictors of adherence to exercise interventions during and after cancer treatment: A systematic review

“…A cancer diagnosis and subsequent treatment may potentially motivate patients to change their lifestyle (eg, to become more active, follow a healthier diet, or quit smoking) . In observational studies, however, a decrease in patients' physical exercise frequency was found after being diagnosed with breast cancer and this effect was more distinct in obese, sedentary, and elderly patients …”

“…[29][30][31] In observational studies, however, a decrease in patients' physical exercise frequency was found after being diagnosed with breast cancer and this effect was more distinct in obese, sedentary, and elderly patients. 32,33 Accumulating data on the negative effects of being overweight on the development of cancer and cancer survival fuel the sense of urgency for successful interventions to enhance a healthy lifestyle. 8,21,34 Unfortunately, low adherence to the interventions and limited recruitment rates are frequently reported in studies investigating exercise interventions in cancer patients, both during and after cancer treatment.…”

Impact of chemotherapy on medium-term physical function and activity of older breast cancer survivors, and associated biomarkers

“…They also spent 50 minutes per day in moderate to vigorous physical activity, which is significantly greater than the normative population of women 60+ years who spent 12 minutes per day[64], although it should be noted that the SenseWear armband used in this study overestimates moderate to vigorous physical activity, so direct comparisons to normative data are tenuous[65]. In patients with cancer, a cohort from the TEAM trial, which randomized postmenopausal patients to exemestane vs tamoxifen followed by exemestane[66], showed that women (median age 63.6 years) spent 6.3 hours/week in moderate to vigorous activity –an amount similar to our patient group-- but noted a declining trend with age. A smaller trial in younger (mean age 48) post-chemotherapy breast cancer survivors showed no differences in body composition, insulin resistance, CRP, physical activity by accelerometry, and questionnaires between cases and controls at baseline, 8 weeks, and 3 months following an exercise intervention[67].…”