Diet-workout regimen may benefit breast cancer patients on CRT

Women with early breast cancer (BCa) who participated in an exercise and nutrition-based supportive care intervention programme called APAD* while being on a chemoradiotherapy (CRT) regimen had durable improvements in patient-reported outcomes, particularly fatigue and quality of life (QoL), compared with those receiving usual care, the APAD1 study shows.

“[T]he long-term efficacy of APAD [is] relevant in clinical practice … [as] post-diagnosis deteriorations in fatigue [and] QoL … have generally been associated with poorer survival in BCa patients,” said the researchers. Fatigue is apparently more distressing than pain, nausea, and vomiting during adjuvant cancer therapy, which eventually impairs QoL and affects prognosis. [J Natl Compr Canc Netw 2015;13:1012-1039; Psychooncology 2011;20:1211-1220; Clin J Oncol Nurs 2012;16:E26-32]

“[The NCCN** recommends] exercise and nutrition consultations … to relieve side effects and cancer-related fatigue during active treatment … [E]xercise may help improve physical fitness, fatigue, QoL, psychological distress, and cognitive abilities, while nutritional consultations may help manage nutritional disorders … that contribute to fatigue,” they added.

Investigators compared the effect of APAD against usual care*** (UC) in 143 BCa patients (mean age 52 years) receiving adjuvant chemotherapy (six cycles) followed by 6 weeks of radiotherapy. Assessments were done before chemotherapy, at the end of chemotherapy (T1) and radiotherapy (T2), and at the 6-month (T3) and 1-year follow-up periods (T4). [BMC Cancer 2019;19:737]

All dimensions of fatigue significantly dropped with APAD vs UC at T1 (effect size [ES], -0.28; p=0.002 for general fatigue, ES, -0.33; p=0.001 for physical fatigue, ES, -0.22; p=0.015 for mental fatigue, ES, -0.30; p=0.002 for reduced activities, and ES, -0.28; p=0.007 for reduced motivation). Significant effects in general and physical fatigue (ES, -0.16; p=0.038 and ES, -0.18; p=0.034, respectively) and reduced activities (ES, -0.17; p=0.044) persisted until T4 with APAD vs UC.

Global QoL as measured by the EORTC QLQ-C30^# increased with APAD vs UC from T1 onwards (adjusted mean difference [aMD], 7.08, 7.69, and 7.58 [T1, T2, and T3, respectively]), hitting its highest point at T4 (aMD, 11.87).

The BMI effect

Of note are the reductions in body mass index (BMI; aMD, -0.46 kg/m²; ES, -0.21; p=0.033), total fat mass (aMD, -1.10 percent; ES, -0.21; p=0.041), and weight (aMD, -1.19 kg; ES, -0.21; p=0.051) among APAD vs UC recipients at T2.

“[Although these were not sustained until T4, the effect of APAD on BMI and body fat] is particularly relevant … in the clinical context of BCa, as BMI before and after diagnosis and weight gain after diagnosis have recently been associated with increased mortality,” underscored the researchers. [Ann Oncol 2014;25:1901-1914; J Natl Cancer Inst 2015;107:djv275]

The sustainability issue

APAD adherence rates were 97 percent and 67 percent for the diet and exercise components, respectively, suggesting that this was a well-received programme.

However, most of the other outcomes were limited to the intervention phases only (T1 and T2) despite the long-term effects on fatigue and QoL, the researchers pointed out. “Difficulties in maintaining positive outcomes [post-intervention] could be related to the cessation of supervision and support for keeping behaviour changes. This finding may promote the necessity of setting longer models that could include … the APAD ‘in-treatment’ module during the 24 weeks of [CRT], followed by a 6-month internet-based ‘survivor’ module designed to maintain behaviour change and support autonomy with limited cost.”

Nonetheless, the findings illustrate how this combination programme during CRT may provide relief from the side effects of adjuvant cancer therapy, noted the researchers. “[Our findings] add evidence to support the role of diet-exercise interventions [in this setting] … and bring new evidence in the … adjuvant [CRT period].”

Cancer care centres are urged to consider incorporating this programme into the management protocol of BCa patients receiving CRT, they added. Larger and longer trials are warranted to explore the superiority of this regimen over diet or exercise alone and its effect during and after treatment.