1. Breast Cancer & Exercise By: Morgan Ashley, Chloe Meltz, & Alicia Walker

2. Breast Cancer in the U.S. 2 nd most common cancer among Women in the U.S. ~1 in 8 (12%) U.S. women will develop invasive breast cancer during their lifetime American Cancer Society estimates that in 2013 the U.S. will see: ~ 232,340 new cases of invasive breast cancer in women ~39,620 women will die from breast cancer Incidence rate of breast cancer is slowly decreasing accompanied by a slight drop in the number of deaths due to breast cancer

3. Selection of Treatment Options Surgical Therapy Adjuvant Therapy Radiation Therapy Drug Therapy Selected based on stage of cancer American Joint Committee on Cancer’s TNM system: T: tumor size N: node involvement M: metastasis All come with side effects Some chronic and incurable

4. Surgical Therapy Mastectomy – removal of breast, pectoral muscles, axillary lymph nodes, and all fat and adjacent tissues) Breast Conserving Surgery (Lumpectomy) – Removal of the entire tumor along with a margin of normal surrounding tissue. Followed by radiation or chemotherapy. Axillary Lymph Node Dissection – examination of the lymph nodes provide prognostic information and helps determine further treatment. Lymphedema may occur as a chronic side effect.

5. Treatment Related Side Effect: Lymphedema Patient may experience heaviness, pain, impaired motor function in the arm, numbness in the fingers.

6. Radiation Therapy Treatment of a defined area of the body to achieve local control of disease Radiation only has an effect on tissues within the treatment field Can be used as: A) Primary treatment following lumpectomy B) Adjuvant therapy following mastectomy C)Palliative treatment for pain ~ ½ cancer patients will receive radiation therapy at some point in their treatment Side effects: Fatigue & specific to tissue being targeted

7. Chemotherapy Use of chemicals as a systemic therapy for cancer Can be used to: A) Cure B) Control C) Palliative relief when cure & control are no longer an option Most effective when therapy is not interrupted and patients receive intended doses Chemotherapeutic agents can not distinguish between normal cells and cancer cells, resulting in the destruction of normal cells Side effects: Fatigue, nausea, anorexia, taste alteration, weight loss, bone marrow suppression, alopecia

8. Treatment Related Side Effects: Fatigue Most common side effect of radiation therapy and chemotherapy “Universal Symptom” Affects 70-100% of cancer patients receiving treatment Origin is multi-factored & exact mechanisms still unclear Chronic, not relieved by sleep or rest Accumulation of muscle metabolites (lactate, hydrogen ions, and other end products from the destruction of cells) results in decreased muscle strength Weight loss, depression and nausea and medications can exacerbate fatigue

9. Exercise: An Intervention For many years: Physician’s recommended that cancer patients rest & avoid physical effort. Inactivity increases further muscular wasting and loss of cardiorespiratory fitness Today: Intervention for chronic, incurable cancer treatment related symptoms Clinicians should encourage patients with breast cancer to start exercise at the beginning of chemotherapy treatment and continue for as long as possible

10. Limiting Factors to Exercise Fatigue Lymphedema Anxiety & Depression Fear

11. Benefits of Exercise Acute Exercise ResponseLong Term Exercise Adaptations Improve mood Hormone Regulation (estrogen) Reduce fatigue intensity Decreases treatment induced symptoms: swelling due to lymphedema, improve appetite, reduce sleep disturbances Safer surgery Easier/Faster Recovery Preserve and improve aerobic fitness & strength Improvements in body composition Increase chemotherapy completion rates Decrease Lymphedema exacerbation Improve Self Esteem & QOL Prevent the manifestation and reduce the intensity of fatigue

12. Acute Exercise Response Hormones: Estrogen Endorphins Serotonin Growth Factors Improves Appetite Improves Sleep Patterns Decreases lymphedema related swelling

13. Physiological Adaptations to Training Courneya K. & Segal R. (2007). Journal of Clinical Oncology. Volume 25, Issue 28. Physiological Adaptations to Training Courneya K. & Segal R. (2007). Effects of Aerobic and Resistance Exercise in Breast Cancer Patients Receiving Adjuvant Chemotherapy. Journal of Clinical Oncology. Volume 25, Issue 28. Resistance Exercise Training Preserve & improve strength* Lean Body Mass* 5.7% higher RDI* Self Esteem* Secondary: QOL Fatigue Depression Aerobic Exercise Training Preserve Aerobic Fitness Peak Oxygen Consumption* Maintain Percent Body Fat* 3.3% higher RDI Self Esteem* Secondary: QOL Fatigue Depression Anxiety

14. Physiological Adaptations to Aerobic Training Preserve aerobic fitness: blunting the 8% decline in Vo2 max seen in usual care group O2 consumption superior to UC and RET groups Prevented Fat gain Improved RDI and chemotherapy completion rates Improved Self Esteem Improved aerobic fitness was associated with improved QOL, fatigue, depression, anxiety

15. Physiological Adaptations to Anaerobic Training Improve Strength: Upper and lower body strength superior to US and AET groups Increase lean body mass: Superior to UC group 5.7% increase in RDI Improve self esteem Decrease exacerbation of lymphedema symptoms (Control: 83% vs. PA group: 45%) Increased lean body mass was associated with improved QOL, fatigue, depression and anxiety

16. Cancer & Treatment Related Fatigue Aerobic & Anaerobic can improve Oppose the physiological impairment resulting from cancer and treatment Resulting in a reduction of fatigue by normalizing physical performance

17. Decrease Risk & Prevention of Reoccurrence More research Pre and Post- menopausal effects Used as Pre and Post- breast cancer treatment Many positive outcomes with exercise other than cancer prevention for the individual

18. Find something you enjoy!

19. References American Caner Society. (2013). Breast Cancer. www.cancer.org. May, 2013. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key- statistics. Berchtold, N.C, Kesslak, J., Pike, C.J., Adlard, P.A, & Cotman, C.W. (2001). Estrogen and exercise interact to regulate brain-derived neurotropihc factor mRNA and protein expression in the hippocampus. European Journal Of Neuroscience,14(12), 1992-2002. Courneya K. & Segal R. (2007). Effects of Aerobic and Resistance Exercise in Breast Cancer Patients Receiving Adjuvant Chemotherapy. Journal of Clinical Oncology. Volume 25, Issue 28.www.cancer.org http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key- Dimeo, F. C. (2001), Effects of exercise on cancer-related fatigue. Cancer, 92: 1689– 1693. doi: 10.1002/1097-0142(20010915)92:6+ 3.0.CO. Epstein, F. H, Clemons, M. Goss, P. Estrogen and the risk of breast cancer. (2001) The New England Journal of Medicine. 344 (4) 276-285. Kushi, L. H., Byers, T., Doyle, C., & Bandera, E (2009). American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention: Reducing the Risk of Cancer With Healthy Food Choices and Physical Activity. A Cancer Journal for Clinicians,56,1-28. Retrieved from http://onlinelibrary.wiley.com/doi/10.3322/canjclin.56.5.254/pdf Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., et al, L., & Camera, I. M. C. (2011). Medical- surgical nursing, assessment and management of clinical problems. (8th ed. ed.). St. Louis, Missouri: Mosby Newton, R.U., Galvao, D.A. (2008) Exercise in Prevention and Management of Cancer. Complementary and Alternative Thereapies in Oncology. DOI 10.1007/s11864-008-0065-1 NLN Medical Advisory Committee. (2011). Position of National Lymphedema Network. National Lymphedema Network. Retrieved from http://www.lymphnet.org/pdfDocs/nlnexercise.pdf. http://www.lymphnet.org/pdfDocs/nlnexercise.pdf