Mc Tiernan - 20th International Nutrition Congress 2013
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1_Poster 2009.qxd:Rad Onc Poster 2009.qxd 4/27/09 4:39 PM Page 1
Medical Education: University of Rochester School of Medicine 2002
Residency:
Board Certification: American Board of Radiology - Radiation Oncology 2008
Ian J. Bristol, MD
The University of Texas M.D. Anderson Cancer Center, Radiation Oncology
Maine Medical Center
Department of Radiation Therapy
Medical Education: Tufts University School of Medicine, MD/MPH 1994
Residency: Tufts-New England Medical Center, Radiation Oncology
Board Certification: American Board of Radiology - Radiation Oncology 1999
Celine M. Godin, MD, MPH
Medical Education: University of Vermont College of Medicine 1989
Residency: University of Wisconsin Hospitals & Clinics, Radiation Oncology
Board Certification: American Board of Radiology - Radiation Oncology 1995
Cornelius J. McGinn, MD
Medical Director, Maine Medical Center
Rodger M. Pryzant, MD
1_Poster 2009.qxd:Rad Onc Poster 2009.qxd 4/27/09 4:39 PM Page 1
Medical Education: Dartmouth Medical School 2010
Residency: Harvard Radiation Oncology Program
Board Certification: American Board of Radiology - Radiation Oncology 2016
Matthew D. Cheney, MD, PhD
Medical Education: University of Rochester School of Medicine 2002
Residency:
Board Certification: American Board of Radiology - Radiation Oncology 2008
Ian J. Bristol, MD
The University of Texas M.D. Anderson Cancer Center, Radiation Oncology
Maine Medical Center
Department of Radiation Therapy
Medical Education: Tufts University School of Medicine, MD/MPH 1994
Residency: Tufts-New England Medical Center, Radiation Oncology
Board Certification: American Board of Radiology - Radiation Oncology 1999
Celine M. Godin, MD, MPH
Medical Education: University of Vermont College of Medicine 1989
Residency: University of Wisconsin Hospitals & Clinics, Radiation Oncology
Board Certification: American Board of Radiology - Radiation Oncology 1995
Cornelius J. McGinn, MD
Medical Director, Maine Medical Center
Medical Education: Baylor College of Medicine 1987
Residency: The University of Texas M.D. Anderson Cancer Center, Radiation Oncology
Board Certification: American Board of Radiology - Radiation Oncology 1992
Rodger M. Pryzant, MD
1_Poster 2009.qxd:Rad Onc Poster 2009.qxd 4/27/09 4:39 PM Page 1
Medical Education: Dartmouth Medical School 2010
Residency: Harvard Radiation Oncology Program
Board Certification: American Board of Radiology - Radiation Oncology 2016
Matthew D. Cheney, MD, PhD
Medical Education: University of Rochester School of Medicine 2002
Residency:
Board Certification: American Board of Radiology - Radiation Oncology 2008
Ian J. Bristol, MD
The University of Texas M.D. Anderson Cancer Center, Radiation Oncology
Maine Medical Center
Department of Radiation Therapy
Medical Education: Tufts University School of Medicine, MD/MPH 1994
Residency: Tufts-New England Medical Center, Radiation Oncology
Board Certification: American Board of Radiology - Radiation Oncology 1999
Celine M. Godin, MD, MPH
Medical Education: University of Vermont College of Medicine 1989
Residency: University of Wisconsin Hospitals & Clinics, Radiation Oncology
Board Certification: American Board of Radiology - Radiation Oncology 1995
Cornelius J. McGinn, MD
Medical Director, Cancer Care Center of York County
Medical Director, Maine Medical Center
Medical Education: Baylor College of Medicine 1987
Residency: The University of Texas M.D. Anderson Cancer Center, Radiation Oncology
Board Certification: American Board of Radiology - Radiation Oncology 1992
Rodger M. Pryzant, MD
Medical Education: Dartmouth Medical School 1995
Residency: Duke University Medical Center, Radiation Oncology
Board Certification: American Board of Radiology - Radiation Oncology 2000
Philip J. Villiotte, MD
Medical Education: Dartmouth Medical School 2010
Residency: Harvard Radiation Oncology Program
Board Certification: American Board of Radiology - Radiation Oncology 2016
Matthew D. Cheney, MD, PhD
Medical Education: University of Rochester School of Medicine 2002
Residency:
Board Certification: American Board of Radiology - Radiation Oncology 2008
Ian J. Bristol, MD
The University of Texas M.D. Anderson Cancer Center, Radiation Oncology
Maine Medical Center
Department of Radiation Therapy
Can Exercise Improve Outcomes in Breast Cancer RT?
A survey study reveals a somewhat encouraging change in quality-of-life
(QOL) outcomes in women engaging in physical exercise while receiving
radiation therapy (RT) for breast cancer.
“Radiation therapy is associated with acute treatment-related complications
that can lead to decreased …QOL,” write Ritu Arya, BA, from the
Department of Radiation Oncology, Duke University Medical Center,
Durham, North Carolina, and colleagues. “Exercise has been shown in other
cancer treatment settings to improve negative outcomes.”
Thus, the researchers sought to explore this same possibility in the breast
cancer treatment setting in a prospective pilot study of women undergoing
RT, published in the July-August issue of Practical Radiation Oncology.
RT is a common, effective part of breast cancer treatment and has been
shown to decrease the risks for recurrence and death, but the downside
is debilitating side effects such as fatigue, radiation dermatitis, pain,
lymphedema, depression, and decreased range of motion of the shoulder.
Women receiving RT for breast cancer also experience “emotional distress
and overall decreased …QOL that extends beyond the treatment period.”
Spotlight
Cancer news and information from the Cancer Care Center of York County
SEPTEMBER 2015
theFaceofCancer
ChangingChangingtheFaceofCancer
2. Recruitment
The researchers enrolled 45 women 18 years and older with biopsy-confirmed ductal
carcinoma in situ or invasive breast carcinoma, but 39 women completed all protocol
assessments. These women were undergoing RT to the chest and/or regional lymph
nodes. Mean age was 54 years (age range, 28-73 years), 21% were African American,
and 77% had a college degree. None of the women were active smokers, and median
body mass index was 29 kg/m2.
Survey Questionnaires
Participants completed a survey that measured their exercise behavior and QOL;
survey times were before the fifth fraction of radiation and during the last week
of treatment. Depending on fractionation schedule, 3 and 6 weeks passed between
surveys.
The Godin Leisure Time Exercise Questionnaire was used to measure exercise
behavior, in metabolic equivalent [MET] hours per week. Exercise intensity (mild,
moderate, and vigorous) was also examined. The researchers used standards of 3 METs
for mild exercise, 5 METs for moderate exercise, and 7 METs for vigorous exercise.
Women with at least 9 METs were in a high exercise category, and those reporting less
than 9 METs were in a low execise cohort.
Before study enrollment, exercise behavior was defined in the questionnaire as patient-
reported median total minutes (frequency × duration) of mild, moderate, and vigorous
intensity physical exercise per week. At study completion, the questionnaire consisted
of median total minutes per week of mild, moderate, and vigorous exercise per week
during RT treatment.
Exercise Regimen
At baseline, 25 women participated in self-perceived mild exercise, 17 in moderate
exercise, and 6 in vigorous exercise for a minimum of 20 minutes per week. For the
entire cohort, the mean number of minutes per week of total exercise was 148, and the
mean METs per week was 10.
Regarding exercise level, 14 women engaged in high exercise (mean of METs ≥9 per
week) and 25 women engaged in low exercise (mean of <9 METs per week). Mean
METs in the high exercise group was 21 per week vs 3 METs per week in the low
exercise group. Median body mass index was not significantly different between the 2
groups, but mean age was (49 years for high exercise vs 57 years in low exercise, P =
.051).
Interestingly, women in the high exercise group had undergone more aggressive
surgical procedures, “more comprehensive radiation treatment, and more systemic
therapy.”
Similar Trends Observed
Patient-reported outcomes were radiation-related effects of pain, fatigue, radiation
dermatitis, lymphedema, and reduced shoulder range of motion. Depression was also
measured. Say the authors, “Outcomes were generally favorable with high QOL scores
reported on the FACT-B [Functional Assessment of Cancer Therapy–Breast] at
baseline and treatment completion for all patients.” However, when the team evaluated
the entire cohort, they noted no significant changes in any of the outcome measures
assessed.
When the researchers analyzed these outcomes by exercise cohort, they also did not
see any statistically significant differences between the high and low exercise groups “in
QOL, fatigue, depression, or pain at baseline or treatment completion.” However, they
noticed that the group performing more vigorous exercise displayed a more positive
change in QOL than those performing less exercise. The high exercise group improved
at a median of 9.5 points in QOL (FACT-B), but the low exercise group remained
static. They also scored a median improvement of 2 points in fatigue compared with
the low exercise group, which yielded a 6-point median decrement in fatigue.
Similar trends were also seen with radiation dermatitis in the high vs the low exercise
group (39% vs 40%) and with shoulder range of motion (91% vs 89% of more
complete range of motion at the end of the study).
Statistically Nonsignificant Findings
The authors stress that physical exercise is an important predictor of QOL in patients
with various types of cancer, based on the current literature. Although they noticed
similar trends in this study, they concluded that these trends were not statistically
significant. “This may be due to our finding that patient-reported outcomes with
radiation therapy are relatively high compared with other treatment modalities and
remain stable throughout treatment,” they write. “Thus, it may be that radiation therapy
has a limited impact on QOL in breast cancer patients.”The authors also suggest that
RT for breast cancer may be more physically well tolerated than other treatments and
that “there may be limited room for QOL improvement during breast RT.”
Pract Radiat Oncol. 2015;5:e275-e281. Summary Jane Warren
![Recruitment
The researchers enrolled 45 women 18 years and older with biopsy-confirmed ductal
carcinoma in situ or invasive breast carcinoma, but 39 women completed all protocol
assessments. These women were undergoing RT to the chest and/or regional lymph
nodes. Mean age was 54 years (age range, 28-73 years), 21% were African American,
and 77% had a college degree. None of the women were active smokers, and median
body mass index was 29 kg/m2.
Survey Questionnaires
Participants completed a survey that measured their exercise behavior and QOL;
survey times were before the fifth fraction of radiation and during the last week
of treatment. Depending on fractionation schedule, 3 and 6 weeks passed between
surveys.
The Godin Leisure Time Exercise Questionnaire was used to measure exercise
behavior, in metabolic equivalent [MET] hours per week. Exercise intensity (mild,
moderate, and vigorous) was also examined. The researchers used standards of 3 METs
for mild exercise, 5 METs for moderate exercise, and 7 METs for vigorous exercise.
Women with at least 9 METs were in a high exercise category, and those reporting less
than 9 METs were in a low execise cohort.
Before study enrollment, exercise behavior was defined in the questionnaire as patient-
reported median total minutes (frequency × duration) of mild, moderate, and vigorous
intensity physical exercise per week. At study completion, the questionnaire consisted
of median total minutes per week of mild, moderate, and vigorous exercise per week
during RT treatment.
Exercise Regimen
At baseline, 25 women participated in self-perceived mild exercise, 17 in moderate
exercise, and 6 in vigorous exercise for a minimum of 20 minutes per week. For the
entire cohort, the mean number of minutes per week of total exercise was 148, and the
mean METs per week was 10.
Regarding exercise level, 14 women engaged in high exercise (mean of METs ≥9 per
week) and 25 women engaged in low exercise (mean of <9 METs per week). Mean
METs in the high exercise group was 21 per week vs 3 METs per week in the low
exercise group. Median body mass index was not significantly different between the 2
groups, but mean age was (49 years for high exercise vs 57 years in low exercise, P =
.051).
Interestingly, women in the high exercise group had undergone more aggressive
surgical procedures, “more comprehensive radiation treatment, and more systemic
therapy.”
Similar Trends Observed
Patient-reported outcomes were radiation-related effects of pain, fatigue, radiation
dermatitis, lymphedema, and reduced shoulder range of motion. Depression was also
measured. Say the authors, “Outcomes were generally favorable with high QOL scores
reported on the FACT-B [Functional Assessment of Cancer Therapy–Breast] at
baseline and treatment completion for all patients.” However, when the team evaluated
the entire cohort, they noted no significant changes in any of the outcome measures
assessed.
When the researchers analyzed these outcomes by exercise cohort, they also did not
see any statistically significant differences between the high and low exercise groups “in
QOL, fatigue, depression, or pain at baseline or treatment completion.” However, they
noticed that the group performing more vigorous exercise displayed a more positive
change in QOL than those performing less exercise. The high exercise group improved
at a median of 9.5 points in QOL (FACT-B), but the low exercise group remained
static. They also scored a median improvement of 2 points in fatigue compared with
the low exercise group, which yielded a 6-point median decrement in fatigue.
Similar trends were also seen with radiation dermatitis in the high vs the low exercise
group (39% vs 40%) and with shoulder range of motion (91% vs 89% of more
complete range of motion at the end of the study).
Statistically Nonsignificant Findings
The authors stress that physical exercise is an important predictor of QOL in patients
with various types of cancer, based on the current literature. Although they noticed
similar trends in this study, they concluded that these trends were not statistically
significant. “This may be due to our finding that patient-reported outcomes with
radiation therapy are relatively high compared with other treatment modalities and
remain stable throughout treatment,” they write. “Thus, it may be that radiation therapy
has a limited impact on QOL in breast cancer patients.”The authors also suggest that
RT for breast cancer may be more physically well tolerated than other treatments and
that “there may be limited room for QOL improvement during breast RT.”
Pract Radiat Oncol. 2015;5:e275-e281. Summary Jane Warren](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)