1. Maximizing Your Health During and After Breast Cancer Treatment
Julie R. Gralow, M.D.
Associate Professor, Medical Oncology
University of Washington School of Medicine
Fred Hutchinson Cancer Research Center
Seattle Cancer Care Alliance

2. Regular Physical Activity and Good Nutrition Can Help Reduce:
Heart disease
High cholesterol levels
High blood pressure
Obesity
Nicotine addiction
Diabetes
Depression
Cancer
Osteoporosis
Insomnia
Age-related declines in muscular strength

3. Exercise During Cancer Treatment

4. Exercise During Cancer Treatment
Maintaining an exercise program throughout cancer treatment is not only safe, but also an effective way to manage fatigue, depression, and treatment side effects

5. Exercise Benefits Physical Health
Improved healing and recovery from surgery
Decreased lymphedema
Higher energy levels, less fatigue
Weight loss/prevent weight gain
Decreased nausea
Less pain
Decreased heart disease and osteoporosis

6. Exercise Benefits Emotional Health
Improved body and self-image
Decreased anxiety
Improved social interaction
Better sense of control
Improved depression and mood
Better sleep patterns

7. Fatigue and Quality of Life Outcomes of Exercise During Cancer Treatment Mock V et al, Cancer Pract 9:
Patients: 52 breast cancer patients randomized to home-based walking program or usual care during adjuvant chemotherapy or radiation therapy
Results: Women who exercised > 90 minutes per week (divided over 3 or more days) reported significantly
Less fatigue
Less emotional distress
Higher functional ability
Better quality of life

8. Exercise and Breast Cancer Post-Treatment

9. Exercise and Survival After Breast Cancer Diagnosis Holmes MD et al, JAMA 2005
Prospective observational study
2987 nurses in the U.S. Nurses’ Health Study diagnosed with stage I, II or III breast cancer
Physical activity categories:
< 3 MET hours (metabolic equivalent tasks) per week
3-8.9 MET hours/week
MET hours/week
> 24 MET hours/week
3 MET hours per week is equal to walking at an average pace of 2-3 miles /hour for 1 hour

10. Exercise and Survival After Breast Cancer Diagnosis Holmes MD et al, JAMA 2005
Results:
Compared to women with < 3 MET hours/week, risk of dying of breast cancer was:
20% less for 3-9 MET hours/week
40-50% less for > 9 MET hours/week of exercise
Conclusion:
Physical activity after a breast cancer diagnosis may reduce the risk of death from this disease
The greatest benefit occurred in women who performed the equivalent of walking 3-5 hours/week at an average pace

11. What About Lymphedema (Arm Swelling After Lymph Node Surgery)?

12. Weight Training and Lymphedema in Breast Cancer Survivors Ahmed RL et al, J Clin Oncol 2005
Patients: 45 breast cancer survivors following axillary lymph node dissection
Study: Randomized to weight training program or not
Weight training sessions 2x per week for 6 months
For upper body, initially used no weights or only wrist weights, weight gradually increased if no symptoms of lymphedema developed
Results:
None of the women in the weight training program experienced a noticeable change in arm swelling
Frequency of new lymphedema, or worsening of existing lymphedema, was similar in both groups

13. Nutrition, Body Weight and Breast Cancer
-Maintain good body weight
-Low fat diet
-High fiber
-Increase fruits and vegetables
-Limit alcohol

14. Nutrition and Survival after the Diagnosis of Breast Cancer: A Review of the Evidence Rock CL et al, JCO 20: , 2002
Being overweight or obese is associated with poorer prognosis in a majority of studies
Treatment-related weight gain influences survival, quality of life, other diseases
Dietary fat: 5 of 12 studies showed inverse relationship with survival
Fruits and vegetables: majority of studies showed favorable relationship with survival

15. Breast Cancer and Alcohol
More than 2 drinks/day associated with increased breast cancer risk!

16. Women’s Intervention Nutrition Study (WINS) Chlebowski R et al, JNCI 98, 2006
Patients: 2,437 postmenopausal women with early stage breast cancer (age 48-79)
Intervention: Randomized within 1 year of surgery to:
dietary intervention (8 biweekly counseling sessions by nutritionists and support throughout)
versus control
Results:
Fat intake/day at 12 months
Intervention group 33.3 gms (+/- 16.7)
Control group gms (+/- 24.4)

17. Relapses (60 month follow-up)
Women’s Intervention Nutrition Study (WINS) Chlebowski R et al, JNCI 98, 2006
Results (cont.):
Relapses (60 month follow-up)
Group Diet Control
All pts 96/975 (9.8%) 181/1462 (12.3%)
24% reduction in breast cancer recurrence in diet intervention group
Conclusion: Lifestyle interventions can reduce recurrences in breast cancer patients

18. Optimizing Health After Breast Cancer Diagnosis and Treatment
Exercise regularly
Avoid obesity, control weight
Eat a healthy diet: low fat, high fiber, low alcohol
Avoid smoking
Wear sunscreen
Reduce stress
Control known diseases: high blood pressure, diabetes, high cholesterol, osteoporosis

19. Optimizing Health After Breast Cancer Diagnosis and Treatment
The majority of breast cancer patients can look forward to a long life after cancer diagnosis and treatment
Cancer patients should not forget about all aspects of health and well-being