Pre- to postdiagnosis leisure-time physical activity and prognosis in postmenopausal breast cancer survivors

Jung, Audrey; Behrens, Sabine; Schmidt, Martina E.; Thoene, Kathrin; Obi, Nadia; Hüsing, Anika; Benner, Axel; Steindorf, Karen; Chang‐Claude, Jenny

doi:10.1186/s13058-019-1206-0

Cited by 38 publications

(49 citation statements)

References 23 publications

(45 reference statements)

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“…The review concluded that there is a need for randomized clinical trials (RCTs) investigating the role of physical activity on all-cause death and breast cancer outcomes. These results were further supported by recent evidence from the MARIE study, a population-based study of 3813 postmenopausal breast cancer patients [ 3 ]. Here, the authors showed that patients who are physically active have a better breast cancer prognosis than those who are inactive, especially for those who were not active before breast cancer diagnosis.…”

Section: Introductionsupporting

confidence: 79%

Does Physical Activity Have an Impact on Recurrence Dynamics in Early Breast Cancer Patients?

Biganzoli

Desmedt

Demicheli

2021

JCM

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Several studies have suggested that pre and/or postdiagnosis physical activity can reduce the risk of recurrence in breast cancer patients, however its effect according to follow-up time has not yet been investigated. We analyzed recurrence and mortality dynamics in randomized clinical trials (RCTs) from Australia and Canada. The combined Australian RCTs evaluated, at a median follow-up of 8.3 years, an 8-month pragmatic exercise intervention in 337 women with newly diagnosed breast cancer, while the Canadian RCT evaluated, at a median follow-up of 7.4 years, supervised aerobic or resistance exercise during chemotherapy in 242 patients. For each RCT, the control arm consisted of patients undergoing usual care. We estimated the event dynamics by the discrete hazard function, through flexible regression of yearly conditional event probabilities with generalized additive models. In the considered RCTs, the recurrence and mortality risk of patients enrolled in the physical activity arm were stably decreased at medium/long term after five year of follow-up. In the Australian RCTs where patients were recruited by urban versus rural area, the latter group did not display benefit from physical activity. Estimated odds ratios (95% confidence intervals) for disease-free survival (DFS) in urban women were 0.63 (0.22–1.85); 0.27 (0.079–0.90); 0.11 (0.013–0.96) at the 3rd, 5th and 7th year of follow-up, respectively. For rural women, DFS patterns were overlapping with odds ratios (ORs), approximating 1 at the different years of follow-up. Although not reaching statistical evidence, the estimates in the Canadian trial were in line with the results from the Australian urban women with ORs (95% CI) for DFS of 0.70 (0.33–1.50); 0.47 (0.19–1.18); 0.32 (0.077–1.29) at 3rd, 5th, 7th follow-up year, respectively. While we acknowledge that the analyzed RCTs were not designed for investigating disease recurrence over time, these results support the evidence that physical activity reduces the risk of developing medium-/long-term metastases. Additional translational research is needed to clarify the mechanisms underlying these observations.

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Section: Introductionsupporting

confidence: 79%

Does Physical Activity Have an Impact on Recurrence Dynamics in Early Breast Cancer Patients?

Biganzoli

Desmedt

Demicheli

2021

JCM

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“…These results were further supported by recent evidence from the MARIE study, a population-based study of 3813 postmenopausal breast cancer patients [3]. Here the authors showed that patients who are physically active have a better breast cancer prognosis than those who are inactive, especially for those who were not active before breast cancer diagnosis.…”

Section: Introductionsupporting

confidence: 73%

Impact of physical activity on recurrence dynamics in early breast cancer patients

Biganzoli

Desmedt

Demicheli

2020

Preprint

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Background Several studies have suggested that pre and/or postdiagnosis physical activity can reduce the risk of recurrence in breast cancer patients, however its effect according to follow-up time has not yet been investigated. Methods We analyzed recurrence and mortality dynamics in randomized clinical trials (RCTs) from Australia and Canada. The combined Australian RCTs evaluated, at median follow-up of 8.3 years, an 8-month pragmatic exercise intervention in 337 women with newly diagnosed breast cancer, while the Canadian RCT evaluated, at median follow-up of 7.4 years, supervised aerobic or resistance exercise during chemotherapy in 242 patients. For each RCT, the control arm consisted of patients undergoing usual care. We estimated the event dynamics by the discrete hazard function, through flexible regression of yearly conditional event probabilities with generalized additive models. Results In the considered RCTs, the recurrence and mortality risk of patients enrolled in the physical activity arm was stably reduced at medium/long term after five year of follow-up. In the Australian RCTs where patients were recruited by urban versus rural area, the latter group did not display benefit from physical activity. Estimated Odds Ratios (95% Confidence Intervals) for Disease Free Survival (DFS) in urban women were 0.63 (0.22-1.85); 0.27 (0.079-0.90); 0.11 (0.013-0.96) at the 3rd, 5th and 7th year of follow-up, respectively. For rural women, DFS patterns were overlapping with ORs approximating 1 at the different years of follow-up. Although not reaching statistical evidence, the estimates in the Canadian trial were in line with the results from the Australian urban women with ORs (95% CI) forDFS of 0.70 (0.33-1.50); 0.47 (0.19-1.18); 0.32 (0.077-1.29) at 3rd, 5th, 7th follow-up year, respectively. Conclusions While we acknowledge that the analyzed RCTs were not designed for investigating disease recurrence over time, these results support the evidence that physical activity reduces the risk of developing medium/long-term metastases. Additional translational research is needed to clarify the mechanisms underlying these observations.

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“…Potentially eligible subjects were identified based on frequent monitoring of hospital admissions, surgery schedules, and pathology records of 51 clinics serving these regions and through the Hamburg Cancer Registry. In 2009, patients were re‐interviewed about weight and other exposures, and follow‐up information about endpoints was ascertained in 2009 and 2015 12 …”

Section: Methodsmentioning

confidence: 99%

Postdiagnosis weight change is associated with poorer survival in breast cancer survivors: A prospective population‐based patient cohort study

Jung

Hüsing

Behrens

et al. 2020

Intl Journal of Cancer

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More women are surviving after breast cancer due to early detection and modern treatment strategies. Body weight also influences survival. We aimed to characterize associations between postdiagnosis weight change and prognosis in postmenopausal long-term breast cancer survivors. We used data from a prospective populationbased patient cohort study (MARIE) conducted in two geographical regions of Germany. Breast cancer patients diagnosed 50 to 74 years of age with an incident invasive breast cancer or in situ tumor were recruited from 2002 to 2005 and followed up until June 2015. Baseline weight was ascertained at an in-person interview at recruitment and follow-up weight was ascertained by telephone interview in 2009. Delayed entry Cox proportional hazards regression was used to assess associations between relative weight change and all-cause mortality, breast cancer mortality, and recurrence-free survival. In total, 2216 patients were included. Compared to weight maintenance (within 5%), weight loss >10% increased risk of all-cause mortality (HR 2.50, 95% CI 1.61, 3.88), breast cancer mortality (HR 3.07, 95% CI 1.69, 5.60) and less so of recurrence-free survival (HR 1.43, 95% CI 0.87, 2.36). Large weight gain of >10% also increased all-cause mortality (HR 1.64, 95% CI 1.02, 2.62) and breast cancer mortality (HR 2.25, 95% CI 1.25, 4.04). Weight maintenance for up to 5 years in long-term breast cancer survivors may help improve survival and prognosis. Postdiagnosis fluctuations in body weight of greater than 10% may lead to increased mortality. Survivors should be recommended to avoid large deviations in body weight from diagnosis onwards to maintain health and prolong life.

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Pre- to postdiagnosis leisure-time physical activity and prognosis in postmenopausal breast cancer survivors

Cited by 38 publications

References 23 publications

Does Physical Activity Have an Impact on Recurrence Dynamics in Early Breast Cancer Patients?

Does Physical Activity Have an Impact on Recurrence Dynamics in Early Breast Cancer Patients?

Impact of physical activity on recurrence dynamics in early breast cancer patients

Postdiagnosis weight change is associated with poorer survival in breast cancer survivors: A prospective population‐based patient cohort study

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