Reduced rates of metabolism and decreased physical activity in breast cancer patients receiving adjuvant chemotherapy.

Demark‐Wahnefried, Wendy; Hárs, Vera; Conaway,; Havlin, Kathleen A.; Bk, Rimer; McElveen, Gregory; Winer, EP

doi:10.1097/01893697-199715030-00018

Cited by 26 publications

(36 citation statements)

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“…Moreover, the presence of the tumor or an endocrine response to treatment, both of which may be present in women recruited after diagnosis, may alter metabolite levels. 59 In addition, changes in diet, exercise or body composition, as a result of treatment, 60,61 all of which can alter estrogen metabolite levels, 40,41 may further affect metabolite measurements in a casecontrol setting. These methodologic limitations may explain the contradictory findings in case-control studies published to date.…”

Section: Discussionmentioning

confidence: 99%

Obesity, hormone therapy, estrogen metabolism and risk of postmenopausal breast cancer

Modugno

Kip

Cochrane

et al. 2005

Intl Journal of Cancer

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Hormone therapy (HT) and body mass index (BMI) have been associated with postmenopausal breast cancer. Because estrogen metabolism may affect breast cancer risk and can be altered by weight and HT, it might play a role in the HT-BMI-breast cancer associations. We undertook a nested case-control study within the Observational Study of the Women's Health Initiative. Baseline levels of 2-and 16a-hydroxy estrone (2-OHE1 and 16a-OHE1) were measured in 200 women who developed breast cancer during follow-up and 200 healthy controls matched to cases by ethnicity, enrollment date, clinic site, type of HT and years since menopause. Wilcoxon nonparametric tests were used to compare estrogen metabolite levels between cases and controls. Conditional logistic regression was used to assess the relationship between BMI, estrogen metabolites and breast cancer risk. 16a-OHE1 levels were modestly but significantly higher in HT users among cases (median 356 pg/ml vs. 315 pg/ml) and controls (354 pg/ml vs. 298 pg/ml). 2-OHE1 levels were substantially and significantly higher in HT users among cases (369 pg/ml vs. 125 pg/ml) and controls (347 pg/ml vs. 134 pg/ml). For non-HT users only, greater BMI and higher 16a-OHE1 levels were individually and jointly associated with increased breast cancer risk (OR for women with high BMI and high 16a-OHE1 compared to those with low BMI and low 16a-OHE1 5 3.51, 95% CI 5 1.34-9.16). No associations between BMI, estrogen metabolism and breast cancer risk were found for HT users. Estrogen metabolism differs according to both BMI and HT use, potentially explaining the interaction between BMI and HT in relation to breast cancer risk. ' 2005 Wiley-Liss, Inc.Key words: breast neoplasms; hormone therapy; estrogen metabolism; body mass index; obesity The Women's Health Initiative (WHI) clinical trial recently confirmed observational study findings 1,2 that progestin-containing hormone therapy (HT) formulations are associated with an increased risk of postmenopausal breast cancer.3 Elevated circulating estrogen levels may underlie this association, as substantial data, including markers of long-term estrogen exposure, 4 implicate estrogen in the etiology of postmenopausal breast cancer. However, for a given dose of estrogen, estrogen-only HT formulations appear to impart less risk than combined estrogen and progestin therapies. 1,3,[5][6][7][8] In particular, the WHI clinical trial reported no increase in risk associated with an estrogen-only formulation, 8 but a 24% increase in risk among women assigned to a combination estrogen-progestin formulation compared to placebo.3 Interestingly, this increase is less than expected, given the magnitude of the increase in circulating estrogens resulting from oral estrogen preparations 9,10 and among studies that associate higher blood levels of estrogen with increased breast cancer risk. 11,12Body size has also been implicated in postmenopausal breast cancer.13,14 For example, risk increases by 3% for each kilogram per meter square increase in body mass index (BMI)...

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Section: Discussionmentioning

confidence: 99%

Obesity, hormone therapy, estrogen metabolism and risk of postmenopausal breast cancer

Modugno

Kip

Cochrane

et al. 2005

Intl Journal of Cancer

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“…If eating habits change because of treatment (e.g., food restriction with nausea or taste aversions from chemotherapy; Broeckel et al, 2000;Jacobsen et al, 1995), vulnerability may be heightened. In contrast, some cancer patients, particularly breast cancer patients receiving adjuvant chemotherapy, are at risk for weight gain (Camoriano, Loprinizi, & Ingle, 1990), perhaps because of changed metabolic requirements (Denmark-Wahnefried et al, 1997). Although cancer patients might be strongly counseled to change their negative health behaviors-such as to stop smoking-this comes when they may be least able to quit, as cigarette smoking and caffeine use can increase with stress (Miller, Cohen, & Herbert, 1999).…”

Section: Health Behaviorsmentioning

confidence: 99%

Biobehavioral outcomes following psychological interventions for cancer patients.

Andersen¹

2002

Journal of Consulting and Clinical Psychology

188

132

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Psychological interventions for adult cancer patients have primarily focused on reducing stress and enhancing quality of life. However, there has been expanded focus on biobehavioral outcomeshealth behaviors, compliance, biologic responses, and disease outcomes-consistent with the Biobehavioral Model of cancer stress and disease course. The author reviewed this expanded focus in quasi-experimental and experimental studies of psychological interventions, provided methodologic detail, summarized findings, and highlighted novel contributions. A final section discussed methodologic issues, research directions, and challenges for the coming decade.Cancer remains a significant national problem, with over 1 million Americans diagnosed each year. The adjustment process for cancer survivors may be burdensome and lengthy, and deteriorations in quality of life are underscored if they also have adverse health effects. A previous review noted the significant quality-of-life gains that can be achieved with psychological interventions (Andersen, 1992), a conclusion echoed here. In this review, I look more broadly and include biobehavioral responses and disease outcomes as areas important for intervention efforts. Although there are proportionately fewer studies that have included the latter, multimodal interventions and assessment of psychological, behavioral, and biologic mechanisms are the pathways for future research.The Biobehavioral Model of cancer stress and disease course (Andersen, Kiecolt-Glaser, & Glaser, 1994) provides the organizational framework for the discussion. Represented in Figure 1, the model includes psychological (e.g., stress and quality of life), behavioral (e.g., health behaviors and compliance), and biologic (e.g., neuroendocrine and immune) components and specifies the pathways by which health outcomes (e.g., disease endpoints-recurrence, disease free interval) might be affected. A complete discussion of the model is available elsewhere , as only brief summaries are provided prior to each section.Studies conducted since 1992 with adult cancer patients are reviewed; selected investigations prior to that period are included because of their importance, novelty, or absence from the earlier article focusing on quality of life (Andersen, 1992). Each component of the model is considered as an outcome following psychological interventions. Prior to each, I review descriptive findings and highlight prominent correlational investigations. For all experimental studies, accrual and retention rates and patient characteristics are provided, as these areas are in need of methodologic attention, as discussed later in the article. Although tedious at times, specific techniques of interventions are provided to enable the reader to distinguish among those with similar labels. Quasi-experimental designs are included for emerging areas. With few exceptions, all studies included psychological outcomes, but in the first section, I focus on studies with only these endpoints. Figure 1). Cancer survivors report con...

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“…Women may feel too fatigued to exercise during the period of active chemotherapy and radiation treatment. 41,42 Therefore, we avoided the active treatment period for the physical activity assessments. Because women with metastatic disease may also not be well enough to exercise, we excluded women with stage IV cancer at diagnosis.…”

Section: Commentmentioning

confidence: 99%

Physical Activity and Survival After Breast Cancer Diagnosis

Holmes¹

2005

JAMA

1,465

778

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Reduced rates of metabolism and decreased physical activity in breast cancer patients receiving adjuvant chemotherapy.

Cited by 26 publications

References 0 publications

Obesity, hormone therapy, estrogen metabolism and risk of postmenopausal breast cancer

Obesity, hormone therapy, estrogen metabolism and risk of postmenopausal breast cancer

Biobehavioral outcomes following psychological interventions for cancer patients.

Physical Activity and Survival After Breast Cancer Diagnosis

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