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Study: Physical activity may prevent chemotherapy-related cognitive decline in women with breast cancer

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Contents

At a glance Clinical trials
Study findings Guidelines
Strengths and limitations Questions for your doctor
What does this mean for me? Resources
In-depth  

 

STUDY AT A GLANCE

What is this study about?

This study is about how physical activity before and during chemotherapy may prevent the treatment-related decline of information processing ( decline) in women with breast cancer.

 

Why is this study important?

Approximately 75 percent of patients with breast cancer report problems during chemotherapy. Research suggests that this decline may continue for years after treatment has been completed.

Physical activity has been linked with improved health outcomes in cancer survivors. Patients with different types of cancer who engage in physical activity after treatment experience less severe chemotherapy-related decline than those who do not.

However, whether physical activity helps and if it does help when it matters is unknown. This study looks at whether physical activity helps lessen decline in breast cancer patients who receive chemotherapy.

 

Study findings 

This study looked at whether physical activity around the time of chemotherapy offered protection against treatment-related decline in breast cancer patients. Specifically, researchers looked at the impact of moderate-to-vigorous physical activity, such as household work, jogging and cycling, on cognition.

The study included 580 women who received chemotherapy for newly diagnosed stages 1-IIIC breast cancer. Patients’ physical activity and function were compared within the group of patients and to cancer-free women of similar age.

Physical activity and the cognition of participants were assessed three times during the study: the week before chemotherapy treatment and at one month and six months after their last chemotherapy session.

Participants self-reported the estimated intensity and minutes per week of their physical activity. function was determined by tests that measured attention span, visual memory and complaints.

Among women who received chemotherapy for breast cancer, findings showed that:

  • For most women, physical activity decreased immediately after chemotherapy (1 month after) and then increased by 6 months after chemotherapy, when activity levels were similar to that of cancer-free women who had no chemotherapy.
  • Patients who engaged in at least 150 minutes per week of moderate-to-vigorous physical activity before treatment had better outcomes at the end of the study than patients who were less active before chemotherapy.
  • Patients who continued moderate-to-vigorous physical activity throughout the study had better outcomes than those whose physical activity decreased throughout the study.
  • Patients who did not engaged in moderate-to-vigorous physical activity showed decline throughout the study.

When comparing patients with cancer-free women:

  • Patients who were physically active (with moderate-to-vigorous physical activity) had similar outcomes as cancer-free women but they were more likely to report complaints. Researchers note that the surveys used to collect information about complaints included questions about emotional and social support, which were not part of the testing for outcomes. It is possible that there is a greater need for social and emotional support that is not addressed by physical activity among women facing breast cancer.

 

Strengths and limitations

Strengths

  • Because the study looked at physical activity during and after chemotherapy treatment, researchers were able to identify when physical activity was most important for reducing decline.
  • Women undergoing chemotherapy were compared to each other based on physical activity and to women of similar age without cancer.
  • The study included researcher-reported and patient-reported changes in cognition, which helped to provide multiple measures of decline in patients.
  • This study was designed around the time of chemotherapy rather than at the time of diagnosis, which provided a more direct look at the impact of physical activity on cognition related to chemotherapy.

Limitations

  • The physical activity of study participants was self-reported. (Patients may not always accurately recall or report activity.)
  • No information was provided on the length of patients’ chemotherapy regimens. Patients may have undergone chemotherapy treatment for different lengths of time. This could have impacted the levels of physical activity and changes in function of study participants, especially since chemotherapy treatment was shown to decrease both factors.
  • No information was given about the type of patients’ breast cancer or whether it was due to an inherited mutation. Whether there are differences in these groups of patients is unknown.
  • The patient population was not racially diverse (90 percent identified as white, 8 percent identified as Black and 3 percent identified as other races and ethnicities). Only group-wide information was given. No information was given about the impact of physical activity on decline among different races.
  • Confounding factors may affect interpretation of these findings. People who exercise less may have other features in common that differ from people who exercise more. Physical exercise is linked to less decline in people without cancer or chemotherapy treatment; how much of this effect is due to chemotherapy is unclear.

 

What does this mean for me?

Research suggests that at least 150 minutes per week—or 30 minutes a day, 5 days per week—of moderate-to-vigorous physical activity (e.g., household work, jogging, cycling, etc.) may help reduce chemotherapy-related decline. If you are about to begin or have already started chemotherapy treatment for breast cancer, it may be important to speak with your doctor about the benefits of moderate-to-vigorous physical activity to improve chemotherapy outcomes and your overall quality of life.

posted 1/6/22

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References

Salerno E, Culakova E, Kleckner A, et al. Physical activity patterns and relationships with function in patients with breast cancer before, during, and after chemotherapy in a , nationwide study. Journal of Clinical Oncology. 2021;39(29):3283-3292. Published online August 18, 2021.
 

Disclosure

FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

This article is relevant for:

People concerned about the impact of chemotherapy

This article is also relevant for:

People with breast cancer

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IN-DEPTH REVIEW OF RESEARCH

Study background

Over 75 percent of breast cancer patients report problems during chemotherapy treatment that for some may persist for years. Previous research looked at how chemotherapy impacts cognition in patients with breast cancer compared with individuals without cancer. Findings showed that a patient’s function declined on tests that measured attention and visual memory from the beginning to the end of treatment compared to cancer-free people. Compared to cancer-free individuals, patients were also more likely to report complaints, such as troubles with recall and sustaining attention over time.

Physical activity greatly benefits individuals with chemotherapy-related decline. However, it remains unclear whether physical activity is important before or during chemotherapy.

Researchers of this study wanted to know

Researchers wanted to know if increased physical activity before, during or after chemotherapy improved function in patients.

Populations looked at in this study

This study included 580 women (average age of 53) who were receiving chemotherapy for early- to breast cancer (stages I to IIIC) and 363 cancer-free, age-matched women. Participants were recruited from 22 locations by the National Cancer Institution Community Oncology Research Program.

Study design

Participants filled out questionnaires about their physical activity and function at three intervals: seven days before chemotherapy treatment and within one month and six months after their last chemotherapy treatment. function was also separately determined by scores on tests that measured attention span and visual recall.

Study findings

Among women who received chemotherapy for breast cancer, findings showed that:

  • patients who engaged in moderate-to-vigorous physical activity throughout the study did not experience a meaningful decline in cognition. On the other hand, patients who never engaged in similar physical activity showed decline throughout the study.
     
    • prior to beginning chemotherapy, 33 percent of patients engaged in moderate-to-vigorous physical activity (e.g., household work, jogging, cycling, etc.) for at least 150 minutes per week.
    • at follow-up within one month of last treatment, fewer patients (21 percent) reported moderate-to-vigorous physical activity.
    • at the six-month follow-up after their last treatment, over 37 percent of patients reported engaging in moderate-to-vigorous physical activity patterns.
       
  • patients who engaged in moderate-to-vigorous physical activity for at least 150 minutes per week before chemotherapy reported less complaints and a better attention span at the end of the study compared with those who were not as physically active.
  • based on test scores, visual memory was better in patients who maintained high physical activity throughout the study, compared with those who were not as active. The highly active patients also had better recovery at the end of the study.
  • patients who reported more exercise (with moderate-to-vigorous physical activity) at an assessment point had better function later. (For example, patients with high levels of physical activity at their one-month post-treatment follow-up had a better function at their six-month follow-up.)

When comparing patients with cancer-free women of similar age, study findings showed that:

  • patients who had chemotherapy to treat breast cancer reported less time for moderate-to-vigorous physical activity prior to and during their treatment when compared with cancer-free women.
  • the physical activity level of patients six months after they completed chemotherapy was similar to that of women who were cancer-free. 
    • Overall, the physical activity of cancer-free women was consistent throughout the study. The physical activity of patients decreased immediately after chemotherapy treatment but recovered to pre-chemotherapy levels by six months posttreatment.
  • although moderate-to-vigorous physical activity was linked with similar outcomes for both cancer-free women and patients receiving chemotherapy, patients with cancer were more likely to report complaints.

Strengths and limitations

Strengths

  • Because the study looked at physical activity during and after chemotherapy treatment, researchers could identify when it was most important for reducing decline.
  • Women undergoing chemotherapy were compared to each other based on physical activity and to women of similar age without cancer.
  • The study included both researcher-reported and patient-reported changes in cognition. This helped to provide multiple measures of decline in patients.
  • The study included whether or not patients received anthracycline-based chemotherapy. This is important because anthracyclines have been linked to decline.

Limitations

  • The physical activity of study participants was self-reported. Patients may not always recall or report activity accurately.
  • No information was given on how long patients underwent chemotherapy. Patients may have undergone varying lengths and received varying doses of chemotherapy regimens, which could impact levels of physical activity and changes in function of patients during the study, especially since chemotherapy was shown to decrease both factors.
  • Although the study contained information about the use of anthracycline chemotherapy, it did not provide information regarding whether anthracyclines caused decline in patients.
  • No information was given about the type of breast cancer diagnosed or whether it was due to an inherited mutation. It is unknown whether there are differences in these groups of patients.
  • The patient population was not racially or ethnically diverse (90 percent identified as white, 8 percent identified as Black, 3 percent identified as other races and ethnicities). No information was given about the impact of physical activity on decline among different races; only whole group information was given.
  • Confounding factors  (other factors that may explain effects) may affect the interpretation of the findings. People who exercise less may have other features in common that differ from people who exercise more. Physical exercise is linked to less decline in people without cancer or chemotherapy treatment. How much of this effect is due to chemotherapy is unclear.

Context

Previous studies show that chemotherapy may induce decline in breast cancer patients. Engaging in moderate physical activity has been shown to increase the quality of life in people receiving chemotherapy.

This study adds additional data, showing that moderate-to-vigorous levels of physical activity before and during chemotherapy may reduce treatment-related decline.

Conclusions

This study showed that at least 150 minutes per week of moderate-to-vigorous physical activity (e.g., household work, jogging, cycling, etc.) may decrease the risk of chemotherapy-related decline in breast cancer patients. The authors suggest that physicians and health professionals should promote physical activity as an intervention to reduce chemotherapy-related side effects. Further research is needed to confirm the benefits and potential impact of physical activity before and during chemotherapy to minimize treatment-related decline.

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posted 1/6/22

Expert Guidelines
Expert Guidelines

Both the National Comprehensive Cancer Network and the American Cancer Society have recommendations for physical activity for cancer survivors:

  • Physical activity and exercise recommendations should be tailored to each person's abilities and preferences. 
  • People should try to engage in some physical activity daily; this may include:
    • taking the stairs.
    • walking more.
  • Each week, people should try to achieve the following: 
    • At least 150 minutes of moderate-intensity exercise, with an ideal goal of 300 minutes, 75 minutes of vigorous activity or a combination of the two.
    • Two to three sessions of strength/resistance training that include all of the major muscle groups (chest, shoulders, arms, back, core, and legs). 
    • Stretch major muscle groups at least two days per week.  
  • Avoid sitting or lying down for long periods and other prolonged sedentary behavior. 

Updated: 02/06/2022

Questions To Ask Your Doctor
Questions To Ask Your Doctor

  • I’ve been recently diagnosed with breast cancer. Will I benefit from increased physical activity?
  • Should I exercise while receiving chemotherapy for breast cancer?
  • What is the recommended amount of exercise for people undergoing chemotherapy?
  • Should I report any changes during my chemotherapy treatment?
  • Other than exercise, what else can I do to prevent chemotherapy-related decline?

Open Clinical Trials
Open Clinical Trials

The following studies are looking at management of side effects: 

Multiple cancers

Breast cancer

Colorectal cancer

Endometrial cancer

Ovarian cancer

  • NCT04533763: Living WELL: A Web-Based Program for Ovarian Cancer Survivors. This studies a group-based and web-delivered tool for ovarian cancer survivors in increasing quality of life and decreasing stress, depressive mood, anxiety, and fatigue across a 12-month period.
  • NCT05047926: Prehabilitation for Advanced Ovarian Cancer Patients. Prehabilitation may improve peri-operative outcomes in patients undergoing cancer surgery. This study will look at structured activity for women undergoing chemotherapy to improve their physical state prior to surgical intervention and thus improve outcomes.

cancer

Updated: 11/03/2022

Open Clinical Trials
Open Clinical Trials

The following are studies focused on exercise for people diagnosed with breast cancer. 

Visit our Featured Research Page and Research Search and Enroll Tool to find additional studies enrolling people with, or at high risk for cancer.

Updated: 12/27/2021

Who covered this study?

MedPage Today

Elizabeth Salerno, PhD, on Exercise and Cognition in Patients with Breast Cancer This article rates 5.0 out of 5 stars

News Medical Life Sciences

Study finds link between physical activity and better cognition among breast cancer patients This article rates 4.5 out of 5 stars

How we rated the media

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