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Questions to Ask Your Doctor About Breast Cancer

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Questions to Ask Your Doctor About Breast Cancer


Nhmagazine Stevens Chamberlin

Medical director of the Comprehensive Breast Program, Mary D. Chamberlin, M.D., right, and licensed clinical psychologist Courtney J. Stevens, Ph.D., left, are among researchers at Dartmouth’s and Dartmouth-Hitchcock’s Norris Cotton Cancer Center who are conducting the clinical research needed to bring new therapies and health recovery programs to people undergoing treatment for breast cancer.

“How do exercise and weight loss impact breast cancer recovery and the chance of recurrence?”

Treatment for breast cancer can be exhausting. Survivors often experience medication side effects, fatigue, depression and anxiety that lead to less physical activity, weight gain and reduced muscle mass. Studies show a higher risk of cancer recurrence and even death for some women who are overweight at diagnosis or who gain weight after diagnosis.

The good news? These effects can be limited and improved by structured exercise and weight loss recovery programs. As part of an academic medical center, we at Dartmouth’s and Dartmouth-Hitchcock’s Norris Cotton Cancer Center (NCCC) believe clinical research is the gold standard for cancer care. Participation in clinical trials is critical to provide data for insurance coverage of interventions such as weight loss and exercise programs as a standard part of cancer treatment. NCCC has 20 to 30 actively enrolling breast cancer treatment and recovery clinical trials to learn what works best for our patients to reach their goals.

For example, in the Breast Cancer and Weight Loss (BWEL) trial, researchers are studying the role of weight loss in recovery and disease recurrence for overweight women with early breast cancer. Participants receive a structured health education intervention and supervised weight loss program with trained coaches for two years after completion of chemotherapy or radiation.

There is strong evidence that exercise improves health-related outcomes among survivors of breast cancer. Studies show that for every 15 minutes of exercise per week, breast cancer mortality drops by 2.5%. But sometimes, exercise can feel harder than chemotherapy. Some women have negative feelings about their ability to exercise, especially after breast cancer treatment. Being older and having a higher body mass index (BMI) increases the likelihood that exercise feels unpleasant.

The PHIT trial, funded by a career development award from the National Cancer Institute, is a new series of exercise intervention development studies that aims to address how a person feels (their affective response) during exercise. An exercise prescription called AFFECT-Rx has been shown to reduce feelings of displeasure during exercise and increase participation in exercise over time among the general population, but has not yet been tested among people who have undergone breast cancer treatment. The PHIT trial will engage this special population to help
refine and optimize AFFECT-Rx, which instructs participants to adjust their pace of exercise until they feel “fairly good” or better while exercising.

The primary goal of the PHIT trial is to see if AFFECT-Rx promotes clinically meaningful increases in exercise.

Q: “What else is new in breast cancer clinical research in New Hampshire?”

CATCH-UP, which stands for “Creating Access to Targeted Cancer Therapy for Underserved Populations” is an exciting new initiative by the National Cancer Institute. This program is designed to bring early-phase trials to minority and underserved populations. NCCC is one of eight cancer centers in the U.S. chosen to participate, with our focus on increasing clinical trial awareness and participation for rural patients who make up almost half of the area served by NCCC here in northern New England. Two new advanced breast cancer trials under CATCH-UP bring cutting-edge drug therapies to those who need it the most:

One is for breast cancer that has spread to bone. It combines standard chemotherapy with a new low-radiation agent. This study will learn about whether adding Radium-223 dicholoride to the usual chemotherapy will lower the chance of breast cancer growing.

The other looks at a sub-type of breast cancer called triple negative (no estrogen, progesterone or HER2 receptor proteins) that has spread beyond the breast or lymph nodes and is treatable but no longer curable. Researchers hope to learn if an individualized vaccine is better or worse for preventing breast cancer from growing or spreading than the standard chemotherapy approach.

For hormone receptor-positive breast cancers, the time that passes between a tumor biopsy and surgery presents a perfect window of opportunity to actively treat some tumors with estrogen-blocking therapy. NAOMI is a Dartmouth-initiated trial designed to study breast cancer’s response to hormone therapy while women wait for their surgery. The goal is to learn more about why some cancers come back many years later and possibly prevent this from happening.

Cancer is a shock. Long-term side effects from treatment can be profound. Sometimes being part of the science can not only help with recovery but also unlock new discoveries.

To learn more about clinical trials or find out if you are eligible to join a study, talk with your cancer doctor, contact our Research Nurses at Cancer.Research.Nurse@hitchcock.org, or explore our website: cancer.dartmouth.edu/patients-families/learn-about-clinical-trials.

Chamberlin 1Mary D. Chamberlin, M.D., is a medical oncologist, medical director of the Comprehensive Breast Program and member of the Cancer Biology and Therapeutics Research Program at NCCC. Her research focuses on hormone therapies, exercise and rehabilitation interventions for early-stage disease and vaccine trials for advanced disease.

Stevens 1Courtney J. Stevens, Ph.D., principal investigator of the PHIT trial, is a licensed clinical psychologist at Dartmouth-Hitchcock and investigator member of NCCC’s Population Sciences Research Program. Her research focuses heavily on the science of behavior change regarding the uptake and maintenance of cancer-prevention behaviors.





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