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February 28, 2022
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The Effects of Adjuvant Endocrine Therapy in Patients with Early-Stage Breast Cancer

The Study

Lifestyle and quality of life in patients with early-stage breast cancer receiving adjuvant endocrine therapy (Di Meglio A, et al., Curr Opin Oncol. 2021 Nov 1)

The Story

In a Review published in Current Opinion, Di Meglio and colleagues analyzed the relevant literature to explore the relationship between healthy lifestyle modifications and improved well-being following endocrine therapy for early-stage breast cancer treatment.

Why it’s Important for Breast Cancer Patients

Up to 80% of breast cancers are hormone receptor-positive, meaning that the growth of cancer cells is stimulated by hormones like estrogen and progesterone. Adjuvant endocrine therapies like tamoxifen or aromatase inhibitors block these hormones from stimulating cancer cell growth.

These treatments reduce cancer recurrence and promote survival rates. However, they also cause side effects like fatigue, insomnia, and cognitive impairment, and may even increase the risk of developing endometrial cancer. In turn, these side effects worsen patients’ quality of life (QOL) and often lead to therapy discontinuation or reduced medication adherence.

Researchers have previously identified several factors that contribute to QOL deterioration in patients on endocrine therapy. These include sedentary behavior, tobacco smoking, alcohol consumption, and inadequate diet.

The Details

The authors reviewed 36 articles that examined the lifestyle behaviors of women with breast cancer receiving endocrine therapy.

These articles summarized findings on the effects of physical activity, diet and nutrition, weight management, tobacco smoking, and alcohol consumption on treatment-associated side effects and patient QOL.

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The Outcomes

Physical activity

Studies showed that physical activity can reduce endocrine-therapy-related symptoms in early-stage breast cancer. Particularly, these studies noted that physical exercise reduced fatigue in breast cancer survivors undergoing therapy. Additionally, activities like Pilates, aerobic exercise, and dance paired with moderate activity enhanced the welfare of patients receiving therapy.

Exercise was also shown to improve anxiety, depression, and the well-being of cancer survivors. When coupled with a balanced diet and appropriate calorie intake, exercise was even used to improve weight management strategies in survivors. The studies also explored the benefits of personalized exercise supervised by a cancer-certified trainer.

Diet and nutrition

Research on the effects of nutrition on clinical outcomes and QOL in cancer is incomplete but ongoing. However, the World Cancer Research Fund and the American Institute for Cancer Research have published guidelines on diets rich in fruit, vegetables, fibers, and low in fats for cancer prevention.

Still, the results of the KOLIBRI trial, where 77% of participants received endocrine therapy, showed that ketogenic diets, low-carb diets, and standard diets produced significant improvements in QOL domains for breast cancer survivors. Notably, patients on a ketogenic diet reported improved sleep and emotional functioning. A low-carb diet produced similar significant outcomes.

Weight management

Weight has consistently been shown to influence breast cancer prognosis and treatment outcomes, with obese patients performing significantly worse on measures of physical function, health, vitality, pain, and overall health-related quality of life.

In the CANTO study, where 83.5% of patients were treated with endocrine therapy, results showed that weight loss in obese breast cancer survivors improved outcomes across several QOL domains, including physical functioning and breast cancer symptoms.

Smoking and alcohol

Cancer survivors are strongly encouraged to give up tobacco smoking and alcohol consumption, or to limit alcohol intake to only 1–2 drinks per day on special occasions.

Two studies examined the impact of drinking on breast cancer survivors. The first showed that increased alcohol intake reduced patients’ QOL, among other outcomes. The other study found that breast cancer survivors reporting moderate sleeping troubles were not at an increased risk of higher alcohol consumption, compared to survivors with less than moderate trouble sleeping.

None of the studies included in this Review assessed the effects of smoking cessation on QOL among breast cancer survivors undergoing endocrine therapy. However, past research has linked tobacco smoking with treatment side effects like long-term sleep and mood changes.

The Key Takeaway

This review emphasizes the importance of lifestyle modifications for surviving early-stage breast cancer. For comprehensive care, studies have confirmed that a combination of the right diet, suitable exercise, and little indulgence in alcohol or tobacco can improve the management of therapy side effects.

Reference: Lifestyle and quality of life in patients with early-stage breast cancer receiving adjuvant endocrine therapy (Di Meglio A, Soldato D, Presti D, Vaz-Luis I. Curr Opin Oncol. 2021 Nov 1;33(6):553-573. doi: 10.1097/CCO.0000000000000781.)

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