{"id":13315,"date":"2017-12-05T13:30:50","date_gmt":"2017-12-05T20:30:50","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=13315"},"modified":"2025-01-17T13:27:27","modified_gmt":"2025-01-17T20:27:27","slug":"obesity-and-breast-cancer-trial","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/obesity-and-breast-cancer-trial\/","title":{"rendered":"UCHealth joins trial weighing obesity and breast cancer links"},"content":{"rendered":"
<\/div>
\"Andrea
Meyers works through one of a series of exercises designed to boost her core strength and stability.<\/figcaption><\/figure>\n

The idea that people who are overweight or obese can benefit by shedding pounds through exercise and a healthy diet is hardly headline-making. But UCHealth is now part of a national trial that takes aim at a more provocative question: Can weight loss help breast cancer survivors prevent their disease from recurring?<\/p>\n

The Breast Cancer Weight Loss Study<\/a> (BWEL), sponsored by the National Cancer Institute\u2019s Alliance for Clinical Trials in Oncology<\/a>, focuses on overweight and obese women who have survived early-stage breast cancer. The aim: use two different approaches to provide them with information about the importance of maintaining healthy lifestyles, including losing weight safely, and measure the results.<\/p>\n

One group of patients will receive a \u201cstandardized intervention\u201d that includes mailings, webinars, magazines, newsletters and cards on the subject. The second group will get the same materials, but they will also take part in a two-year telephone counseling program that pairs them with trained coaches staffing a BWEL call center at the Dana-Farber Cancer Institute in Boston. These coaches will advise patients about strategies to manage their weight by increasing their activity and following a healthy diet. Patients who complete the study will have a total of 42 telephone sessions with coaches.<\/p>\n

In a nod to technology\u2019s growing role in health care, participants in the second group will use products from Fitbit, a trial partner with Dana Farber, to monitor their activity levels, calories burned, heart rate, weight and other measures. The tools, including a fitness tracker and wireless scale, are essential to the study, said Jennifer Ligibel, MD, a breast cancer specialist at Dana Farber\u2019s Susan F. Smith Center for Women\u2019s Cancers and principal investigator for the BWEL trial.<\/p>\n

\"In
Andrea Meyers exercises at the Anschutz Health and Wellness Center with BFitBWell exercise specialist Ian Moran. Meyers, who was diagnosed with breast cancer about a year ago, says the program helped her to increase her activity and has strengthened her physically and mentally.<\/figcaption><\/figure>\n

\u201cWe need an objective means to evaluate if what we do is working,\u201d Ligibel said in a phone interview. \u201cA key to losing weight is for people to be able to track their progress. We want to do anything we can to increase their motivation. Over time, we need things to keep people engaged, to keep things new.\u201d<\/p>\n

Weighing the risks<\/h2>\n

More than 1,100 sites, including UCHealth, are involved in the trial, which aims to enroll some 3,100 patients overall. Researchers will follow patients for 10 years after they enroll, comparing rates of breast cancer recurrence in the two groups. A fundamental question to be answered is whether weight loss should be standard treatment for breast cancer patients \u2013 and if so, the most effective ways to deliver it.<\/p>\n

\u201cExercise may play a role in reducing the risk of recurrence in breast cancer patients, but in particular in this trial, we want to look at how exercise is obtained,\u201d said Regina Brown, MD, principal investigator for UCHealth, which is recruiting patients at UCHealth\u2019s University of Colorado Hospital in Aurora; Memorial Hospital in Colorado Springs; and Poudre Valley Hospital in Fort Collins. Brown is also medical director of Oncology at the UCHealth Lone Tree Medical Center<\/a>.<\/p>\n

The BWEL trial is exploring ground that has intrigued researchers for many years, Brown said. \u201cWhen we think about what we call the obesity issue, we know that an element of inflammation goes with it,\u201d she said. \u201cWe also know that there is a connection between inflammation and cancer<\/a>.\u201d<\/p>\n

Brown also noted that studies<\/a> have linked excess body weight and higher than normal body mass index to increased risk of postmenopausal breast cancer. Aromatase, a protein found in fat, stimulates the production of estrogen, Brown explained. About 80 percent of all breast cancers have a receptor for estrogen.<\/p>\n

Oncologists can treat breast cancer in postmenopausal women who have these hormone-receptor-positive cells with drugs that block aromatase, Brown said. Such targeted therapies are primary cancer-fighting tools. The BWEL trial targets the \u201csecondary setting,\u201d as Brown put it \u2013 preventing the cancer from recurring. But the weight-loss work could one day go farther, she added.<\/p>\n

\u201cWe may be able to take the data, apply it, and say, \u2018Now, based on these tools, can we help to prevent cancer in the first place?\u2019\u201d Brown said.<\/p>\n

Actively engaging patients<\/h2>\n

The outcome of the BWEL trial will not be known for years, but Brown stressed that increasing activity, reaching and maintaining a healthy weight, following a nutritious diet and generally sticking to a healthy lifestyle brings immediate benefits to cancer survivors.<\/p>\n

\"Regina
Regina Brown, MD, is principal investigator for the BWEL trial at UCHealth.<\/figcaption><\/figure>\n

\u201cPatients who are more active do better with their symptoms,\u201d such as pain and nausea, Brown said.<\/p>\n

That\u2019s one of the underlying assumptions of the University of Colorado Cancer Center\u2019s BFitBWell program<\/a>. Launched in 2013, BFitBWell (which is not connected to the BWEL trial), provides a three-month regimen of structured physical activity, led by exercise physiologists, to help strengthen people who have been diagnosed with cancer or who are getting treatment for it.<\/p>\n

BFitBWell has assisted 378 patients since its inception, said Program Manager Nicole Klochak, CES, CPT, and now has two full-time exercise specialists. Recently hired part-time data specialist and professional research assistant Jared Scorsone is gathering data to assess the program\u2019s effectiveness in improving patients\u2019 overall strength, preserving lean muscle mass and relieving symptoms.<\/p>\n

\u201cExercise is therapy,\u201d said Klochak, noting that it\u2019s an effective inflammation fighter and a way for patients to proactively battle the draining effects of surgery, chemotherapy and radiation, such as fatigue, shortness of breath and muscle atrophy. It\u2019s also a boost for quality of life and a hedge against depression for the most basic of reasons, Klochak said.<\/p>\n

\u201cExercise is a part of treatment that patients can control,\u201d she said. \u201cIt can help to restore a sense of normalcy in their lives.\u201d<\/p>\n

An important part of the BFitBWell approach centers on helping patients understand why it\u2019s so important to take on the rigors of physical activity, even when they might not feel up to it, Klochak said.<\/p>\n

\u201cWe tell them to think of it literally as another pill,\u201d she said. \u201cExercise can have similar benefits in terms of saving lives.\u201d<\/p>\n

Bouncing back by pumping up<\/h2>\n

Andrea Meyers, 63, of Denver, is not enrolled in the BWEL trial, nor is she obese. But she can speak to the physical and psychological trauma of a breast cancer diagnosis \u2013 and to the ways that getting active helped get her life back on track.<\/p>\n

A retired teacher and professional musician \u2013 she plays the cello in the Arapahoe Philharmonic and serves on its Education Committee \u2013 Meyers was diagnosed with breast cancer about a year ago after a mammogram. She underwent a double mastectomy at a Littleton hospital and struggled to come to terms with the prospect of an arduous recovery period.<\/p>\n

\u201cIt turned everything in my life upside-down,\u201d Meyers said. Apart from the physical challenges, she struggled to confront the new reality imposed by the disease. The cello that had long tuned the harmony of her life stayed in its case, untouched. Getting out of bed or off the couch required an exertion of will.<\/p>\n

\u201cI was very depressed, listless and miserable,\u201d Meyers said.<\/p>\n

She had had one chemotherapy session at a community provider when she met UCHealth medical oncologist Anthony Elias, MD<\/a> \u2013 a violinist and fellow member of the Philharmonic. She took Elias up on his offer to help with her treatment and switched her chemotherapy regimen to the University of Colorado Cancer Center<\/a>. During physical therapy designed for cancer patients<\/a> at the Lone Tree Health Center, Meyers saw a brochure for BFitBWell and decided to learn more. She enrolled in the program in early July for a $59 monthly membership with the Anschutz Health and Wellness Center, where she would have her workout sessions.<\/p>\n

After a standard physical function assessment, the BFitBWell team developed an individualized exercise prescription for Meyers. It initially taxed her depleted resources, but the regular workout routine offered a welcome roadmap to recovery and a way to prepare for what would be 19 radiation treatments.<\/p>\n

\"Andrea
As Moran looks on, Meyers strengthens her arms and upper body on weighted battle ropes at the Wellness Center.<\/figcaption><\/figure>\n

\u201cI was aware of what I was facing physically and mentally, and the program gave me concrete objectives,\u201d Meyers said.<\/p>\n

From survivor to warrior<\/h2>\n

On a recent morning at the Wellness Center, a bright and fit Meyers demonstrated some of the exercises she followed during her three months with BFitBWell. Exercise specialist Ian Moran guided her through the paces, which started with a warm-up session on a treadmill in the first-floor workout room, bathed in natural light.<\/p>\n

After a few minutes, Meyers and Moran moved to an open exercise area on the second floor. Moran took out a heavy ball and placed it on the floor. Meyers balanced the ball with one hand on the alternate knee and lifted her legs while extending her free arm as Moran counted off the reps. She then put her legs in two purple disks resembling frisbees and alternately drove them forward and back. She stepped up and down on a wooden box while holding a pair of 10-pound dumbbells; worked long, heavy battle ropes up and down, as if playing drums; and pulled long, elastic straps while leaning back, her heels dug in to the floor.<\/p>\n

After a time, Meyers was breathing heavily from the exertion of these and other routines. But she was far from overtaxed. \u201cI love it,\u201d she said. \u201cI remember at the beginning of all this how shaky I was.\u201d<\/p>\n

The circuit is designed to build core stability and overall strength with a variety of exercises, Moran said, but always with an eye toward safety and attention to what each individual can handle.<\/p>\n

\u201cWe want to make the activities of daily living easier for them, and to have them leave feeling better than when they came in,\u201d he said.<\/p>\n

For Meyers, who will have breast reconstructive surgery sometime during the next four to eight months, the term \u201ccore strength\u201d has multiple meanings. She is confident that exercise has not only deepened her physical reserves, but also toughened her mental resolve.<\/p>\n

\u201cI want to be healthy and not tired for reconstruction,\u201d she said. \u201cI want to be alive, and I know I have to be mentally ready if I\u2019m going to be a viable candidate for stronger outcomes from my surgery.\u201d<\/p>\n

With the help of BFitBWell, Meyers no longer thinks of herself simply as a survivor, but rather as a warrior in battling back from, and beyond, her disease. Ligibel believes the BWEL trial can help clinicians determine how best to help put overweight and obese breast cancer survivors on the same path. The study aims to contribute to growing bodies of literature that separately link obesity and breast cancer recurrence, and show that carefully crafted interventions, such as one tested in the ENERGY trial<\/a>, can help survivors lose weight.<\/p>\n

\u201cWe\u2019re building on these studies,\u201d Ligibel said. \u201cIt\u2019s at least important to do so in the short term to improve patients\u2019 quality of life.\u201d<\/p>\n

For more information about the BWEL trial at UCHealth, contact Lisa Lopez at 720-553-1133<\/span> or <\/span><\/i>lisa.lopez@ucdenver.edu<\/a>.<\/span><\/i><\/p>\n

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The idea that people who are overweight or obese can benefit by shedding pounds through exercise and a healthy diet is hardly headline-making. But UCHealth is now part of a national trial that takes aim at a more provocative question: Can weight loss help breast cancer survivors prevent their disease from recurring? 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