Patients with metastatic breast cancer live an average of 2-3 years with the disease, facing distressing side effects like fatigue. The multinational PREFERABLE-EFFECT study showed that exercise has beneficial effects on quality of life, fatigue and other clinically relevant outcomes in these patients. We are very grateful that, with support of this grant, we can now start to unravel HOW exercise impacts fatigue. This is essential to developing effective, targeted interventions, which could ultimately shape exercise guidelines and more effectively alleviate fatigue, thereby improving quality of life.– Dr Anouk Hiensch
Background
Fatigue is a significant problem for cancer patients, especially those with advanced cancer like metastatic breast cancer. It can make daily activities harder, increase pain, and reduce the quality of life. We need ways to help patients with metastatic breast cancer feel less tired and improve their quality of life. While exercise is recommended for patients with curable disease, we don’t know much about its effects in metastatic breast cancer patients, and we don’t understand how exercise reduces fatigue.
Aim and objectives
In this study, we aim to uncover how exercise can help reducing fatigue in metastatic breast cancer patients. We will focus on four main pathways: the biological pathway (like inflammation and body composition), physical fitness (such as muscle strength), the emotional and behavioral pathway (including sleep and pain), and the clinical pathway (like the tumor receptor status). First, we will study how exercise affects each of these pathways. Then, we will explore whether these pathways are the reasons exercise helps with fatigue. Finally, we will combine all this information to understand how these different aspects work together.
How it will be done
The study will use data from our EU funded PREFERABLE-EFFECT randomised controlled trial looking into how a 9-month exercise program, tailored to the individual patient with metastatic breast cancer, impacted their quality of life and fatigue. Our findings revealed that supervised exercise is safe and has a positive impact on the quality of life and fatigue in patients with metastatic breast cancer. In this research, we will focus on the abovementioned pathways as potential mechanisms that might explain how exercise reduces fatigue. Additionally, we will conduct patient interviews to gain insight into other important factors that may play a role in reducing fatigue through exercise. We will perform several statistical analyses to understand the mechanisms behind the positive effects of exercise on fatigue in patients with metastatic breast cancer. A Patient Advisory Group will be established, consisting of study participants from all participating countries, to put our study findings into perspective (interpretation) and to spread them widely (dissemination). Furthermore, the results will be disseminated via the network of the European Breast Cancer Coalition Europa Donna.
Potential impact
The proposed study seeks to figure out how exercise can help patients with metastatic cancer feel less tired. Our study findings can inform clinical practice, improve exercise guidelines, and inform the development of more personalized exercise interventions. This will help to reduce fatigue and to improve the quality of life for this specific patient population. Also, this study can be a useful starting point for more research on the underlying mechanisms of exercise in different types of cancer.