Breast cancer survivors face dual challenges: 1) risk of recurrent disease and 2) dealing with the long term sequelae of their treatments. Facing these challenges can be burdensome, resulting in reduced quality of life. Obesity and sedentary lifestyle further complicate these issues. The goal ofthe WISER Survivor trial is to assess the effects of exercise and/or weight loss through caloric restriction on a common long term adverse effect of treatment (lymphedema), biomarkers for recurrence, and quality of life. Lymphedema is a chronic, progressive, incurable condition characterized by arm swelling and negative alterations in function and appearance, as well as bothersome symptoms. It is among the more common, expensive, and feared persistent adverse breast cancer treatment effects. In our completed work, twice weekly weight-lifting reduced by half the number of incident clinical lymphedema events requiring medical care. In the proposed WISER Survivor trial we seek to assess whether adding aerobic exercise or weight loss through caloric restriction to the weight-lifting intervention further improves lymphedema clinical outcomes. The WISER Survivor Trial will also test the effects ofthe exercise and weight loss interventions on the same recurrence biomarkers to be tested in the mouse model study (Project 1). The biomarkers include sex hormones, markers of inflammation, growth factors, adipokines, and oxidative stress. The innovation of these two paired projects include the novel approach of assessing effects of these interventions in the recurrence setting, as well as comparing effects on biomarkers in equivalent interventions in mice and humans. In addition, we assess effects of our energy balance interventions on a novel biomarker related to pathogenic angiogenesis. Another innovation includes a unique opportunity to assess whether changes in any of these biomarkers are correlated with clinical lymphedema outcomes. Finally, we seek to assess effects of our interventions on quality of life in breast cancer survivors with lymphedema. Therefore, we propose a one year randomized controlled weight loss and exercise intervention trial in a multi-ethnic cohort of oven/veight and obese post-menopausal breast cancer survivors with clinically confirmed lymphedema. There will be four groups in this trial: exercise only, weight loss only, exercise and weight-loss combined, and a control group, with a sample size of 125 per group (total N=500).

Public Health Relevance

Breast cancer survivors face many unique challenges, including risk for recurrence and persistent adverse effects of cancer treatment. Obesity and sedentary lifestyle complicated these effects. We seek to examine whether exercise and/or weight loss will improve biomarkers for breast cancer recurrence, a persistent adverse effect called lymphedema, and quality of life within 500 survivors with breast cancer-related lymphedema.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Specialized Center--Cooperative Agreements (U54)
Project #
5U54CA155850-03
Application #
8504805
Study Section
Special Emphasis Panel (ZCA1-SRLB-4)
Project Start
Project End
Budget Start
2013-06-01
Budget End
2014-05-31
Support Year
3
Fiscal Year
2013
Total Cost
$431,426
Indirect Cost
$90,466
Name
University of Pennsylvania
Department
Type
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Brown, Justin C; Kumar, Anagha; Cheville, Andrea L et al. (2015) Association between lymphedema self-care adherence and lymphedema outcomes among women with breast cancer-related lymphedema. Am J Phys Med Rehabil 94:288-96
Sturgeon, Kathleen; Schadler, Keri; Muthukumaran, Geetha et al. (2014) Concomitant low-dose doxorubicin treatment and exercise. Am J Physiol Regul Integr Comp Physiol 307:R685-92
Sturgeon, Kathleen M; Ky, Bonnie; Libonati, Joseph R et al. (2014) The effects of exercise on cardiovascular outcomes before, during, and after treatment for breast cancer. Breast Cancer Res Treat 143:219-26
Brown, Justin C; Schmitz, Kathryn H (2014) The prescription or proscription of exercise in colorectal cancer care. Med Sci Sports Exerc 46:2202-9
Brown, Justin C; Lin, Lilie L; Segal, Saya et al. (2014) Physical activity, daily walking, and lower limb lymphedema associate with physical function among uterine cancer survivors. Support Care Cancer 22:3017-25
Hammer, Sean M; Brown, Justin C; Segal, Saya et al. (2014) Cancer-related impairments influence physical activity in uterine cancer survivors. Med Sci Sports Exerc 46:2195-201
James, Peter; Berrigan, David; Hart, Jaime E et al. (2014) Effects of buffer size and shape on associations between the built environment and energy balance. Health Place 27:162-70
Brown, Justin C; Mao, Jun J; Stricker, Carrie et al. (2014) Aromatase inhibitor associated musculoskeletal symptoms are associated with reduced physical activity among breast cancer survivors. Breast J 20:22-8
Brown, Justin C; Cheville, Andrea L; Tchou, Julia C et al. (2014) Prescription and adherence to lymphedema self-care modalities among women with breast cancer-related lymphedema. Support Care Cancer 22:135-43
Schmitz, Kathryn H; Neuhouser, Marian L; Agurs-Collins, Tanya et al. (2013) Impact of obesity on cancer survivorship and the potential relevance of race and ethnicity. J Natl Cancer Inst 105:1344-54

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