Study at UH to Take Novel Approach to Improving Breast Cancer Outcomes in Older Women
August 18, 2022
Can resistance training help older patients with cancer better tolerate chemotherapy?
UH Clinical Update | August 2022
Older breast cancer patients, age 65 or over, at UH Seidman Cancer Center will soon have access to a new NIH-funded study (the THRIVE intervention) testing whether regular resistance exercise sessions delivered via telehealth during the time they’re undergoing chemotherapy can boost the chemo dose they can safely tolerate.
Why it matters: Only 50 – 76% of breast cancer patients over age 65 receive chemotherapy at a relative dose intensity (RDI) above 85% of that prescribed by their oncologists, says University Hospital’s Nathan Berger, MD, one of the principal investigators on the new grant. As a result, these older women have a 57% increase in 10-year disease recurrence, compared with patients who receive full prescribed dose.
Addressing the problem: Exercise is predicted to help with the factors behind decreased RDI in older patients, such as reduced functional status, depression, falls and loss of muscle mass.
Going further: UH’s Cynthia Owusu, MD, a co-investigator on the new grant, has shown that older breast cancer survivors who exercise regularly after breast cancer treatment gain many benefits. But this new NIH study will be among the first to test whether this finding holds true while women are undergoing chemotherapy.
The THRIVE intervention: For the upcoming study, a total of 270 breast cancer patients age 65 years or over, undergoing chemotherapy, will be enrolled from three participating institutions, including 90 from UH Seidman Cancer Center. The THRIVE intervention (TeleHealth Resistance exercise Intervention to preserve dose intensity and Vitality in Elder Breast Cancer Patients) is as follows:
- Progressive resistance exercise via 30-minute telehealth sessions twice a week, led by an exercise professional
- Walking for 30 minutes three times a week
- Monitoring daily protein intake with a checklist
- Protein supplements if indicated
Patients in the control group will receive health education and support via tablet.
Measuring success: For the THRIVE study, Dr. Berger and Dr. Owusu will measure:
- Changes in patients’ RDI
- Changes in grade 3+ chemo toxicities
- Changes in aspects of the comprehensive geriatric assessment, such as physical functional status, psychological state, social support, falls, use of assistive technology and nutritional status
- Changes in body composition
- Patient-reported outcomes, such as fatigue
Convenience for patients: Breast cancer patients enrolled in the study will receive a pre-loaded tablet with:
- Exercise videos
- Exercise log
- Protein log
- Intervention binder
- Zoom/BWEL web portal
They will also receive the following shipped to their homes:
- Resistance bands
- FitBits
- Protein supplement
- Monthly newsletter
- Hard copy intervention binder
Following the science: Studies over the past decade have shown the beneficial effect exercise has for patients with cancer, Dr. Berger says. Exercising during the chemo timeframe is just the next logical step. “All of a sudden there is interest in looking at exercise actually during therapy,” he says. “It is no longer counter-intuitive.”
“In actual fact, in older women with breast cancer, there hasn't been a study like this, where the intervention is delivered during chemotherapy,” Dr. Owusu adds. “It's going to fill a gap that currently exists in the literature.”
More THRIVE details: The THRIVE study will begin enrolling patients in January 2023 at UH Seidman Cancer Center, Penn State Cancer Institute and the Harvard, Dana Farber Cancer Institute. The study, supported by a $7 million NIH grant and administered locally through Case Western Reserve University, is scheduled to last five years.