OPTIMISING CARE FOR METASTATIC BREAST CANCER PATIENTS THROUGH EXERCISE AND DIET

Marina Reeves is a Professor in the School of Public Health and Deputy Associate Dean of Research in the Faculty of Medicine at the University of Queensland. She is also an advanced accredited practicing dietician coordinating a research program that is focused on breast cancer epidemiology and the role of supportive care interventions in improving outcomes and quality of life for women diagnosed with breast cancer.

We spoke with Professor Reeves about the importance of optimizing care for metastatic breast cancer patients through diet and exercise.

“So metastatic breast cancer is when the cancer spreads outside of the local breast area, usually to distant parts of the body. For women with breast cancer, it’s often to the bones, or it could be the lungs, brain, liver, or other sites.”

“And so those women live with an incurable, but treatable, disease. And treatments have evolved over the last few years. So, it’s great that we’ve got some newer treatments. And those women are living for longer than they did in the past, which is wonderful. But they’re living for longer still with battling side effects and impacts on their quality of life.”

“And so, our research is really focused on how exercise and diet can help to improve their quality of life. Potentially they’re survival, but really focused on improving that quality of life.”

How does exercise benefit women with metastatic breast cancer, both physically and emotionally?

“We’ve got really good evidence on how exercise benefits women with early-stage breast cancer. Both evidence that shows that it’s likely associated with survival, but also helps to manage a range of side effects, so fatigue, but also helps to improve their mental wellbeing, as exercise does for everyone in the population.”

“In the metastatic setting, this evidence is just starting to slowly grow and so we’ve got some really good evidence now, through a new trial that’s just come out, on the benefits of exercise specifically for women around fatigue, quality of life, reducing pain, and improving sexual function.”

“So, lots of benefits that we can start to see in this population of women with metastatic breast cancer, which is great.”

What types of exercises are recommended for women who might be undergoing treatment for metastatic breast cancer?

“So, it’s really important that you start slowly, but often. So even if you’re not doing any exercise at the start, any exercise is going to be beneficial, but ultimately what we want women to be able to get to, similar to the general population, is increasing what we’d call vigorous physical activity or that aerobic cardiovascular physical activity, which could just be walking, but also trying to get them to increase their resistance exercise, so strength based exercise, because it’s really important.”

“And our particular interest is on maintaining that muscle mass and preventing what we know with age, but also with cancer and with treatments will decline.”

What role does diet play in managing metastatic breast cancer?

“So, women are bombarded with information, if a woman was diagnosed with either early-stage breast cancer or metastatic breast cancer and went to ‘doctor Google’, they will find a wealth of information, but not necessarily evidence based information. And so, we know this population is particularly prone to misinformation around diet.”

“And so, we know that dietary intake in addition to resistance exercise is really important in maintaining that muscle mass. And so, our primary recommendation to women is around maintaining adequate protein intake. We also know that some women, depending on the treatments that they’ve had, can get taste alterations. So, the taste of meat, or certain foods may not be the same as they were.”

“So, we really work on how to make sure that you’re still getting adequate protein intake within the foods that you’re eating.”

What support resources are available for women with metastatic breast cancer who want to incorporate exercise and diet into their care plan?

“This is an area that we’re particularly passionate about advocating for, because currently women with metastatic diagnosis, not just around diet and exercise, but generally tend to get a lot less support than what a woman with an early-stage diagnosis receives. And so, there’s a strong movement and need for there to be equitable access to that support.”

“Currently, Breast Cancer Network Australia has resources and information available. Some hospitals may provide some tailored support for metastatic breast cancer, but very few of them offer exercise programs for that group of women. They’ll offer exercise programs for early stage, but very few will offer exercise programs specifically for metastatic women.”

“And so, we’re trying to advocate and create the evidence to change that practice. We do know that women have access, if they go and see their GP, to get onto a chronic disease management plan. And that gives them Medicare reimbursed sessions to see an exercise physiologist or a dietician, but it’s limited in terms of the number of sessions that they can receive with that.”

“So, our goal is to try and change the way and the supports that are available to these women in the future.”

“So, my hopes for women with breast cancer, and my reason for focusing on this research is my mum who had metastatic breast cancer, and I saw the terrible time that she went through and the impacts of the treatment and the cancer on her quality of life.”

“And so, my goal is that no women have to suffer like my mum. Ideally, no women ever die from breast cancer again. And that would be the ideal, that no one ever gets breast cancer. But my goal is that we can create the supportive care intervention so that women can live and thrive with a metastatic breast cancer diagnosis.”