Physical Activity in Metastatic Breast Cancer : Feasibility and results of an intervention (ABLE and MUST studies) and association with Survival (StoRM study)

Environ 5% des patientes sont diagnostiquées chaque année avec un cancer du sein d’emblée métastatique et 20 à 30% des cancers du sein localisés évoluent vers un stade secondairement métastatique. Les bénéfices de l’activité physique pendant les traitements chez les patientes avec un cancer du sein localisé ont largement été démontrés mais la littérature est limitée dans le cancer du sein métastatique. Ce travail de thèse a permis d’évaluer les effets potentiels de l’activité physique chez des patientes atteintes d’un cancer du sein métastatique à travers trois études.L’étude observationnelle StoRM a montré une association du niveau d’activité physique recueilli par questionnaire à une meilleure survie des patientes HER2. L’étude interventionnelle ABLE a mis en évidence la faisabilité d’une intervention en activité physique avec une montre connectée dans cette population avec un excellent taux d’adhérence (96%), l’intérêt et la volonté des patientes pour les programmes d’activité physique ainsi qu’une amélioration fonctionnelle. L’intervention a contribué au un maintien de la qualité de vie, de la fatigue et du niveau d’activité physique malgré les traitements et l’avancée de la maladie. De potentiels biomarqueurs prédictifs d’une progression tumorale ont été identiés. L’étude MUST a montré que l’antioxydant SOD et de la force isométrique d’extension du quadriceps semblent prévenir la sarcopénie et une association entre le statut sarcopénie et le risque de toxicités a été confirmé. Ce travail de thèse représente une première étape dans l’analyse des effets de l’activité physique auprès de patientes atteintes d’un cancer du sein métastatique. L’activité physique semble être bénéfique dans cette population, mais ces résultats nécessitent d’être confirmés dans une étude à plus grande échelle. Ces résultats préliminaires soulignent l’importance de proposer des interventions adaptées en activité physique aux patientes atteintes d’un cancer du sein métastatique dès le diagnostic pour poursuivre un mode de vie actif le plus longtemps possibleApproximately 5% of patients are diagnosed with metastatic breast cancer each year and 20 to 30% of localized breast cancers become secondarily metastatic. Benefits of physical activity during treatment in patients with localized breast cancer have been widely demonstrated, but the literature is limited in metastatic breast cancer. This thesis work assessed the potential effects of physical activity in patients with metastatic breast cancer through three studies.The StoRM observational study showed an association between the level of physical activity collected by questionnaire with an improvement of survival for HER2 patients. The ABLE intervention study highlighted the feasibility of a physical activity intervention with an activity tracker in this population with an excellent adherence rate (96%), patients' interest and willingness to participate in physical activity programs and functional improvements. The intervention contributed to maintaining quality of life, fatigue and physical activity levels despite treatment and disease progression. Potential biomarkers predictive of tumor progression have been identified. The MUST study showed that the antioxidant SOD and quadriceps isometric extension force appear to prevent sarcopenia and an association between sarcopenia status and toxicity risk was confirmed. This thesis work represents a first step in analyzing the effects of physical activity on patients with metastatic breast cancer. Physical activity appears to be beneficial in this population, but these results need to be confirmed in a larger scale study. These preliminary results highlight the importance of providing appropriate physical activity interventions for patients with metastatic breast cancer at the time of diagnosis in order to maintain an active lifestyle as long as possibl

Patterns of Sequelae in Women with a History of Localized Breast Cancer: Results from the French VICAN Survey

Breast cancer (BC) remains complex for women both physically and psychologically. The objectives of this study were to (1) assess the evolution of the main sequelae and treatment two and five years after diagnosis in women with early-stage breast cancer, (2) explore patterns of sequelae associated with given sociodemographic, clinical, and lifestyle factors. The current analysis was based on 654 localized BC patients enrolled in the French nationwide longitudinal survey “vie après cancer” VICAN (January–June 2010). Information about study participants was collected at enrollment, two and five years after diagnosis. Changes over time of the main sequelae were analyzed and latent class analysis was performed to identify patterns of sequelae related to BC five years after diagnosis. The mean age (±SD) of study participants at inclusion was 49.7 (±10.5) years old. Six main classes of sequelae were identified two years and five years post-diagnosis (functional, pain, esthetic, fatigue, psychological, and gynecological). A significant decrease was observed for fatigue (p = 0.03) and an increase in cognitive sequelae was reported (p = 0.03). Two latent classes were identified—functional and esthetic patterns. Substantial sequelae remain up to five years after BC diagnosis. Changes in patient care pathways are needed to identify BC patients at a high risk

Association between Nutritional Status and Treatment Response and Survival in Patients Treated with Immunotherapy for Lung Cancer: A Retrospective French Study

Malnutrition is associated with a greater risk of morbidity and mortality and lower tolerance to chemotherapy. Our purpose was to study the association between nutritional status and the efficiency and tolerance of immunotherapy in non-small cell lung cancer (NSCLC). Nutritional and oncological data were reported at 2 months (M2) and 4 months (M4) after the initiation of immunotherapy (M0). The influence of nutritional status at M0 was estimated with the efficacy and toxicity of immunotherapy at M2 to M4. In total, 127 patients were included in the study, and nutritional status was estimated at M0 for 120 patients: 67% were not malnourished, 20% presented with moderate malnutrition, and 13% presented with severe malnutrition. There was no significant link between the nutritional status at M0 and the toxicity of immunotherapy at M2 and M4. However, severe malnutrition was significantly associated with treatment efficacy at M2 (p = 0.04) and with a lower survival rate with an HR (Hazard Ratio) = 2.32–95% C.I: 1.13–4.75 (p = 0.02). Furthermore, a monthly decrease of 1% of the weight had an HR = 1.17–95% C.I: 1.13–1.21 (p = 0.0001). Severe malnutrition and weight loss are independent factors associated with lower survival. Studies integrating the systemic detection of sarcopenia with a closer nutritional follow-up could highlight an improvement in survival

There is a need for a complete consideration of overall movement behaviors for the prevention, treatment, and follow-up of cancer risks and patients

International audienceNo abstract availabl

Compliance with public health recommendations of cancer-free female research volunteers: the French Seintinelles study

International audiencePurpose: Acting on modifiable risk factors can prevent approximately 40% of cancers. Knowing the factors that lead people to adopt healthy behaviors is crucial for designing effective primary prevention campaigns. Our study attempts to provide knowledge in this direction. Methods: This cross-sectional study was conducted via the Seintinelles collaborative research platform in a community of women without a personal cancer history, and volunteering to take online questionnaires. We collected data on sociodemographic and health factors, knowledge of cancer risk factors, behaviors, and possible behavior changes (tobacco/alcohol use, diet, body weight, and physical activity) in the last 10 years. Results: The study involved 1465 women aged between 18 and 84 years. Factors such as young age, living alone, and obesity were associated with some positive or negative behavior changes. Being professionally active and having comorbidities favored certain positive behavior changes, while having dependent children, living in a rural area, and being hospitalized were associated with negative or no change in behaviors. Lack of knowledge about modifiable risk factors for cancer was associated with the non-adoption of various healthy behaviors (consumptions of fruit and vegetables, processed and red meat; physical activity). Only 5.5% of participants currently reported to be compliant with seven public health recommendations (smoking; alcohol, fruit/vegetables, and red/processed meat intakes; body mass index; and physical activity). Conclusions: This study allowed to identify the need to increase the level of knowledge on modifiable risk factors for cancer among the general population and to better clarify the content of prevention messages

Changements de comportement de santé chez les femmes survivantes du cancer: l’étude Seintinelles

International audienceIntroduction: The number of cancer survivors increases and their risks of recurrence, second cancer, morbidity and death is high; measures to prevent these risks are thus critical. Knowing the factors that lead cancer survivor to adopt or not healthy behaviours is crucial for designing effective prevention campaigns and better support them in after-cancer. Our study attempts to provide additional knowledge in this direction. Methods: This retrospective study was conducted via the Seintinelles collaborative research platform in a community of women with cancer volunteering to take online questionnaires. We collected data on sociodemographic factors and health, knowledge of cancer risk factors, and possible behaviour changes (tobacco/alcohol use, diet, physical activity) after cancer diagnosis. Results: The study involved 1180 women aged between 26 and 79 years. Several cancer-related factors (cancer other than breast cancer, longer time since diagnosis, taking drug treatment for cancer, sequelae, negative evolution of the cancer) favoured certain positive changes in behaviour. Sociodemographic factors (age, habitat environment, currently employed, living status, dependent children) or factors related to health (general condition, presence of comorbidities, neurological problems, hospitalizations, body mass index) favoured or not certain changes in behaviour. Lack of knowledge about modifiable risk factors for cancer was associated with not adopting healthy behaviours after cancer. Discussion: This study made it possible to identify important elements to be addressed in order to improve cancer risk prevention messages

Cancer du sein: Place de l'exercice physique pendant les traitements

International audienceDuring breast cancer treatment, it is essential to integrate physical exercise into the personalised care plan from the time of diagnosis. Adapted physical activity, practised in safe conditions, aims to maintain or improve muscle mass and function, to reduce the symptoms associated with the cancer or its treatments and to improve the biological parameters of comorbidities.Pendant le traitement d’un cancer du sein, il est indispensable d’intégrer l’exercice physique dans le programme personnalisé de soins dès le diagnostic. Une activité physique adaptée, pratiquée dans des conditions de sécurité, a pour but de maintenir ou d’améliorer la masse et la fonction musculaires, de réduire les symptômes associés au cancer ou à ses traitements et d’améliorer les paramètres biologiques de comorbidités

Physical activity preferences before and after participation in a 6‐month physical activity intervention among women with metastatic breast cancer

International audienc