Zusammenhang von Körperzusammensetzung und körperlicher Aktivität bei nicht-metastasierten Mammakarzinom-Patientinnen unter onkologischer Therapie

Das Mammakarzinom ist weltweit die häufigste maligne Krebserkrankung der Frau. Es ist ebenso die häufigste Todesursache bei den Krebserkrankungen. Körperliche Inaktivität und Übergewicht erhöhen neben den Risikofaktoren weiblichen Geschlechts, Genetik, Alter und den weiblichen Geschlechtshormonen das Risiko an einem Mammakarzinom zu erkranken. Darüber hinaus sind die Rezidivraten bei übergewichtigen Frauen erhöht und die rezidivfreien Intervalle verkürzt. Das Ziel der vorliegenden Dissertationsarbeit ist es, die Körperzusammensetzung und die körperliche Aktivität bei nicht-metastasierten Brustkrebs-Patientinnen unter onkologischer Therapie im ersten halben Jahr nach Diagnosestellung zu untersuchen. In der klinischen BeGyn I Beobachtungsstudie wurden 110 Mammakarzinom-Patientinnen aus einem Patientenkollektiv der Brustsprechstunde von nicht-metastasierten Brustkrebs-Patientinnen der Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin der Universität des Saarlandes vom 01. September 2019 bis zum 31. Januar 2021 rekrutiert. Die Patientinnen wurden leitliniengerecht mit Chemotherapie, endokriner Therapie, Operation und/oder Bestrahlung behandelt. Die körperliche Aktivität der Patientinnen wurde mithilfe eines Studientagebuchs und eines Fitnesstrackers (Fitbit-Uhr) über sechs Monate erfasst. Die Körperzusammensetzung wurde durch die bioelektrische Impedanz Analyse und der Calipometrie zu Beginn der Therapie und nachfolgend alle drei Monate gemessen. In die BeGyn I Studie wurden 110 Patientinnen eingeschlossen, 18 Patientinnen waren im hier untersuchten Zeitraum Drop-outs. In der vorliegenden Dissertationsarbeit wurden 92 Patientinnen untersucht, 57 Patientinnen in der Chemotherapie-Gruppe und 35 Patientinnen in der Nicht-Chemotherapie-Gruppe. Das Gewicht der Patientinnen in den Gruppen blieb zu den Messzeitpunkten weitgehend stabil. Die Muskelmasse der Patientinnen konnte im Verlauf in der Chemotherapie-Gruppe durchschnittlich gesteigert werden, während sie sich in der Nicht-Chemotherapie-Gruppe geringfügig verringert hat. Der mittels BIA gemessene Körperfettanteil der Patientinnen der Chemotherapie-Gruppe und Nicht-Chemotherapie-Gruppe Gruppekonnte in Korrelation mit der körperlichen Aktivität nach drei und sechs Monaten gesenkt werden.  Breast cancer is not only the most common malignant cancer among women worldwide, it is also the leading cause of death among women with cancer. Physical inactivity and being overweight are two risk factors, alongside the female gender, genetics, age and female sex hormones, that increase the chance of developing breast cancer. For overweight women, recurrence rates are higher and disease-free intervals are much shorter. The aim of this dissertation is to evaluate the body composition and physical activity of patients with non-metastatic breast cancer undergoing oncological treatment for the first six months after diagnosis. In the observational BeGyn I study, 110 patients were recruited from consultations in the Obstetrics, Gynecology and Reproductive Medicine department of the University Hospital of Saarland. The recruitment started on September 1st, 2019 and ended on January 31st, 2021. Patients received chemotherapy, endocrine therapy, surgery and/or radiotherapy in correspondence with the guidelines. Over a period of six months, physical activity was recorded with the aid of journals and Fitbit watches. The body compositions were recorded at the start of treatment and every three months thereafter. It was measured by using bioelectrical impedance analysis and calipometry. Of the 110 patients, included in the BeGyn I study, 18 dropped out during the assessment period. The remaining 92 patients consisted of 57, who received chemotherapy as part of their treatment and 35, who did not receive chemotherapy as part of their treatment. Body weight during therapy was stable in both groups of patients. An average increase in muscle mass was observed in the chemotherapy group, while a slight decrease was observed in the non-chemotherapy group. Using BIA, a decrease in the body fat percentage of the patients in both groups was observed after three as well as six months

Prevalence and Relevance of Vitamin D Deficiency in Newly Diagnosed Breast Cancer Patients : A Pilot Study

(1) Background: Vitamin D plays an important role in many types of cancer. It was the aim of this study to analyze serum 25-hydroxyvitamin D (25(OH)D) levels in newly diagnosed breast cancer patients, and the association with prognostic and lifestyle factors. (2) Methods: 110 nonmetastatic breast cancer patients were included in the prospective observational “BEGYN” study at Saarland University Medical Center between September 2019 and January 2021. At the initiation visit, serum 25(OH)D levels were measured. Clinicopathological data on prognosis, nutrition, and lifestyle were extracted from data files and obtained using a questionnaire. (3) Results: Median serum 25(OH)D in breast cancer patients was 24 ng/mL (range 5–65 ng/mL), with 64.8% of patients being vitamin D deficient. 25(OH)D was higher among patients that reported the use of vitamin D supplements (43 ng/mL versus 22 ng/mL; p < 0.001), and in summer compared to other seasons (p = 0.03). Patients with moderate vitamin D deficiency were less likely to have triple negative breast cancer (p = 0.047). (4) Conclusions: Routinely measured vitamin D deficiency is common in breast cancer patients and needs to be detected and treated. However, our results do not support the hypothesis that vitamin D deficiency may be a main prognostic factor for breast cancer

Improved awareness of physical activities is associated with a gain of fitness and a stable body weight in breast cancer patients during the first year of antineoplastic therapy: the BEGYN-1 study.

peer reviewed[en] BACKGROUND: Breast cancer is the most frequent cancer in women. Reduced physical activity and overweight are associated with poor prognosis. Breast cancer patients have a high risk to gain weight, lose muscle mass and reduce physical activity during therapy. Concepts are urgently needed to motivate patients to engage in physical activity. METHODS: 110 non-metastatic breast cancer patients were included in the prospective observational BEGYN-1 study. Physiological parameters and body composition were measured before the start of therapy and then quarterly for one year. Patients used a fitness tracker and documented their physical activity in a diary throughout the study. RESULTS: Although the patients were not offered any guided exercise, and despite the restrictions during the COVID-19 pandemic, they increased their physical activity (metabolic equivalent of task (MET) -minutes): p<0.001), physical fitness (decreasing resting heart rate: p=0.001) and did not gain weight (median - 0.4kg) over the course of the study. CONCLUSION: Improved awareness of physical activity is associated with an increase in physical activity, fitness, and a stable weight during the first year of therapy in breast cancer patients. Counselling at diagnosis should motivate patients to engage in physical activity, wear a fitness tracker and document activities

Zusammenhang von Körperzusammensetzung und körperlicher Aktivität bei nicht-metastasierten Mammakarzinom-Patientinnen unter onkologischer Therapie

Das Mammakarzinom ist weltweit die häufigste maligne Krebserkrankung der Frau. Es ist ebenso die häufigste Todesursache bei den Krebserkrankungen. Körperliche Inaktivität und Übergewicht erhöhen neben den Risikofaktoren weiblichen Geschlechts, Genetik, Alter und den weiblichen Geschlechtshormonen das Risiko an einem Mammakarzinom zu erkranken. Darüber hinaus sind die Rezidivraten bei übergewichtigen Frauen erhöht und die rezidivfreien Intervalle verkürzt. Das Ziel der vorliegenden Dissertationsarbeit ist es, die Körperzusammensetzung und die körperliche Aktivität bei nicht-metastasierten Brustkrebs-Patientinnen unter onkologischer Therapie im ersten halben Jahr nach Diagnosestellung zu untersuchen. In der klinischen BeGyn I Beobachtungsstudie wurden 110 Mammakarzinom-Patientinnen aus einem Patientenkollektiv der Brustsprechstunde von nicht-metastasierten Brustkrebs-Patientinnen der Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin der Universität des Saarlandes vom 01. September 2019 bis zum 31. Januar 2021 rekrutiert. Die Patientinnen wurden leitliniengerecht mit Chemotherapie, endokriner Therapie, Operation und/oder Bestrahlung behandelt. Die körperliche Aktivität der Patientinnen wurde mithilfe eines Studientagebuchs und eines Fitnesstrackers (Fitbit-Uhr) über sechs Monate erfasst. Die Körperzusammensetzung wurde durch die bioelektrische Impedanz Analyse und der Calipometrie zu Beginn der Therapie und nachfolgend alle drei Monate gemessen. In die BeGyn I Studie wurden 110 Patientinnen eingeschlossen, 18 Patientinnen waren im hier untersuchten Zeitraum Drop-outs. In der vorliegenden Dissertationsarbeit wurden 92 Patientinnen untersucht, 57 Patientinnen in der Chemotherapie-Gruppe und 35 Patientinnen in der Nicht-Chemotherapie-Gruppe. Das Gewicht der Patientinnen in den Gruppen blieb zu den Messzeitpunkten weitgehend stabil. Die Muskelmasse der Patientinnen konnte im Verlauf in der Chemotherapie-Gruppe durchschnittlich gesteigert werden, während sie sich in der Nicht-Chemotherapie-Gruppe geringfügig verringert hat. Der mittels BIA gemessene Körperfettanteil der Patientinnen der Chemotherapie-Gruppe und Nicht-Chemotherapie-Gruppe Gruppekonnte in Korrelation mit der körperlichen Aktivität nach drei und sechs Monaten gesenkt werden.  Breast cancer is not only the most common malignant cancer among women worldwide, it is also the leading cause of death among women with cancer. Physical inactivity and being overweight are two risk factors, alongside the female gender, genetics, age and female sex hormones, that increase the chance of developing breast cancer. For overweight women, recurrence rates are higher and disease-free intervals are much shorter. The aim of this dissertation is to evaluate the body composition and physical activity of patients with non-metastatic breast cancer undergoing oncological treatment for the first six months after diagnosis. In the observational BeGyn I study, 110 patients were recruited from consultations in the Obstetrics, Gynecology and Reproductive Medicine department of the University Hospital of Saarland. The recruitment started on September 1st, 2019 and ended on January 31st, 2021. Patients received chemotherapy, endocrine therapy, surgery and/or radiotherapy in correspondence with the guidelines. Over a period of six months, physical activity was recorded with the aid of journals and Fitbit watches. The body compositions were recorded at the start of treatment and every three months thereafter. It was measured by using bioelectrical impedance analysis and calipometry. Of the 110 patients, included in the BeGyn I study, 18 dropped out during the assessment period. The remaining 92 patients consisted of 57, who received chemotherapy as part of their treatment and 35, who did not receive chemotherapy as part of their treatment. Body weight during therapy was stable in both groups of patients. An average increase in muscle mass was observed in the chemotherapy group, while a slight decrease was observed in the non-chemotherapy group. Using BIA, a decrease in the body fat percentage of the patients in both groups was observed after three as well as six months

Longitudinal Assessment of Physical Activity, Fitness, Body Composition, Immunological Biomarkers, and Psychological Parameters During the First Year After Diagnosis in Women With Non-Metastatic Breast Cancer: The BEGYN Study Protocol

Background: Moderate physical activity is associated with an improved prognosis and psychosocial outcome in breast cancer patients. Although exercise and physical activity are associated with multiple physiological and psychological effects, many of the underlying mechanisms remain obscure. The BEGYN study (Influence of physical activity in breast cancer patients on physiological and psychological parameters and on biomarkers) aims at identifying potential associations between the extent of physical activity, fitness, body composition, immunological biomarkers, psycho-emotional parameters, and the course of treatment during the first year after diagnosis of breast cancer. Methods: The prospective observational BEGYN study will include 110 non-metastatic breast cancer patients. The patients will be assessed during a base line visit prior to the initiation of the antineoplastic therapy and after 3, 6, 9 and 12 months. The physical activity will be measured using a fitness tracker and a self-assessment diary during the entire study. Each visit will include the assessment of (i) cardiorespiratory fitness measured by spiroergometry, (ii) body composition, (iii) psycho-emotional parameters (quality of life, mental health, fatigue, depression, distress, anxiety, well-being), and (iv) extensive blood tests including routine laboratory, vitamin D, selenium and immunologically relevant biomarkers (e.g., leukocyte subpopulations and cytokine profiles). Discussion: Whereas most studies investigating the influence of physical activity in breast cancer patients focus on specific activities for three months or less, the BEGYN study will quantify the daily physical activity and cardiorespiratory fitness of breast cancer patients based on objective measurements in the context of the oncological therapy for 12 months after diagnosis. The study will reveal potential associations between exercise, immune status and physical as well as psycho-emotional outcome and the clinical course of the disease. Moreover, complementary therapies such as Vit D and Selenium supplementation and parameters investigating the motivation of the patients are part of the study. Due to this holistic approach, the BEGYN study will guide towards confirmatory studies on the role of physical activity in breast cancer patients to develop individualized counselling regarding the recommended type and extent of exercise

Improved awareness of physical activities is associated with a gain of fitness and a stable body weight in breast cancer patients during the first year of antineoplastic therapy: the BEGYN-1 study

Background: Breast cancer is the most frequent cancer in women. Reduced physical activity and overweight are associated with poor prognosis. Breast cancer patients have a high risk to gain weight, lose muscle mass and reduce physical activity during therapy. Concepts are urgently needed to motivate patients to engage in physical activity. Methods: 110 non-metastatic breast cancer patients were included in the prospective observational BEGYN-1 study. Physiological parameters and body composition were measured before the start of therapy and then quarterly for one year. Patients used a fitness tracker and documented their physical activity in a diary throughout the study. Results: Although the patients were not offered any guided exercise, and despite the restrictions during the COVID-19 pandemic, they increased their physical activity (metabolic equivalent of task (MET) -minutes): p<0.001), physical fitness (decreasing resting heart rate: p=0.001) and did not gain weight (median - 0.4kg) over the course of the study. Conclusion: Improved awareness of physical activity is associated with an increase in physical activity, fitness, and a stable weight during the first year of therapy in breast cancer patients. Counselling at diagnosis should motivate patients to engage in physical activity, wear a fitness tracker and document activities

Course of Vitamin D Levels in Newly Diagnosed Non-Metastatic Breast Cancer Patients over One Year with Quarterly Controls and Substitution

(1) Background: Vitamin D levels in patients remain inadequately understood, with research yielding inconsistent findings. Breast cancer patients, particularly due to oncological therapies, face an increased risk of osteopenia, which can be exacerbated by a vitamin D deficiency. (2) Methods: The prospective observational “BEGYN-1” study assessed serum 25(OH)D levels at baseline and quarterly thereafter. Clinical, pathological, nutritional, vitamin supplementation, and lifestyle data were recorded. (3) Results: Before treatment, 68.5% of patients were vitamin D deficient (<30 ng/mL), with 4.6% experiencing severe deficiency (<10 ng/mL). The median baseline 25(OH)D levels were 24 ng/mL (range: 4.8 to 64.7 ng/mL). Throughout the study, the median vitamin D levels increased to 48 ng/mL (range: 22.0 to 76.7 ng/mL). Before diagnosis, 16.7% received vitamin D substitution, and 97.8% received vitamin D substitution throughout the year with a median weekly dose of 20,000 IU. It took at least three quarterly assessments for 95% of patients to reach the normal range. A multiple GEE analysis identified associations between 25(OH)D levels and supplementation, season, age, VLDL, magnesium levels, and endocrine therapy. (4) Conclusions: Physicians should monitor 25(OH)D levels before, during, and after oncological therapy to prevent vitamin D deficiency and to adjust substitution individually. While variables such as seasons, age, VLDL, magnesium, diet, and oncological interventions affect 25(OH)D levels, supplementation has the greatest impact

A Plea for Monitoring Serum Selenium Levels in Breast Cancer Patients: Selenium Deficiency Is Rare during the First Year of Therapy, and Selenium Supplementation Is Associated with Elevated Risk of Overdosing

(1) Background: The role of selenium in cancer biology remains poorly understood. Our aim was to study the course of selenium serum levels and the use of selenium supplements during breast cancer therapy. (2) Methods: Serum selenium levels, clinical–pathological data, selenium supplementation, and lifestyle factors were monitored quarterly over one year. (3) Results: A total of 110 non-metastatic breast cancer patients were enrolled in the prospective observational “BEGYN-1” study. At baseline, 2.9% of patients were selenium-deficient (<50 ng/mL), 1.9% were overdosed (>120 ng/mL), and 6.4% received substitution. The median selenium level was 81.5 ng/mL and ranged between 78.7 and 84.5 ng/mL within the year. A total of 25.3% of the patients received supplementation, resulting in significantly higher selenium levels (p < 0.05). A total of 8.7–28.6% of the patients using supplements were overdosed. Selenium levels strongly correlated with mushroom consumption (p = 0.003), but no association was found with therapy or clinical characteristics. (4) Conclusions: Although selenium deficiency is rare, serum selenium levels should be assessed in breast cancer patients. Mushrooms and nuts should be preferred over supplements to correct selenium deficiency. Ruling out selenium deficiency helps prevent the risk of selenosis and avoid unnecessary, costly supplementation in patients who are often financially burdened due to their disease

Transforming knowledge systems for life on Earth : Visions of future systems and how to get there

Formalised knowledge systems, including universities and research institutes, are important for contemporary societies. They are, however, also arguably failing humanity when their impact is measured against the level of progress being made in stimulating the societal changes needed to address challenges like climate change. In this research we used a novel futures-oriented and participatory approach that asked what future envisioned knowledge systems might need to look like and how we might get there. Findings suggest that envisioned future systems will need to be much more collaborative, open, diverse, egalitarian, and able to work with values and systemic issues. They will also need to go beyond producing knowledge about our world to generating wisdom about how to act within it. To get to envisioned systems we will need to rapidly scale methodological innovations, connect innovators, and creatively accelerate learning about working with intractable challenges. We will also need to create new funding schemes, a global knowledge commons, and challenge deeply held assumptions. To genuinely be a creative force in supporting longevity of human and non-human life on our planet, the shift in knowledge systems will probably need to be at the scale of the enlightenment and speed of the scientific and technological revolution accompanying the second World War. This will require bold and strategic action from governments, scientists, civic society and sustained transformational intent.Peer reviewe