Will 30% of Early Stage (1-IIIA) go on to metastasize??
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Rosem, in cases like yours when you have extreme nausea, etc, I think the advice was wise... Eat whatever you can. You have to so your body has fuel. I think many without nausea do it fueled by the steroid induced munchies, and it is understandable, but in those cases, if MOs would offer suggestions, it might help. Ditto for exercise. If someone is really sick with low counts, extreme pain, etc, they will likely not be able to exercise. But for those who have less side effects, exercise should be encouraged.
Yorkie, walking is a fabulous form of exercise.
Paxton, Exercise helps me as much mentally as physically.
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My MO told me the exact same thing. Just eat whatever tasted good. My diet wasn't terrible but wasn't great either. Unfortunately I gained 18 pounds that I blamed on the steroids. My DH and I would walk most evenings. We also have three kiddos that kept me active even when I didn't want to be. My mom took them for a week after my third AC infusion. That was my worst week. No energy and just felt blah. I think it was because I wasn't forced to get up and move around.
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exercise is extremely important - during and after -
while in treatment I walked very short bursts but it made me feel great to get out of the house.
now I exercise to keep my weight down, my joints limber etc, thanks to hormone therapy we need to keep our bones strong and our joints oiled up!
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I usually walk 2.5 - 7 miles a day, 5-6 days a week now. My MO said that was one of the most important things I could do to help prevent a recurrence. Rozem is right, it helps me keep my weight down and my joints from becoming stiff from the AI.
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claire....👍❤❤❤
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I am 100 percent in favor of exercise and healthy eating, but I recurred having exercised, never missed one day of tamoxifen, never outside my healthy BMI in my entire life, low oncotype. I had even lost 13 pounds right before I had my recurrence. Sometimes cancer is a formidable foe. and I encourage everyone to give it a multi focal approach. Dont just rely on healthy activities and dont just rely on your treatment.
If nothing else I believe good diet and exercise help avoid some of the worries posted here about treatments. Chemo, tamoxifen, AI i have done them all and I was still able to improve other health measures. My fasting glucose is better, my triglycerides and HDL improved. My bone density is steady.
In the words of Nike, just do it!
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Molly50- I have a family history of stoke, TIAs & blood clots. I'm almost done with 5years of Tamoxifen. The way i understood it, it had to be my personal experience with any of these that would exclude me from Tamoxifen. My MO said that since I had taken birth control pills for about 2years & didn't have any of these problems, I'd probably do OK. I wasn't so sure about this. Just trying to figure out what risks I'm willing to take.
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I'm another one who hated exercise! I have trouble cooling down afterwards and used to be kicked out of aerobic classes due to my pulse. Now I have a pacemaker but no habits. I often wonder what will happen to those who can't exercise anymore.
Our risk of recurrence has nothing to do with exercise as you can see from the above posts. It just implies a lifestyle of "neglect" which alcohol also does. It's just another way to blame the patient.
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I'm another one who believes exercise is important for all sorts of reasons, including helping to prevent a recurrence. No, it doesn't prevent all recurrences, but neither do any of the drugs and treatments they give us. My doctors also believe exercise is an important factor in helping to prevent recurrence and unlike my treatments, it has no bad side effects and actually helps me to feel and look better.
Like Lisey, I absolutely hated exercise and was "slender and happy in my sedentary life" (nice phrase, BTW) prior to BC but after lots of reading and advice from my doctors, I decided I just had to it.
I flunked out of aerobics classes, didn't like Pilates at all, Zumba-so not for me, although our daughters love it-but yoga stuck. I went to a few studio classes and now do daily workouts at home with a CD. I'm not big on classes, but still check in for one or two every few months to make sure my alignment is good and I discovered that I actually like walking (not running, not jogging) in our local park (I can them nature walks, not exercise) when the weather is nice. The point being, I had to try several things until I found a form of exercise I liked enough to stick with and I think that is the key to regular exercise-finding something you truly like to do. I feel better, my muscle tone is better and now I wonder why I didn't start exercising sooner. I'm even thinking about getting a bike next spring-our parks have lots of bike paths-something I would never, ever, ever have thought of doing a few short years ago. Exercise is definitely growing on me.
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I figure I get enough exercise cleaning up after my damn kids. My blood pressure, cholesterol, etc are some of the lowest they've seen. My time is so valuable - taking an hour away to move my body without accomplishing anything feels wasteful. My friend who is a physical trainer told me at this age, health is 80% nutrition - 20% exercise. I'm focusing on my food intake rather than treadmill walking... no need to walking on the treadmill when I'm going everywhere as a mom and trying to work a full time job in my studio.
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LOL. Well, you may be getting your exercise in then! I had worked a desk job for many years prior to BC diagnosis and at some point several years ago our 6 kids starting picking up after themselves, or maybe I just gave up and quit doing it! The house really was a mess for awhile.
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To chime in on the exercise discussion, following chemo I was really worn down, fatigued and had lots of muscle aches. I could hardly move. I wasn't very active and my job as a teacher is rather sedentary. My MO suggested exercise, but I'm not much of a gym person. My solution, I got a part time job at Walmart in the sporting goods department and I LOVE it for so many reasons. Most importantly, it gets me moving for 20 hours per week; stocking shelves, bending, lifting, pulling/pushing carts, climbing ladders. Second, its a great distraction, less time for the dark thoughts. Plus I made a lot of new friends. I've been there a year now. I am feeling so much stronger. It may sound funny, but I work at Walmart for the exercise, lol.
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Since treatment, I've gained weight. I've been trying (not very successfully) to lose it. I swam for an hour every day this summer with one of my sons -- that was fine, but the outdoor pool is closing soon and my son is not as enthusiastic about the indoor pool. I moved my classes to buildings further away from my office so that I get in 40 minutes of walking on the days I teach. My big problem, I think, is reward eating. My sons have autism, and my days can be really stressful. After working, doing household chores, and looking after them, I have a hard time restraining myself at dinner. I just chow down. I feel like I "deserve" it after a typical day. Ugh. I don't think exercise and better eating will necessarily prevent recurrence, but I would like to do all I can to avoid it. So, I try.
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Elaine Therese, I am so there with you on the reward eating. I just "deserve" that piece of cake, cookie or ice cream at the end of a long day. Maybe in the middle of the long day, too, lol. Plus I get really envious of the "skinny" ones who eat all that stuff and never gain weight. They are usually the young ones and their time will come I remind myself. One of my co-workers is always eating donuts and fattening drinks, yet looks great, but she's in her early 40's. When we returned to school this week I noticed, with a chuckle, that her hips and butt and widening. It eventually catches up with you.
I lost fifteen pounds during chemo, but have since gained it back. I'm so disappointed in myself, but hope to never do the "chemo" diet again.
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I totally disagree that taking an hour "just" to exercise is wasteful. It's a far better use of my time than a lot of things I can think of and has no downside. Yes, I could injure myself but I could do that a variety of ways. Some of my happiest times have been in the barre studio and accomplishing greater strength and balance. As one of my favorite motivational quotes goes, exercise is the most underutilized antidepressant.
I get that not everybody likes to exercise and that's fine. But a waste, it is not.
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twohobbies ....cancer does not play by the rules that is for sure, and having a recurrence does not mean we did anything wrong as your situation proves. We do the best we can -with the information we have.
Exercise is important for overall health, I am not convinced it is what will keep the cancer away - I know many will disagree with me here. Maybe because it keeps us slender and fat creates estrogen ? I don't know - is there any studies that anyone knows about that shows a survival benefit with x number of hours of exercise per week?
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It could also be that since my brain is flooded with dopamine 24/7, exercise has minimal effect on my mood - unlike others. (COMT met/met). I'm never in a depressiion, so there aren't those rewards other people get from it. It's totally a wasted hour for me... but cleaning the house, doing pottery and making money at a job I love.. well that is totally how I'd spend my time.
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As Labelle said, I think its important to find something you like and then start a little and then do a little more. Somehow it grows on you and now I miss it if the weather is bad and I cant go. I mostly walk or ride my bike on our forest preserve trails.
Rosem I will look for the studies and post.
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There are studies about survival benefits of exercise. I am too tired to find them right now, but they exist. No one thing is going to stay the beast. All we can do is live as well as possible while we are still here
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I am physically stronger than any female I have met. I have a skinny girlfriend who can't scuba dive because she can't lift the air tank!!! So what good is that? Am I healthier because I'm stronger? I do a lot of yard work including cutting down trees and dragging branches and heaving them into piles. My friend can't even hold the saw once it's turned on!! She swims 50 laps a day or so. Woo hoo. I also work full time.
Exercise and being fit aren't necessarily related....
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Barbe that is also exercise - your gardening. Great for building those muscles!
So here's a very recent article saying that exercise only helps certain types of breast cancer as far as recurrence and death. August 2016
Exercise and Prognosis on the Basis of Clinicopathologic and Molecular Features in Early Stage Breast Cancer: The LACE and Pathways Studies.
Jones LW1, Kwan ML2, Weltzien EK2, Chandarlapaty S3, Sternfeld B2, Sweeney C4, Bernard PS5, Castillo AL2, Habel LA2, Kroenke CH2, Langholz BM6,Quesenberry CP2, Dang CT7, Weigelt B8, Kushi LH2, Caan BJ2.
Author information
Abstract
To investigate whether the impact of post-diagnosis exercise on breast cancer outcomes in women diagnosed with early stage breast cancerdiffers on the basis of tumor clinicopathologic and molecular features. Using a prospective design, 6,211 patients with early stage breast cancerfrom two large population-based cohort studies were studied. Age-adjusted and multivariable Cox regression models were performed to determine the relationship between exercise exposure (total MET-hrs.wk-1) and recurrence and breast cancer death for: (1) all patients ('unselected' cohort), and on the basis of (2) classic clinicopathologic features, (3) clinical subtypes, (4) PAM50-based molecular intrinsic subtypes, and (5) individual PAM50 target genes. After a median follow-up of 7.2 years, in the unselected cohort (n=6,211) increasing exercise exposure was not associated with a reduction in the risk of recurrence (adjusted ptrend = 0.60) or breast cancer death (adjusted ptrend = 0.39). On the basis of clinicopathologic features, an exercise-associated reduction in breast cancer death was apparent for tumors <2 cm (HR: 0.50, 95% CI, 0.34 to 0.72), well / moderately differentiated tumors (HR: 0.63, 95% CI, 0.43 to 0.91), and ER-positive tumors (HR: 0.72, 95% CI, 0.53 to 0.97). Stratification by clinical subtype indicated that the ER+/PR+/HER2-/low-grade clinical subtype was preferentially responsive to exercise(recurrence: adjusted HR: 0.63, 95% CI, 0.45 to 0.88; breast cancer death: adjusted HR: 0.57, 95% CI, 0.37 to 0.86). The impact of exercise oncancer outcomes appears to differ as a function of pathologic and molecular features in early stage breast cancer.
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In addition, many of the meds we take deplete our bones. Exercise, especially weight bearing exercise builds bones. It also improves mood, lowers risk of cardiovascular disease etc. Plus I find I have more energy and am happier when I exercise.
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I don't think any of us who DO like working out are saying it is a cure all, and I certainly haven't seen anyone say that only certain types of physical activity count. I'm not sure why this is turning into a competition of whose lifestyle choices are better or whatever; I mean, I also work full time, I'm a lawyer, I have constant stress. We all had cancer or we wouldn't be here. I don't think any of us "deserved" cancer no matter how we lived our lives.
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Meta Analysis of 22 studies
Acta Oncol. 2015 May;54(5):635-54. doi: 10.3109/0284186X.2014.998275. Epub 2015 Mar 9.
Physical activity, risk of death and recurrence in breast cancer survivors: A systematic review and meta-analysis of epidemiological studies.
Lahart IM1, Metsios GS, Nevill AM, Carmichael AR.
Author information
Abstract
Strong evidence exists supporting the effect of lack of physical activity on the risk of developing breast cancer. However, studies examining the effects of physical activity on breast cancer outcomes, including survival and prognosis have been inconclusive. Therefore, the aim of the current study was to provide a systematic review and meta-analysis of studies investigating the association between physical activity and breast cancerrecurrence and death.
METHODS:
PubMed, EMBASE, and CENTRAL databases were searched up to 18 October 2014. Reference lists of retrieved articles and relevant previous reviews were also searched. Observational studies that reported risk estimates for all-cause and/or breast cancer-related death and/or breast cancer recurrences by levels of physical activity, were included in the review. Random effects models were used to calculate pooled hazard ratios (HR) and 95% confidence intervals (CI) and to incorporate variation between studies. The Newcastle-Ottawa scale was used to critically appraise the risk of bias across studies.
RESULTS:
Twenty-two prospective cohort studies were eligible in this meta-analysis. During average follow-up periods ranging from 4.3 to 12.7 years there were 123 574 participants, 6898 all-cause deaths and 5462 breast cancer outcomes (i.e. breast cancer-related deaths or recurrences). The average Newcastle-Ottawa score was six stars (range 4-8). Compared to those who reported low/no lifetime recreational pre-diagnosis physical activity, participants who reported high lifetime recreational pre-diagnosis physical activity levels had a significantly lower risk of all-cause (HR = 0.82, 95% CI 0.70-0.96, p < 0.05) and breast cancer-related death (HR = 0.73, 95% CI 0.54-0.98, p < 0.05). Significant risk reductions for all-cause and breast cancer-related death was also demonstrated for more recent pre-diagnosis recreational physical activity (HR = 0.73, 95% CI 0.65-0.82, p < 0.001; and HR = 0.84, 95% CI 0.73-0.97, p < 0.05, respectively), post-diagnosis physical activity (HR = 0.52, 95% CI 0.43-0.64, p < 0.01; and HR = 0.59, 95% CI 0.45-0.78, p < 0.05, respectively) and meeting recommended physical activity guidelines (i.e. ≥ 8 MET-h/wk) post-diagnosis (HR = 0.54, 95% CI 0.38-0.76, p < 0.01; and HR = 0.67, 95% CI 0.50-0.90, p < 0.01, respectively). However, there was evidence of heterogeneity across lifetime recreational pre- and post-diagnosis physical activity analyses. Both pre-diagnosis (lifetime and more recent combined) and post-diagnosis physical activity were also associated with reduced risk of breast cancer events (breast cancer progression, new primaries and recurrence combined) (HR = 0.72 95% CI 0.56-0.91, p < 0.01; and HR = 0.79, 95% CI 0.63-0.98, p < 0.05, respectively).
CONCLUSION:
There is an inverse relationship between physical activity and all-cause, breast cancer-related death and breast cancer events. The current meta-analysis supports the notion that appropriate physical activity may be an important intervention for reducing death and breast cancer events among breast cancer survivors.
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Opposing study - postmenopausal, ER+ women. Exercise good for overall survival but no bearing on breast cancer.
Cancer. 2014 Sep 15;120(18):2847-54. doi: 10.1002/cncr.28783. Epub 2014 May 19.
Physical activity and survival of postmenopausal, hormone receptor-positive breast cancer patients: results of the Tamoxifen Exemestane Adjuvant Multicenter Lifestyle study.
de Glas NA1, Fontein DB, Bastiaannet E, Pijpe A, De Craen AJ, Liefers GJ, Nortier HJ, de Haes HJ, van de Velde CJ, van Leeuwen FE.
Author information
Abstract
BACKGROUND:
Physical activity has been related to improved breast cancer outcomes. Especially in the older breast cancer population, physical activity may be important because old age is associated with comorbidities and decreased physical function. The purpose of this study was to investigate the relation between physical activity and overall survival, breast cancer-specific survival, and recurrence in several age groups of postmenopausal breast cancer patients.
METHODS:
The Tamoxifen Exemestane Adjuvant Multinational Lifestyle study was a side study of the Tamoxifen Exemestane Adjuvant Multinational trial and prospectively investigated lifestyle habits of postmenopausal, hormone receptor-positive breast cancer patients. The relations between prediagnosis and postdiagnosis physical activity and overall survival, breast cancer-specific survival, and recurrence-free survival were assessed with Cox regression and competing risk regression models.
RESULTS:
Among 521 patients, high levels of physical activity before and after the diagnosis were associated with better overall survival (the multivariate hazard ratios were 0.50 [95% confidence interval = 0.26-0.98] and 0.57 (95% confidence interval = 0.26-1.40] for patients who were very active before and after the diagnosis, respectively, in comparison with inactive patients). This was most evident in patients who were 65 years old or older. Physical activity was not significantly associated with breast cancer-specific survival or the relapse-free period.
CONCLUSIONS:
Overall survival was better for patients who were active before and after the diagnosis. In contrast with previous studies, breast cancer survival and the risk of recurrence were not significantly associated with physical activity. These findings confirmed the need for more studies investigating the use of physical activity to supplement breast cancer treatment in older patients.
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Paxton, I don't see it as a competition of whose lifestyle is better. If someone is meaning to project that, I missed it! Its a topic of interest because its something we can control. Does it help us or not? Should I make more time for exercise? My MO never mentions exercise, my BS harps on it and keeping weight maintained. As I just posted, if you look at multiple studies, sometimes there are different leanings, or further studies are needed, our favorite phrase. So while we may not be convinced it will "work", its something we can do that might help, and certainly might help me survive something else, should I survive this breast cancer.
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TwoHobbies - thanks so much for digging out and posting all those studies. It's handy to have them all in one thread and is much appreciated.0
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Hi:
The "irreversible" mechanism of action of exemestane (AROMASIN) has come up elsewhere and caused some confusion. The "irreversible" mechanism of action does not mean that the action of exemestane cannot be thwarted by discontinuing the drug. If it were truly "irreversible" in a layperson sense, you wouldn't need to take it for so long.
To obtain full therapeutic benefit, the drug still needs to be taken in the prescribed dose, including frequency, as this is how it was used in the trials that established its efficacy. In case of a missed dose, follow any label instructions regarding what to do if a dose is missed.
Regarding its biochemical mechanism of action, the FDA label for the drug explains:
"Exemestane is an irreversible, steroidal aromatase inactivator, structurally related to the natural substrate androstenedione. It acts as a false substrate for the aromatase enzyme, and is processed to an intermediate that binds irreversibly to the active site of the enzyme, causing its inactivation . . ."
Per one recent review article:
"Many of the most widely employed and successful drugs in clinical use are irreversible drugs.[1-8] Aspirin, which was developed by Bayer in 1897 as an anti-inflammatory agent, is probably the best known example. As with many other examples, the covalent mechanism of action of Aspirin was discovered by serendipity more than 70 years after its commercialization. Aspirin causes the irreversible inhibition of cyclooxygenases 1 (COX-1) and 2 (COX-2), which are enzymes involved in the prostaglandin biosynthesis, by acylation of a serine residue that is close to the active site.[9, 10] Other examples are penicillins and cephalosporins,[7] which are antibiotics that inhibit the cross-linking of bacterial cell walls catalyzed by penicillin binding proteins (Figure 1). Fosfomycin,[11-13] which is an antibiotic that targets MurA, an enzyme involved in peptidoglycan biosynthesis, and omeprazole, which is a proton pump inhibitor for the treatment of diverse stomach diseases, are further examples.[14]
Once withdrawn, the effects of these so-called "irreversible inhibitors" wear off.
Hopeful82014 specifically sought advice about "irreversibility":
https://community.breastcancer.org/forum/78/topics...
"I heard back from the oncology pharmacist navigator with the following:
Regarding the "permanence" of aromatase inhibition with Exemestane:
"No, it would not be forever. Usually a drug is considered "out of your system" after 4-5 "half lifes". Half life for exemestane is 24hrs, so theoretically 95% of the drug would be gone in 4-5 days. However, the effect continues to linger on beyond that, but I couldn't find any time period. I would guess not more than a month…."
This advice makes good sense. By becoming stably bound to its enzyme target, these inhibitors act in a one-on-one manner. While therapy continues, prolonged duration of inhibition of the bound enzyme is theoretically possible. However, once drug is discontinued, free inhibitor washes out, and levels of inhibitor decrease according to half-life. Aromatase enzyme activity will recover via synthesis of new target enzyme. Any remaining inhibitor irreversibly bound to one enzyme molecule, can't go get another aromatase enzyme molecule, so newly synthesized aromatase enzyme would be free to do its business.
By the way, that thread also highlighted additional dosing information for exemestane (AROMASIN):
"Recommended Dose: One 25 mg tablet once daily after a meal (2.1)."
"The recommended dose of AROMASIN in early and advanced breast cancer is one 25 mg tablet once daily after a meal."
"Absorption: Following oral administration, exemestane appeared to be absorbed more rapidly in women with breast cancer than in the healthy women, with a mean -tmax of 1.2 hours in the women with breast cancer and 2.9 hours in healthy women. Approximately 42% of radiolabeled exemestane was absorbed from the gastrointestinal tract. A high-fat breakfast increased AUC and Cmax of exemestane by 59% and 39%, respectively, compared to fasted state."
The effect of food on absorption of the drug is quite large, and the instructions to take it with food seem important to receiving the full benefit of treatment. There is also some indication that fat may aid in absorption.
Those taking this drug may wish to discuss timing of their dose relative to a meal and fat content of the meal (as close to the same time each day as possible) with their MO.
BarredOwl
[Edit: inserted "still" in paragraph 2]
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Barred Owl, thanks for explaining in such detail. I knew there had to be an answer and frankly I am HAPPY on exemestane. My SE's are so minimal and I do take it with food as directed.
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thank you for those studies
can someone summarize in laymen's terms?
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