Meme kanseri tanısı olan hastalarda düzenli egzersiz yaşam kalitesini önemli oranda artırır

Meme kanseri tanısı olan hastalarda düzenli egzersiz yaşam kalitesini önemli oranda artırır

Sağlıklı ve kanserle mücadele eden bireylerin en çok merak ettiği konu bağışıklık sistemimi nasıl daha güçlü yapabilirim. Özelikle Covid19 pandemisi ile bağışıklığı güçlendirici ek gıda takviyelerine tüm dünyada olduğu gibi ülkemizde de ilgi artı. Fakat çok sayıda çalışma vitamin ve omega-3 olmak üzere ek gıda takviyelerinin yararlı olmadığı ve özelikle kanser tedavisi görenlerde ters etki gösterebileceği gösterildi.

Son 20 yılda egzersiz yapmak ile kanser tedavisi gören hastalarda, tedaviye bağlı yan etkilerini azaldığı ve kanser sonrası düzenli egzersiz ile kanser hastalığının tekrarlamasının belirgin azaldığına dair çalışmalar yayınlanmaya başlandı.

Özelikle bağırsak, meme ve prostat kanseri tanısı sonrası düzenli egzersiz yapmak ile hastalığın tekrarlama oranında önemli bir azalma tespit edildiğini belirten yayınlar mevcut.

Egzersizle birlikte kandaki inflamatuar sitokin (TNF, IL) seviyesinin azalması, büyüme faktörleri, anjiyojenik faktörler ve tümör mikro çevresi üzerindeki etkinliğiyle bunu sağladığı ileri sürülmektedir.

Son yapılan çalışmalarda egzersiz adaptif immün yanıtı artırarak kanser gelişimini engellediği gösterilmiştir. Egzersiz viseral yağ oranını azaltarak, proinflamatuar sitokin miktarını azaltır

Aynı zamanda egzersiz hipofiz adrenal aksı aktifleştirerek katekolamin ve kortizol seviyesini artırarak inflamatuar sitokin düzeyini azaltır.

Egzersiz aynı zamanda parasempatik ve vagal aktiviteyi artırarak asetilkolin ile ilişkili T hücreyi aktifleşerek NF-κB düzeyini azaltarak inflamasyonu azaltıyor.

Egzersiz sitotoksik CD8 lenfositleri aktifleştirerek immün yanıtı artırıp kanser hücrelerine karşı bağışıklık sistemin aktifleşmesinde rol alıyor.

Son yapılan çalışmada evre IV meme kanseri olan ve günlük en az 30 dakika egzersiz programları yapan hastalarda, ağrıya bağlı semptomlarının azaldığı, yorgunluk durumunda gerilediği ve egzersiz ile yaşam kalitesinin belirgin düzeldiği saptandı.

Sistemik tedavilerle birlikte eğitici eşliğinde hastalığa uygun egzersiz yapmak meme kanseri olan hastaların yaşam kalitesini belirgin artırabilir.

KAYNAKLAR

Exercise and the immune system: taking steps to improve responses to cancer immunotherapy. Gustafson MP, et al. J Immunother Cancer 2021;9:e001872. doi:10.1136/jitc-2020-001872

Effect of Exercise on Symptom Burden and Quality of Life in Patients With Metastatic Breast Cancer

By The ASCO Post Staff

Last Updated: 3/22/2024 11:23:46 AM

Taking part in an exercise program may improve pain, fatigue, and quality of life in patients with metastatic breast cancer, according to recent findings presented by Hiensch et al at the 2024 European Breast Cancer Conference (EBCC; Abstract 1)

Background

“Although there’s been quite a lot of research looking at exercise for [patients] with early-stage cancer, we have seen very little research on exercise in patients with more advanced disease,” explained lead study author Anouk Hiensch, MSc, of the University Medical Center Utrecht. “Patients with metastatic cancer often undergo continuous treatment that aims to prolong their life. Thanks to these treatments, many patients with metastatic cancer live longer, but many also report a deteriorating quality of life over time. We therefore need supportive care strategies, like exercise, that make the lives of these patients better,” she added.

Study Methods and Results

In the PREFERABLE-EFFECT study, the researchers recruited 357 patients (average age, 55 years) with metastatic breast cancer from eight cancer centers across Germany, Poland, Spain, Sweden, the Netherlands, and Australia. The patients were then randomly assigned to partake in a 9-month exercise program—consisting of twice weekly personalized training with resistance, aerobic, and balance exercises overseen by a physiotherapist or exercise physiologist—in addition to usual care (n = 178) or usual care alone (n = 179). The patients in both groups were encouraged to be physically active for at least 30 minutes every day and given activity trackers.

At baseline and after follow-up at 3, 6, and 9 months, the researchers asked the patients about their levels of fatigue and their quality of life, including any pain they were experiencing.

Overall, the patients who engaged in the exercise program experienced less fatigue and had a better quality of life. The researchers found that patients of all ages seemed to benefit from the exercise program but observed the greatest improvements among female patients younger than 50 as well as those experiencing pain at baseline. However, they emphasized, all patients with metastatic cancer should be offered exercise as part of their cancer care.

“Older patients did also benefit from exercise; however, the program might require some additional fine-tuning for them to benefit as much as younger patients,” suggested Dr. Hiensch.

Conclusions

“Based on these findings, we recommend supervised exercise for all patients with metastatic breast cancer—particularly those who are experiencing pain—as part of their standard care. If patients are interested in exercising, [we] recommend talking to their [physician] or nurse first and looking for an exercise trainer who is trained in helping patients [with cancer],” emphasized Dr. Hiensch. “We don’t know exactly why exercise helps [these] patients who are suffering from pain, but we think it could be because exercise reduces inflammation. We have collected blood samples from our trial participants, and studying these samples may tell us more,” she underlined.

The researchers plan to conduct a cost-effectiveness analysis to help encourage policymakers and health insurers to fund exercise programs for patients with cancer.

“This research is good news for patients with advanced breast cancer, because it shows they can enjoy a better quality of life with less fatigue and pain if they take part in an exercise program as part of their package of treatment and care. [Patients] with metastatic cancer cannot always be cured of their disease, but they can live for many months or years, so ensuring they have the best possible quality of life is absolutely vital,” concluded Michail Ignatiadis, MD, PhD, of the Institut Jules Bordet in Brussels and Chair of the 2024 EBCC, who was not involved in the research.