Every Day Counts: A Lifestyle Program for Women with Metastatic Breast Cancer

摘要 由于发病率的增加，转移性乳腺癌(MBC)的女性社区正在增长 并改进了对复发的早期确诊女性的治疗。解决这一问题的研究 需要新兴的、服务不足的幸存者群体。乳腺癌的治疗与不良反应有关 身体成分发生变化，包括肥胖增加和瘦体重(LBM)减少。这些 变化导致胰岛素抵抗和炎症，从理论上讲，这些变化有助于肿瘤的进展。 低水平的LBM也与治疗副作用和细胞能量产生减少有关，因为 线粒体功能障碍导致疲劳、症状负担和生活质量(QOL)下降。 对BC早期幸存者的生活方式干预，促进身体成分变化的积极变化 结果提高了生活质量，减少了疲劳，改善了BC预后的生物标志物。到目前为止，患有MBC的女性 基本上被排除在这些试验之外。我们的形成性工作支持患有MBC的女性感兴趣 参与并有能力参与生活方式干预试验。因此，根据目前的癌症存活率 指南中，我们建议在女性MBC患者中进行一项随机试验(n=40)：(1)检查其可行性和 “每一天都很重要”--12周认知-行为生活方式干预的可接受性；(2)检查 每日计数对体成分变化的影响及其与血清生物标志物的关系 预后和存活率，以及患者报告的结果；以及(3)探讨生活方式干预对 线粒体功能及其与症状负担的关系。我们的多学科研究适用于 创新、高度集成的生理模型，为生活方式行为对健康的影响提供生物学基础 结果，整合支持和技术以促进干预坚持。这项研究反映出“第一步” 在研究轨迹中帮助辨别生活方式行为如何影响生活质量、预后和帮助 对于患有MBC的女性来说，每一天都很重要。

Abstract The community of women with metastatic breast cancer (MBC) is growing due to increases in incidence and improved treatments for women diagnosed at earlier stages who relapse. Research that addresses this burgeoning and underserved survivor group is needed. Breast cancer (BC) treatment is associated with adverse body composition changes including increases in adiposity and decreases in lean body mass (LBM). These changes contribute to insulin resistance and inflammation which are theorized to contribute to tumor progression. Low levels of LBM are also associated with treatment side-effects and decreased cellular energy production due to mitochondrial dysfuntion which lead to fatigue, symptom burden and compromised quality of life (QOL). Lifestyle interventions with early stage BC survivors that promote positive changes in body composition changes result in enhanced QOL, reduced fatigue, and improved biomarkers of BC prognosis. To date, women with MBC have been largely excluded from these trials. Our formative work supports that women with MBC are interested in and capable of participating in a lifestyle intervention trial. Thus, based on current cancer survivorship guidelines, we propose a randomized pilot (n=40) in women with MBC to: (1) examine the feasibility and acceptability of “Every Day Counts” - a 12 week cognitive-behavioral lifestyle intervention; (2) examine the impact of Every Day Counts on body composition changes and the associations with serum biomarkers of prognosis and survival, and patient reported outcomes; and (3) explore the effect of the lifestyle intervention on mitochondrial function and its association with symptom burden. Our multidisciplinary study applies an innovative, highly integrated physiologic model to provide a biologic basis for the impact of lifestyle behaviors on outcomes, integrating support and technology to promote intervention adherence. This study reflects ‘a first step’ in a research trajectory to help discern how lifestyle behaviors influence quality of life, prognosis and help make every day count for women with MBC.