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

摘要 转移性乳腺癌（MBC）的妇女社区正在增长，由于发病率的增加， 并改善对早期诊断复发的妇女的治疗。研究解决这个问题 需要一个迅速发展和得不到充分服务的幸存者群体。乳腺癌（BC）治疗与不良反应有关。 身体组成变化，包括肥胖增加和瘦体重（LBM）减少。这些 这些变化导致胰岛素抵抗和炎症，理论上它们导致肿瘤进展。 低水平的LBM也与治疗副作用和细胞能量产生减少有关， 线粒体功能障碍导致疲劳、症状负担和生活质量（QOL）受损。 对早期BC幸存者的生活方式干预，促进身体成分变化的积极变化 导致QOL增强、疲劳减轻和BC预后的生物标志物改善。迄今为止，患有MBC的妇女 在很大程度上被排除在这些试验之外。我们的形成性工作支持MBC女性感兴趣 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，我们提出了一个随机试点（n=40）的妇女与MBC：（1）检查的可行性， 接受“每一天都很重要”-一个12周的认知行为生活方式干预;（2）检查 每日计数对身体组成变化的影响以及与血清生物标志物的相关性 预后和生存，以及患者报告的结果;（3）探讨生活方式干预对 线粒体功能及其与症状负荷的关系。我们的多学科研究采用了 创新的，高度整合的生理模型，为生活方式行为对 结果，整合支持和技术，以促进干预措施的遵守。这项研究反映了“第一步” 在一个研究轨迹中，帮助辨别生活方式行为如何影响生活质量、预后， 对MBC女性来说每天都很重要

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.