Impact of Lifestyle Factors on Prognosis Among Breast Cancer Survivors in the USA

Rachel E Ellsworth; Allyson L Valente; Craig D Shriver; Barry Bittman; Darrell L Ellsworth


Expert Rev Pharmacoeconomics Outcomes Res. 2012;12(4):451-464. 

In This Article

Lifestyle Interventions in Patients With Metastatic Breast Cancer

The majority of intervention studies considering the effects of lifestyle factors on breast cancer prognosis may suffer from design limitations that restrict their ability to adequately address survival or recurrence in diverse populations of breast cancer patients.[114] Epidemiologic studies often target women with early-stage breast cancer and do not usually enroll large numbers of patients with late-stage, metastatic disease. Compared with women with localized disease who have a 98% 5-year survival rate, women with stage  IV breast cancer have 5-year survival rates of only 23%. Patients living with metastatic disease have different health concerns than women free from metastasis. For example, women with stage IV breast cancer may need bone-strengthening therapy, psychological counseling to deal with social isolation, nutritional counseling to help with appetite and weight loss, treatment for fatigue and pain management. Intervention studies must be tailored to the specific needs of patients with metastatic disease, recognizing that diet, exercise and stress reduction techniques used in other breast cancer survivors may be less desirable or inappropriate.

Despite limited research on patients with metastatic disease, lifestyle interventions have shown emotional benefit in women with stage IV breast cancer. Women randomized to weekly supportive–expressive group therapy demonstrated improved mood and perception of pain,[115] as well as a significantly greater decline in mood disturbance and traumatic stress symptoms compared with controls.[116] Likewise, women randomized to receive cognitive therapy for depression had significantly lower levels of depressive symptoms, anxiety, fatigue and insomnia following treatment compared with those assigned as waitlist controls.[117] Additional studies have shown that other lifestyle interventions, such as yoga-based palliative care, and integrative treatment with nutrition, fitness and mind–spirit instruction improve QoL.[118]