Kathy D. Miller, MD; Jennifer A. Ligibel, MD


December 23, 2013

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Kathy D. Miller, MD: Hi. I'm Kathy Miller, Associate Professor of Medicine at Indiana University School of Medicine in Indianapolis. Welcome to this edition of Medscape Oncology Insights, coming to you from the 2013 San Antonio Breast Cancer Symposium.

This year we have been talking a lot about strategies to keep our patients healthier longer, and one such study was the HOPE study.[1] Joining me today is Dr. Jennifer Ligibel, Assistant Professor in the Department of Medicine at Harvard Medical School, and Senior Physician in Adult Oncology at the Dana-Farber Cancer Institute in Boston.

Jennifer A. Ligibel, MD: Thank you for inviting me.

HOPE Gets Survivors to Exercise

Dr. Miller: Tell me about the HOPE study.

Dr. Ligibel: This study was led by Melinda Irwin at Yale, and it enrolled women who were having joint pain on aromatase inhibitors, which is a very common side effect. The study was looking to see whether exercise could alleviate joint pain in women who were already experiencing it. They randomly assigned women to a year-long exercise program that included both home-based aerobic exercise, (primarily walking) and supervised strength training. They looked to see whether the severity of pain, and the way the pain interfered with their lives, improved with exercise. The study showed a dramatic improvement with the exercise program in these women who were already experiencing joint pain with aromatase inhibitors.

Dr. Miller: I have to ask you about some of the details because this is a huge problem, not just for aromatase inhibitor joint issues but for overall health in our patients. I talk to all of my patients about exercise, and getting them to exercise is incredibly difficult. How did you get them to exercise?

Dr. Ligibel: That is a good question. I also talk to all of my patients in the clinic about exercise, and I find that just mentioning it without giving people the support doesn't, unfortunately, result in most people being able to exercise regularly. This study used a supervised exercise program, so the patients worked with a trainer who met with them twice a week throughout the entire period of the study. They met with them at gyms that were close to their homes, so it was convenient for people. The trainers gave them assignments for exercises to do at home, and then they did strength training with them.

Some of the things that helped the women keep to their exercise level were to be part of a group, working with a trainer, or having somebody -- even if it's a friend or a colleague -- who is helping them, because it is very hard to start an exercise program in a vacuum. This program was definitely supervised, it supported the women through the entire course of the intervention, and it really helped them make changes.

Dr. Miller: That is a big commitment, and expensive to do in a study. It's expensive to do for many of our patients who may not live near a gym, and they may not be able to afford their own personal trainer. Is there a way to take the message of this study and expand it beyond such narrow confines?

Dr. Ligibel: Yes. This was a proof-of-principle study, because we wanted to make sure that we achieved the dose of exercise in this study. If the women didn't really exercise, we wouldn't have been able to see whether there was a benefit. Many times the first study done has a more structured program, and then we try to see how we can support this with a larger group of people. One program that has been developed, not as part of a research study but as a clinical program to help cancer survivors exercise more, is the LIVESTRONG at the YMCA program.

I often tell my patients in the clinic who are looking to start exercising, but can't seem to do it on their own, that this is potentially a good way to get started. It's free, which is a good thing, and it teaches people how to use a gym and how to create an exercise program. We need to figure out what benefits exercise has for people, and then we have to figure out how to enable all our patients to do it -- not just the 120 or so who can participate in a research study.

Programs such as LIVESTRONG, which are trying to find ways to help survivors become more active in a more generalizable sense, are definitely the next important frontier for this type of exercise research in cancer survivors.


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