Chemo for Breast Cancer May Lead to Declined Physical Function

Older adults who had early-stage breast cancer and received chemotherapy may experience an accelerated physical functional decline, an expert told CURE®.

It’s important to preserve physical function during and after chemotherapy, which could ultimately improve health outcomes, Dr. Mina Sedrak explained. He defined physical functional decline as “frailty” that leads to becoming more vulnerable to stressors.

Sedrak is an associate professor of medicine and director of the cancer and aging program at the David Geffen School of Medicine at UCLA.

“We decline easier when we're frail. We get hospitalized much easier,” he said. “When we fall, we have more problems. And so, frailty is a state of aging.”

He emphasized that it’s important for patients to stay physically active before, during and after chemotherapy. Although the combination of early-stage breast cancer and chemotherapy may accelerate physical functional decline, he noted that it doesn’t mean patients should not receive the treatment.

“There are outcomes that matter to patients that we need to be capturing in our studies, like physical function and the treatments we use to cure our patients, which lead to incredible results, may also have some costs to the success,” he said. “Unfortunately, that cost may mean leaving the patient with some health challenges after the treatment is over. And we would like to raise awareness about these problems, so that doctors can begin to identify those patients who might develop the problems earlier and then doing something to prevent, mitigate or delay the onset of these health problems.

“Because the goal for all of our patients should be is to not just maximize quantity and length of life, but also quality of life,” Sedrak added. “This is especially important for older adults, but this is applicable to all patients of all ages.”

READ MORE: 'Tailored' Exercise in Advanced Breast Cancer Improves Quality of Life

Ways to Mitigate Physical Functional Decline in Breast Cancer Survivors

Moderate to vigorous exercise is an important approach to slow the decline in physical function, Sedrak said. However, patients and survivors should be increasing their exercise habits to more than just walking.

“That's really important, because a lot of patients sometimes will say, ‘Well, I walk,’ and walking is good, but the recommendations are that 150 minutes a week should be spent on sort of moderate to vigorous exercise,” Sedrak explained. “So, exercise is a great way to potentially improve and prevent and mitigate these problems.”

Moderate to vigorous exercise, he said, includes a combination of aerobic and strength training components. Examples of activities to incorporate these two components can be using resistant bands or light dumbbells, Sedrak mentioned.

“Watching some videos on the internet to understanding a little bit about small resistance training exercises could help build and tone their muscle during chemotherapy,” he said. “That has been shown to be very helpful for keeping their bodies strong and trying to preserve their physical function during systemic treatment.”

Sedrak acknowledged that although incorporating moderate to vigorous exercise can be a challenge for patients and survivors, it’s the “only way” to help with fatigue and declining physical functioning.

“For now, if you are an older adult and you have a high-risk breast cancer that needs chemotherapy to achieve the best outcome, make sure that you get up and move, even when it's hard because of the fatigue,” he noted. “That's the hardest part — the fatigue is very hard, but fatigue [causes more] fatigue. Movement is the only thing we can do to fight this fatigue. And while it may be counterintuitive, and definitely easier said than done, it is extremely important to prioritize movement before, during and shortly after chemotherapy is over.”

Advice for Patients and Survivors of Early-Risk Breast Cancer

Patients and survivors with early-risk breast cancer who received chemotherapy should talk with their doctors to understand their individual risk of functional decline, Sedrak said.

“What I would tell patients is talk to their doctor about ways to understand the benefits and risks of chemotherapy,” he said. “I think that having a shared decision making that's concordant with the patient's goals and values is important.”

He also reemphasized exercising to preserve physical functioning, with the hopes of another modality coming in the future.

“For right now, we know exercise is the way, but I think there may be some other exciting modalities [in the future that] may be in combination with exercise or sequentially after exercise or before exercise that could further improve physical functioning.”

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