How breast cancer affects patients’ symptoms even before treatment begins
New research from the University of Alberta reveals that many newly diagnosed breast cancer patients experience symptoms like fatigue, depression, and poor sleep quality even before beginning treatments such as chemotherapy or radiation. However, current approaches to symptom management tend to focus primarily on the side effects of treatment, often neglecting the critical early period right after diagnosis.
Kerry Courneya
“Breast cancer can begin to affect patients’ symptoms and quality of life even before they start those difficult treatments,” says Kerry Courneya, a professor in the Faculty of Kinesiology, Sport, and Recreation and a member of the Cancer Research Institute of Northern Alberta. Courneya led a study examining the links between fitness levels and symptoms reported by patients within 90 days of diagnosis. Study participants had undergone initial surgery but had not yet started further treatments like chemotherapy, radiation, or hormone therapy.
Among the participants, 51.5 per cent reported poor sleep quality, 26.5 per cent experienced significant fatigue, and 10.4 per cent faced moderate depression. Courneya warns that these symptoms can not only affect patients’ quality of life but also potentially impact treatment outcomes and survival rates, making symptom management crucial in what he calls “the cancer care continuum.”
“Patients have a long treatment trajectory ahead of them, which can be very daunting. They may experience high anxiety and fear about how treatments will make them feel, so there are many challenges during that newly diagnosed time frame,” Courneya explains.
The study assessed health-related fitness in three main categories: cardiopulmonary fitness, maximum muscular strength and endurance, and body composition. To get an accurate measure, researchers used gold-standard evaluation methods, including gas exchange analysis to measure peak cardiopulmonary fitness (VO2 max), chest and leg press tests for muscular strength, and dual x-ray absorptiometry (DEXA) scans for body composition.
The study found that patients with lower VO2 peak were more likely to report symptoms of fatigue, depression, and poor sleep quality. “Cardiopulmonary fitness is critical, and, in this study, we showed that patients in the top third or quarter of fitness had a lower risk of these symptoms,” Courneya says.
In addition, the research showed that patients with weaker upper-body strength reported more fatigue, and those with higher body weight more often experienced poor sleep quality.
Drawing on data from 1,458 participants in the Alberta Moving Beyond Breast Cancer (AMBER) cohort study, Courneya’s team achieved a level of detail rarely seen in similar studies. “Nearly 1,500 breast cancer patients is a very large cohort, and these fitness measures are the gold standard,” Courneya says. “So we’re going to be able to look at a lot of questions that previous studies were not able to address.”
The findings could help healthcare practitioners design exercise programs targeted to relieve specific symptoms for each patient. “Having this comprehensive assessment of fitness could help us identify the type, amount and intensity of exercise optimal to treat a given symptom,” Courneya explains.
Courneya and his collaborators will continue to follow this cohort through the cancer care continuum, tracking patients at one, three, and five years after diagnosis. Future studies will assess the impact of fitness levels on the treatment period, including whether greater fitness helps patients complete treatments on time.
“We found in previous studies that patients who are fitter and stronger at the start of treatment are more likely to complete chemotherapy and stay on schedule,” he says.
Courneya emphasizes that patients may not have much time to improve fitness between diagnosis and the start of treatment, making it critical to build fitness while they’re healthy. “Even if exercise and fitness don’t prevent you from getting breast cancer, they put you in the best possible physical shape to go through diagnosis, get through treatments, and recover afterward,” he says.
| Staff
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