Evidence from the Breast Cancer Customization Project suggests that a more comprehensive approach is needed to help patients find the motivation to adopt an active lifestyle.
Physical activity is often recommended by clinicians as a lifestyle intervention to help prevent and manage non-communicable diseases, including cancer. It is also essential for the quality of life of patients diagnosed with cancer.
For breast cancer patients, observational studies have shown that physical activity is associated with improved prognosis. At the 2024 European Society for Medical Oncology (ESMO) Congress (September 13-17, Barcelona), a study called the OptiTrain Breast Cancer Trial investigated the impact of interventions in 240 women who were starting chemotherapy. They participated in a 16-week program combining high-intensity interval training (HIIT) with either resistance training (RT-HIIT) or aerobic exercise (AT-HIIT). The results indicated that compared to the control group, which received standard care, those who received the intervention showed significant benefits in terms of prognosis, with notable effects on overall survival (OS) and invasive breast cancer-free survival (IBCFS) (Abstract #232O). The Cox proportional hazard model revealed that, despite the small sample size, the RT-HIIT intervention had a particularly significant impact on OS (adjusted HR 0.18), breast cancer-free interval (HR 0.22), and IBCFS (HR 0.22).
Although these programs are beneficial, they need to be tailored to the specific values and beliefs of patients to more comprehensively support them and help them build intrinsic motivation to follow the recommendations. This is especially crucial for patients with a poor prognosis and/or severe symptoms, who are less likely to continue exercising, particularly when they feel fatigued, experience treatment side effects, or face psychological challenges.
Certain technologies, such as video conferencing and mobile apps, can facilitate patient engagement, particularly for those who live far from hospitals. A second study presented at the congress— the Phase III eMouvoir study, which included 684 breast cancer survivors with 12 months of evaluable data (Abstract #LBA12)—also demonstrated the benefits of personalized physical activity combined with remote guidance and interactive learning in significantly improving quality of life. At four months, statistically significant improvements were observed in both the physical (P=0.03) and mental health (P=0.01) summary scores of the 36-item short-form questionnaire, although these benefits were not sustained at one year.
Additionally, in a weight-loss trial involving 540 overweight early-stage breast cancer patients (Abstract #1817MO), the impact of a phone-based weight-loss intervention (WLI) on moderate- or high-intensity physical activity (MVPA) was described. Compared to the control group, the WLI group showed a significant increase in median minutes of MVPA between baseline and six months (median increase: 40 minutes/week vs. 0 minutes/week; P=0.0004). MVPA was correlated with weight loss, and patients engaging in ≥150 minutes of MVPA per week lost more weight than those engaging in <150 minutes (P=0.0005). Longer follow-up is needed to evaluate whether the increase in MVPA is associated with reduced breast cancer recurrence and mortality. Nonetheless, the weight-loss data is significant, as obesity is known to be associated with a substantially increased risk of disease recurrence (JAMA Netw Open. 2023;6). Therefore, increasing physical activity is a key motivator for weight loss, which in turn can improve patients’ quality of life.
Finally, in a real-world study involving 1,850 evaluable patients (Abstract #1836P), which explored patient-reported health behaviors, a lack of physical activity was associated with a higher symptom burden (P<0.001), lower compliance with remote patient monitoring (P<0.028), and lower engagement with digital educational resources (P<0.001). Nearly 50% of patients reported a lack of physical activity. These data underscore the importance of regular follow-ups, monitoring, and guidance to ensure the benefits of physical activity are communicated and patients are encouraged and motivated to stay active for as long as possible.
The data presented at the congress emphasizes that simple recommendations may not be enough to encourage cancer patients to adopt healthy lifestyle behaviors. A more structured approach is needed to help them overcome common barriers. Healthcare professionals in clinical practice, as well as all stakeholders involved in cancer patient care, should consider physical activity an important adjunct to cancer prevention, symptom management, and survivorship care, offering both direct and indirect health benefits. However, programs targeting both the general population and cancer patients should be tailored to individual needs and attitudes, as well as personal and social resources and specific goals. This approach has the potential to increase patient engagement and intrinsic motivation, leading to a shift from temporary to sustained behavior change and helping to reduce the long-term risk of non-compliance with health recommendations. Lastly, technology applied in the health field presents a real opportunity to develop tools and measures that identify individuals at risk of low adherence to health recommendations, enabling timely interventions and promoting the adoption of active lifestyles.
