Effects of Diet and Osteopathy on Quality of Life and Inflammation in Breast Cancer Patients Under Hormonal Therapy
- Conditions
- Breast Cancer
- Interventions
- Other: manual treatment with osteopathic techniquesOther: manual treatment with osteopathic techniques and nutritional treatmentOther: nutritional treatment
- Registration Number
- NCT06164119
- Lead Sponsor
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
- Brief Summary
Breast cancer patients under hormonal therapy may experience significant adverse events related to this treatment and as a result, failure to adhere to adjuvant therapies or discontinuation of treatment has been reported to be high.
Promoting weight control and the adoption of healthy lifestyle habits in breast cancer survivors has an impact on hormonal status, quality of life and physical functioning, contributing to reduce cancer recurrence risk, cancer-related and chronic-condition-related mortality.
Manipulation procedures, such as manual treatment with osteopathic techniques, have positive effects on osteoarticular pain, peripheral neuropathies, anxious-depressive disorders, asthenia and sleep disorders, also improving immune and neuroendocrine responses.
The aim of this study is to evaluate the effects of dietary intervention and manual treatment with osteopathic techniques in women diagnosed with breast cancer under antiestrogenic hormonal treatment through the assessment of:
* modifications of quality of life (QoL)
* frequency and severity of symptoms related to antiestrogenic hormonal treatment
* body weight
* body composition
* food habits
* metabolic and inflammatory state
* physical performance
* patient's satisfaction to multidisciplinary treatment.
This study focuses on patient's centricity evaluating the effects that long lasting adjuvant therapies have on breast cancer survivors. Improving personalized patient's treatment through collaborative interactions between clinicians, osteopaths and nutrition specialists might result in implementation strategies to determine novel evidence-based treatments for ameliorating patient's adherence to oncological therapies, impacting prognosis and survival.
- Detailed Description
Breast cancer patients under hormonal therapy may experience significant adverse events related to this treatment. Premenopausal women may encounter the classic symptoms of menopausal syndrome: hair thinning or loss; hot flashes, sweating, fatigue, insomnia, joint pain, vaginal dryness, decreased libido, anxious-depressive disorders, cognitive dysfunction; dry eyes; weight gain. Postmenopausal women may instead experience joint stiffness and joint pain, depressive and anxious symptoms, fatigue and irritability.
Since most of these adverse events do not resolve spontaneously a few weeks/months after starting treatment, they often negatively impact patient's quality of life.
As a result of treatment-related adverse events, failure to adhere to adjuvant therapies or discontinuation of treatment has been reported to be high and this may negatively impact patient's prognosis and survival.
Patients with breast cancer frequently experience weight gain during and after adjuvant hormonal treatment. Indeed, menopause, musculoskeletal pain and the consequent physical activity reduction, work together to reduce the basal energy metabolism. On the other side, the psychological distress and the eventual use of food for emotional reward, do promote weight gain. Notably, breast cancer patients who are overweight or obese show an increased risk of overall mortality, cancer-specific mortality, breast cancer relapse or second primary contralateral breast cancer. The explanation lies in the fact that the increase in fat mass is directly correlated to an increased production of estrogens, insulin, leptin and proinflammatory cytokines which, all together, exhibit a mitogenic activity on mammary cells. Proinflammatory cytokines and insulin deregulation on their turn, favor with time the onset of other chronic diseases such as diabetes, dyslipidemia, metabolic syndrome in general, thus increasing the risk of overall mortality. Conversely, weight loss can improve hormonal status, quality of life and physical functioning and contribute to reduce cancer recurrence risk, cancer-related and chronic-condition-related mortality. Therefore, it is important to promote weight control and the adoption of healthy lifestyle habits in breast cancer survivors.
Manipulation procedures, such as manual treatment with osteopathic techniques, involve the mechanical displacement of fluids and the removal of toxic substances with neurovascular and neuromuscular effects, thus producing positive alterations at the metabolic, biochemical and circulatory level. Several studies conducted on patients with breast cancer have supported the positive effect of manual therapy (acupuncture, shiatsu treatments, massages) on the control of various problems such as osteoarticular pain, peripheral neuropathies, anxious-depressive disorders, asthenia and sleep disorders, also improving immune and neuroendocrine responses.
Nevertheless, there are no studies on the effect of manual treatment with osteopathic techniques on the control of symptoms related to the side effects induced by anti-tumor therapies.
The aim of this study is to evaluate the effects of dietary intervention and manual treatment with osteopathic techniques in women diagnosed with breast cancer under antiestrogenic hormonal treatment through the assessment of:
* modifications of quality of life (QoL)
* frequency and severity of symptoms related to antiestrogenic hormonal treatment
* body weight
* body composition
* food habits
* metabolic and inflammatory state
* physical performance
* patient's satisfaction to multidisciplinary treatment.
This study focuses on patient's centricity evaluating the effects that long lasting adjuvant therapies have on breast cancer survivors. Improving personalized patient's treatment through collaborative interactions between clinicians, osteopaths and nutrition specialists might result in implementation strategies to determine novel evidence-based treatments for ameliorating patient's adherence to oncological therapies, impacting prognosis and survival.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- Female
- Target Recruitment
- 600
- Age >18 years
- Voluntary written informed consent
- Histologically confirmed estrogen receptor-positive invasive breast cancer or in situ breast cancer after breast surgery
- Absence of locoregional relapse or distant metastasis
- Premenopausal or postmenopausal status
- Hormonal therapy with tamoxifen and/or LHRH analogues or aromatase inhibitors
- Patients with or without neoadjuvant or adjuvant chemotherapy
- Patients with a BMI > 18.5 kg/m^2
- Absence of language barrier
- Previous hormonal therapy
- Use of medical treatments that contrast adjuvant hormonal therapy adverse effects (e.g. menopausal symptoms and arthralgia).
- Underweight patients (BMI <18.5 kg/m^2)
- Patients diagnosed with eating disorders (e.g. anorexia nervosa, bulimia, binge eating, orthorexia)
- Psychiatric disorders or cognitive impairments
- Previous malignancies other than in situ cervical carcinoma or non-melanoma skin cancer
- Non-epithelial breast cancer at histological examination
- In situ lobular breast cancer
- Participation in other randomized clinical trials that could interfere with current study
- Patients living distant from trial center and unable to attend for check-ups and meetings.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- FACTORIAL
- Arm && Interventions
Group Intervention Description A2: manual treatment with osteopathic techniques in premenopausal patients manual treatment with osteopathic techniques Premenopausal breast cancer patients under tamoxifen and/or LHRH analogues are treated with manual treatment with osteopathic techniques (8 once-a-week manual treatments with osteopathic techniques). A1: manual treatment with osteopathic techniques and nutritional treatment in premenopausal patients manual treatment with osteopathic techniques and nutritional treatment Premenopausal breast cancer patients under tamoxifen and/or LHRH analogues are treated with manual treatment with osteopathic techniques (8 once-a-week manual treatments with osteopathic techniques) and nutritional treatment (personalized Mediterranean Diet). A3: nutritional treatment in premenopausal patients nutritional treatment Premenopausal breast cancer patients under tamoxifen and/or LHRH analogues are treated with nutritional treatment (personalized Mediterranean Diet). B1: osteopathic techniques and nutritional treatment in postmenopausal patients manual treatment with osteopathic techniques and nutritional treatment Postmenopausal breast cancer patients under aromatase inhibitors are treated with manual treatment (8 once-a-week manual treatments with osteopathic techniques) and nutritional treatment (personalized Mediterranean Diet). B2: manual treatment with osteopathic techniques in postmenopausal patients manual treatment with osteopathic techniques Postmenopausal breast cancer patients under aromatase inhibitors are treated with manual treatment with osteopathic techniques (8 once-a-week manual treatments with osteopathic techniques). B3: nutritional treatment in postmenopausal patients nutritional treatment Postmenopausal breast cancer patients under aromatase inhibitors are treated with nutritional treatment (personalized Mediterranean Diet).
- Primary Outcome Measures
Name Time Method Evaluation of the effect of dietary intervention and manual treatment with osteopathic techniques on quality of life (QoL) of women diagnosed with breast cancer under hormonal treatment baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Quality of life will be assessed using the Functional Assessment of Cancer Therapy - Endocrine Symptoms (FACT-ES) questionnaire comparing the before-and-after treatment difference in FACT-ES QoL scale (range 0-200; the higher the FACT-ES score, the better the quality of life, QoL) evaluated at baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3).
The difference between pre treatment (baseline, T0) score and 24-weeks (six months, T2) score of the FACT ES QoL scale will be analyzed by ANOVA, and the interaction between the dietetic treatment and manual treatment with osteopathic techniques will be tested at 5% significance level. In a secondary ANOVA analysis, the baseline-to-52-weeks (T3) follow-up difference of the FACT ES QoL scale scores will additionally be analyzed.
These analyses will be conducted separately in Groups A and B.
- Secondary Outcome Measures
Name Time Method White blood cells baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) White blood cells will be assessed collecting blood exams measuring white blood cells count (cells/mcL).
Body composition baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Body composition will be evaluated combining two anthropometric measures: the waist circumference (cm) and calf circumference (cm).
Hemoglobin baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Hemoglobin will be assessed collecting blood exams measuring hemoglobin levels (g/dL).
Platelets baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Platelets will be assessed collecting blood exams measuring platelets count (cells/mcL).
Inflammatory state: erythrocyte sedimentation rate baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) inflammatory state will be assessed collecting blood exams measuring erythrocyte sedimentation rate (ESR) (mm/h)
Food habits baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Food habits will be assessed through a food frequency questionnaire.
Monocytes baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Monocytes will be assessed collecting blood exams measuring monocytes count (cells/mcL).
Neutrophils baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Neutrophils will be assessed collecting blood exams measuring neutrophils count (cells/mcL).
Metabolic state: plasma glycemia baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Metabolic state will be assessed collecting blood exams measuring plasma glycemia (mg/dl)
Metabolic state: high-density lipoprotein (HDL) cholesterol baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Metabolic state will be assessed collecting blood exams measuring high-density lipoprotein (HDL) cholesterol (mg/dL).
Inflammatory state: c-reactive protein (CRP) baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) inflammatory state will be assessed collecting blood exams measuring c-reactive protein (CRP) (mg/L).
Testosterone baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Testosterone levels will be assessed collecting blood exams measuring testosterone levels (ng/dL).
Red blood cells baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Red blood cells will be assessed collecting blood exams measuring red blood cells count (cells/mcL).
Lymphocytes baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Lymphocytes will be assessed collecting blood exams measuring lymphocytes count (cells/mcL).
Vitamin D baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Vitamin D will be assessed collecting blood exams measuring Vitamin D levels (ng,mL).
Treatment-related adverse events of hormonal treatment in premenopausal and postmenopausal patients baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Symptoms related to hormonal treatment will be evaluated using Menopause Rating Scale (MRS) (range 0-44; higher scores indicating worse symptoms) in Group A and EORTC Quality of Life Questionnaire - Breast Cancer Module (EORTC-QLQ-C30/BR23) (range 0-100; higher scores corresponding to worse symptoms) in Group B, respectively.
Body weight baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Body weight will be evaluated using body mass index (BMI), measuring weight in kilograms divided by the square of height in meters.
Metabolic state: low-density lipoprotein (LDL) cholesterol baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Metabolic state will be assessed collecting blood exams measuring low-density lipoprotein (LDL) cholesterol (mg/dL).
Sex hormone binding globulin (SHBG) baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Sex hormone binding globulin (SHBG) will be assessed collecting blood exams measuring sex hormone binding globulin levels (SHBG) (nmol/L).
Modifications of blood lipid profile baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) modifications of blood lipid profile will be assessed collecting blood exams measuring plasma lipids by UPLC-MS.
Metabolic state: serum insulin concentration baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Metabolic state will be assessed collecting blood exams measuring serum insulin concentration (µU/ml).
Metabolic state: triglycerides baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Metabolic state will be assessed collecting blood exams measuring triglycerides (mg/dL).
Patient's satisfaction to multidisciplinary treatment 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Patient's satisfaction to multidisciplinary treatment will be assessed with Functional Assessment of Chronic Illness Therapy - Treatment Satisfaction - General questionnaire (FACIT-TS-G) (range 0-25; the higher the score, the better the satisfaction).
Metabolic state: total cholesterol baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Metabolic state will be assessed collecting blood exams measuring total cholesterol (mg/dL).
Inflammatory state: Interleukin-6 (IL-6) baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) inflammatory state will be assessed collecting blood exams measuring Interleukin-6 (IL-6) levels (pg/mL).
Inflammatory state: Tumour necrosis factor-α (TNF-α) baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) inflammatory state will be assessed collecting blood exams measuring Tumour necrosis factor-α (TNF-α) levels (pg/ml).
Physical performance baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3) Physical performance will be assessed using International Physical Activity Questionnaires (IPAQ) measuring physical activity levels (higher scores indicating higher physical activity).
Trial Locations
- Locations (1)
Fondazione IRCCS Istituto Nazionale dei Tumori
🇮🇹Milan, Italy