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Medical Education: Tufts University School of Medicine, MD/MPH 1994Residency: Tufts-New England Medical Center, Radiation OncologyBoard Certification: American Board of Radiology - Radiation Oncology 1999

Celine M. Godin, MD, MPH

Medical Education: University of Vermont College of Medicine 1989Residency: University of Wisconsin Hospitals & Clinics, Radiation OncologyBoard Certification: American Board of Radiology - Radiation Oncology 1995

Cornelius J. McGinn, MD

Medical Director, Cancer Care Center of York County

Medical Director, Maine Medical Center

Medical Education: Baylor College of Medicine 1987Residency:The University of Texas M.D. Anderson Cancer Center, Radiation OncologyBoard Certification: American Board of Radiology - Radiation Oncology 1992

Rodger M. Pryzant, MD

Medical Education: Dartmouth Medical School 1995Residency: Duke University Medical Center, Radiation OncologyBoard Certification: American Board of Radiology - Radiation Oncology 2000

Philip J. Villiotte, MD

1_Poster 2009.qxd:Rad Onc Poster 2009.qxd 4/27/09 4:39 PM Page 1

Medical Education: Dartmouth Medical School 2010Residency: Harvard Radiation Oncology ProgramBoard Certification: American Board of Radiology - Radiation Oncology 2016

Matthew D. Cheney, MD, PhD

Medical Education: University of Rochester School of Medicine 2002Residency:Board Certification: American Board of Radiology - Radiation Oncology 2008

Ian J. Bristol, MD

The University of Texas M.D. Anderson Cancer Center, Radiation Oncology

Maine Medical CenterDepartment of Radiation Therapy















Ian J. Bristol, MD

















Ian J. Bristol, MD

















Ian J. Bristol, MD



Can Exercise Improve Outcomes in Breast Cancer RT?

A survey study reveals a somewhat encouraging change in quality-of-life (QOL) outcomes in women engaging in physical exercise while receiving radiation therapy (RT) for breast cancer.

“Radiation therapy is associated with acute treatment-related complications that can lead to decreased …QOL,” write Ritu Arya, BA, from the Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, and colleagues. “Exercise has been shown in other cancer treatment settings to improve negative outcomes.”

Thus, the researchers sought to explore this same possibility in the breast cancer treatment setting in a prospective pilot study of women undergoing RT, published in the July-August issue of Practical Radiation Oncology.

RT is a common, effective part of breast cancer treatment and has been shown to decrease the risks for recurrence and death, but the downside is debilitating side effects such as fatigue, radiation dermatitis, pain, lymphedema, depression, and decreased range of motion of the shoulder. Women receiving RT for breast cancer also experience “emotional distress and overall decreased …QOL that extends beyond the treatment period.”

SpotlightCancer news and information from the Cancer Care Center of York County

SEPTEMBER 2015

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Recruitment

The researchers enrolled 45 women 18 years and older with biopsy-confirmed ductal carcinoma in situ or invasive breast carcinoma, but 39 women completed all protocol assessments. These women were undergoing RT to the chest and/or regional lymph nodes. Mean age was 54 years (age range, 28-73 years), 21% were African American, and 77% had a college degree. None of the women were active smokers, and median body mass index was 29 kg/m2.

Survey Questionnaires

Participants completed a survey that measured their exercise behavior and QOL; survey times were before the fifth fraction of radiation and during the last week of treatment. Depending on fractionation schedule, 3 and 6 weeks passed between surveys.

The Godin Leisure Time Exercise Questionnaire was used to measure exercise behavior, in metabolic equivalent [MET] hours per week. Exercise intensity (mild, moderate, and vigorous) was also examined. The researchers used standards of 3 METs for mild exercise, 5 METs for moderate exercise, and 7 METs for vigorous exercise. Women with at least 9 METs were in a high exercise category, and those reporting less than 9 METs were in a low execise cohort.

Before study enrollment, exercise behavior was defined in the questionnaire as patient-reported median total minutes (frequency × duration) of mild, moderate, and vigorous intensity physical exercise per week. At study completion, the questionnaire consisted of median total minutes per week of mild, moderate, and vigorous exercise per week during RT treatment.

Exercise Regimen

At baseline, 25 women participated in self-perceived mild exercise, 17 in moderate exercise, and 6 in vigorous exercise for a minimum of 20 minutes per week. For the entire cohort, the mean number of minutes per week of total exercise was 148, and the mean METs per week was 10.

Regarding exercise level, 14 women engaged in high exercise (mean of METs ≥9 per week) and 25 women engaged in low exercise (mean of <9 METs per week). Mean METs in the high exercise group was 21 per week vs 3 METs per week in the low exercise group. Median body mass index was not significantly different between the 2 groups, but mean age was (49 years for high exercise vs 57 years in low exercise, P = .051).

Interestingly, women in the high exercise group had undergone more aggressive surgical procedures, “more comprehensive radiation treatment, and more systemic therapy.”

Similar Trends Observed

Patient-reported outcomes were radiation-related effects of pain, fatigue, radiation dermatitis, lymphedema, and reduced shoulder range of motion. Depression was also measured. Say the authors, “Outcomes were generally favorable with high QOL scores reported on the FACT-B [Functional Assessment of Cancer Therapy–Breast] at baseline and treatment completion for all patients.” However, when the team evaluated the entire cohort, they noted no significant changes in any of the outcome measures assessed.

When the researchers analyzed these outcomes by exercise cohort, they also did not see any statistically significant differences between the high and low exercise groups “in QOL, fatigue, depression, or pain at baseline or treatment completion.” However, they noticed that the group performing more vigorous exercise displayed a more positive change in QOL than those performing less exercise. The high exercise group improved at a median of 9.5 points in QOL (FACT-B), but the low exercise group remained static. They also scored a median improvement of 2 points in fatigue compared with the low exercise group, which yielded a 6-point median decrement in fatigue.

Similar trends were also seen with radiation dermatitis in the high vs the low exercise group (39% vs 40%) and with shoulder range of motion (91% vs 89% of more complete range of motion at the end of the study).

Statistically Nonsignificant Findings

The authors stress that physical exercise is an important predictor of QOL in patients with various types of cancer, based on the current literature. Although they noticed similar trends in this study, they concluded that these trends were not statistically significant. “This may be due to our finding that patient-reported outcomes with radiation therapy are relatively high compared with other treatment modalities and remain stable throughout treatment,” they write. “Thus, it may be that radiation therapy has a limited impact on QOL in breast cancer patients.” The authors also suggest that RT for breast cancer may be more physically well tolerated than other treatments and that “there may be limited room for QOL improvement during breast RT.”Pract Radiat Oncol. 2015;5:e275-e281. Summary Jane Warren

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