الفهرس 
Physiological and psychological problems of breast cancer survivorsOnly 14 pages are availabe for public view
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Abstract
Excess adiposity over the pre- and postmenopausal years is linked to poorer prognosis among postmenopausal breast cancer. Weight loss could potentially reduce risk of recurrence among those with excess weight via beneficial effects on the hormonal (decreased circulating levels of oestradiol, testosterone, and insulin) and secretory profiles of adipocytes (decreased production of leptin, tumour necrosis factor, interleukin 6 and increased production of adiponectin). Only modest reductions in adipose tissue are achieved and sustained with current weight loss programmes, which makes strategies to mitigate the adverse metabolic effect of adiposity a priority for cancer prevention and better prognosis. The adverse hormonal and secretory effects of adipose tissue are influenced substantially by acute changes in energy balance prior to changes in adiposity. Human and animal studies have shown dietary energy restriction to bring about favourable changes in circulating levels of insulin, leptin, sex hormone binding globulin, insulin-like growth factor-1, estradiol, testosterone, reactive oxygen species, and the production and secretion of locally acting adipokines and inflammatory cytokines, that is, increased adiponectin and decreased interleukin- 6. Achieving and sustaining energy restriction remains a difficult challenge. Physical exercise is an important aid to keep people fit but also enhances the metabolic processes of the body.
This study aimed to assess the effect of dietary and exercise intervention on body weight, psychological well-being and biomarkers of disease recurrence in female breast cancer survivors.
A randomized controlled trial approach was used to conduct this study which was implemented in the Cancer management and research department, Medical Research Institute; Alexandria University. The study population was one hundred and ten postmenopausal women who have undergone appropriate treatment for operable breast cancer within the past 3-18 months. All eligible patients during a period of 12 months were included in our study until the required sample size was reached. Patients with metastatic breast cancer, patients with inoperable or active loco-regional disease, patients following alternative or complementary diets, patients with physical/ psychiatric impairment that would seriously impair their physical mobility, patients using hormone replacement therapy within the past four months or patients who are currently in exercise (two or more times/ week for at least 30 minutes per session during the previous 3 months) were excluded from the study. These patients will be randomly allocated to one of 2 groups:
i. Dietary and exercise intervention group.
ii. Usual care given at the cancer unit, as a control group.
The data collection technique used in this study was based on:
1- Interviewing the breast cancer survivors using a pre-designed structured questionnaire to obtain information related to: Personal characteristics, medical and reproductive history and activity level, as well as dietary history. Psychological well being assessment was done using The Arabic Version of the General Health Questionnaire (GHQ-30 items).The extent and severity of common depressive symptoms assessment was done using The Arabic Version of the Short Form of Beck Depression Inventory (BDI).Clinical assessment included: Anthropometric measurements, Body composition analysis, and Blood pressure measurement. Biochemical parameters were also done including: total estrogen level, total leucocytic count and lymphocytic count.
2- Implementing a designed dietary and exercise intervention program incorporating: healthy eating dietary advice and written information and attend moderate intensity aerobic exercise sessions (30 min of aerobic exercise at an intensity of 70%-85% heart rate reserve, and a 10 min cool-down period involving lower intensity aerobic exercise and some light stretching) on three to five days per week for a period of 24 weeks. The aim of this strategy is to induce a steady weight loss of up to 0.5 kg each week. In addition, the overall quality of the diet was examined with a view to: Reducing the patient’s total daily calorie intake to 500 below their calculated energy requirements, eating at least 5 portions of fruits and vegetables a day, increasing the intake of fiber, reducing refined carbohydrates and reducing the dietary intake of fat to 25% of the total calories. Regular follow up of each patient in the intervention group at one to two weeks intervals was done to review their eating habits and dietary intake, to check their body weight and to encourage them to identify ways which can further improve their nutritional intake.