Programa de exercício aeróbico em mulhers com câncer de mama em vigência de quimioterapia neoadjuvante: um estudo de viabilidade

Abstract

The clinical treatment of breast cancer is based on surgery, radiotherapy, hormone therapy, targeted therapies and chemotherapy, which can be adjuvant or neoadjuvant. Neoadjuvant chemotherapy (neoCT) aims to reduce the size of the tumor, which increases the chances of breast-conserving surgery, enables the assessment of tumor sensitivity to drugs, in addition to acting early on possible micrometastases. Although advances in antineoplastic therapy increase survival, they also allow for the emergence of cardiovascular complications due to treatment-related cardiotoxicity. The practice of physical exercise has been pointed out in the literature as a non-pharmacological measure both to control the side effects of systemic therapy and to improve cardiorespiratory capacity, which can deteriorate as a sequel to cancer treatment. However, implementing an active life in these women is a challenge, since the vast majority are sedentary and not very motivated to practice physical exercise. The primary objective of this thesis was to evaluate the viability of an aerobic exercise program in women with breast cancer undergoing neoCT. Participants were recruited from three institutions: Instituto de Previdência dos Servidores do Estado de Minas Gerais (IPSEMG), Hospital das Clínicas of the Federal University of Minas Gerais (UFMG) and Santa Casa de Misericórdia de Belo Horizonte. Data collection took place at the IPSEMG physiotherapy clinic between August/2021 and December/2022. Twenty-six women with breast cancer undergoing neoCT were randomly allocated into intervention groups, with aerobic exercise and guidance on healthy lifestyle habits, or a control group, with guidance on healthy lifestyle habits. The results of the thesis were presented in two articles. The first, the main product of the thesis, is a feasibility study of the effect of aerobic exercise in women with breast cancer undergoing neoCT. The second article evaluated the applicability of the Incremental Shuttle Walking Test (ISWT) in the cardiorespiratory and functional assessment of women undergoing treatment for breast cancer. In the first article, at baseline 19 (73%) participants reported not practicing any type of physical activity, the 26 women were overweight 29.62 (27.33-31.92), of the 26 participants, 53.7% had depressive symptoms evaluated by the Beck Short Form. In the intervention group, eight participants performed a total of 271 sessions, an average of 40.25 (21.95-58.64) sessions per participant, with an adherence rate of 55.9%. The women were followed up throughout the neoCT treatment (6 months) and the main justification for absences and non-adherence to treatment were the side effects of systemic therapy such as nausea, fatigue and discomfort, the day of the intervention coincided with the day of the infusion of neoCT, followed by personal problems. As for the adverse events reported by the participants during the intervention, such as fatigue, nausea, body aches, uncomfortable, in 2.8% to 11.9% of the sessions, the women reported mild to moderate discomfort during the intervention. No serious adverse events were recorded. We calculated the effect size of the intervention through the distance walked on the ISWT, and the adjusted activity score on the Human Activity Profile questionnaire, and in future clinical trials, to test this intervention, the number of participants must be 180 women. Despite the absence of statistical significance in the evaluated outcomes, some results are relevant to be reported. Regarding quality of life, it was possible to observe an impact on the emotional state, social function, functional performance and cognitive function. Regarding symptoms, the domains with the highest scores were fatigue, pain, insomnia, constipation and financial difficulties. Regarding the functional scale, the future perspectives affected the quality of life more and in the symptom scales, the side effects of systemic therapy and hair loss were the ones that had the most impact. When comparing control and intervention groups, the difference in the total score assessed through the fatigue questionnaire was 10 points in favor of the intervention group, signaling that the practice of physical exercise reduced cancer fatigue. We conclude that the practice of physical exercise was safe and feasible in women with breast cancer with few adverse events. The main barriers to the practice of physical exercise were the side effects of systemic therapy and the high number of consultations, tests and infusion procedures, chemotherapy to which these women undergo. In the second article, we evaluated 26 women with breast cancer about to start or undergoing neoCT. The ISWT measured the distance covered in meters and the hemodynamic variables during effort. Post-test intercurrences were investigated using a signs and symptoms questionnaire. The variables were compared in the pre- and post-test using the paired t-test. Mean age was 48±10.04 years, body mass index of 29±5.66 kg/m2 and left ventricular ejection fraction of 68±3.58%; 22% women were inactive, 31.8% moderately active and 45.5% active. The distance in the ISWT was 351.9±121.35 meters, there was an increase of 19.34±5.95 mmHg in SBP (p<0.0001), 4.86±1.16 mmHg in DBP (p=0.023), 31.77±3.35 beats in HR (p< 0.0001). In the post-test the symptoms were: dyspnea, tiredness, dizziness, nausea and headache, 30 min after the test there was a reduction of these symptoms. The ISWT is a viable and safe test in women with breast cancer. ISWT imposed moderate effort with adequate hemodynamic response to effort and low prevalence of more severe symptoms, which reinforces the feasibility of its use.