Community-based participatory research to improve life quality and clinical outcomes of patients with breast cancer (DianaWeb in Umbria pilot study)

Milena Villarini, Chiara Lanari, Daniele Nucci, Vincenza Gianfredi, Tiziana Marzulli, Franco Berrino, Alessandra Borgo, Eleonora Bruno, Giuliana Gargano, Massimo Moretti, Anna Villarini, Milena Villarini, Chiara Lanari, Daniele Nucci, Vincenza Gianfredi, Tiziana Marzulli, Franco Berrino, Alessandra Borgo, Eleonora Bruno, Giuliana Gargano, Massimo Moretti, Anna Villarini

Abstract

Introduction: Breast cancer (BC) is the most frequent cancer in Europe and the International Agency for Research on Cancer (IARC) has estimated over 460 000 incident cases per year. Survival among patients with BC has increased in the past decades and EUROCARE-5 has estimated a 5-year relative survival rate of 82% for patients diagnosed in 2000-2007. There is growing evidence that lifestyle (such as a diet based on Mediterranean principles associated with moderate physical activity) may influence prognosis of BC; however, this information is not currently available to patients and is not considered in oncology protocols. Only a few epidemiological studies have investigated the role of diet in BC recurrence and metastasis.

Methods and analysis: DianaWeb is a community-based participatory research dedicated to patients with BC and represents a collaborative effort between participants and research institutions to determine if specified changes in lifestyle would result in improved outcomes in terms of quality of life or survival. The aim of the study is to recruit a large number of participants, to monitor their lifestyle and health status over time, to provide them tips to encourage sustainable lifestyle changes, to analyse clinical outcomes as a function of baseline risk factors and subsequent changes, and to share with patients methodologies and results. DianaWeb uses a specific interactive website (http://www.dianaweb.org/) and, with very few exceptions, all communications will be made through the web. In this paper we describe the pilot study, namely DianaWeb in Umbria.

Ethics and dissemination: DianaWeb does not interfere with prescribed oncological treatments; rather, it recommends that participants should follow the received prescriptions. The results will be used to plan guidelines for nutrition and physical activity for patients with BC. The pilot study was approved by the ethics committee of the University of Perugia (reference number 2015-002), and is supported by Fondazione Cassa di Risparmio di Perugia (2013.0185 021).

Keywords: PREVENTIVE MEDICINE.

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References

    1. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J et al. . Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 2013;49:1374–403. 10.1016/j.ejca.2012.12.027
    1. De Angelis R, Sant M, Coleman MP et al. . Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5—a population-based study. Lancet Oncol 2014;15:23–34. 10.1016/S1470-2045(13)70546-1
    1. Berrino F, Villarini A, De Petris M et al. . Adjuvant diet to improve hormonal and metabolic factors affecting breast cancer prognosis. Ann N Y Acad Sci 2006;1089:110–18. 10.1196/annals.1386.023
    1. Ghose A, Kundu R, Toumeh A et al. . A review of obesity, insulin resistance, and the role of exercise in breast cancer patients. Nutr Cancer 2015;67:197–202. 10.1080/01635581.2015.990569
    1. Chan DS, Norat T. Obesity and breast cancer: not only a risk factor of the disease. Curr Treat Options Oncol 2015;16:22.
    1. Rock CL, Demark-Wahnefried W. Nutrition and survival after the diagnosis of breast cancer: a review of the evidence. J Clin Oncol 2002;20:3302–16. 10.1200/JCO.2002.03.008
    1. Makari-Judson G, Braun B, Jerry DJ et al. . Weight gain following breast cancer diagnosis: implication and proposed mechanisms. World J Clin Oncol 2014;5:272–82. 10.5306/wjco.v5.i3.272
    1. Villarini A, Pasanisi P, Raimondi M et al. . Preventing weight gain during adjuvant chemotherapy for breast cancer: a dietary intervention study. Breast Cancer Res Treat 2012;135:581–9. 10.1007/s10549-012-2184-4
    1. Carmichael AR. Obesity and prognosis of breast cancer. Obes Rev 2006;7:333–40. 10.1111/j.1467-789X.2006.00261.x
    1. Muti P, Quattrin T, Grant BJ et al. . Fasting glucose is a risk factor for breast cancer: a prospective study. Cancer Epidemiol Biomarkers Prev 2002;11:1361–8.
    1. Sieri S, Muti P, Claudia A et al. . Prospective study on the role of glucose metabolism in breast cancer occurrence. Int J Cancer 2012;130:921–9. 10.1002/ijc.26071
    1. Contiero P, Berrino F, Tagliabue G et al. . Fasting blood glucose and long-term prognosis of non-metastatic breast cancer: a cohort study. Breast Cancer Res Treat 2013;138:951–9. 10.1007/s10549-013-2519-9
    1. Minicozzi P, Berrino F, Sebastiani F et al. . High fasting blood glucose and obesity significantly and independently increase risk of breast cancer death in hormone receptor-positive disease. Eur J Cancer 2013;49:3881–8. 10.1016/j.ejca.2013.08.004
    1. Agnoli C, Berrino F, Abagnato CA et al. . Metabolic syndrome and postmenopausal breast cancer in the ORDET cohort: a nested case-control study. Nutr Metab Cardiovasc Dis 2010;20:41–8. 10.1016/j.numecd.2009.02.006
    1. Berrino F, Villarini A, Traina A et al. . Metabolic syndrome and breast cancer prognosis. Breast Cancer Res Treat 2014;147:159–65. 10.1007/s10549-014-3076-6
    1. Key T, Appleby P, Barnes I et al. . Endogenous sex hormones and breast cancer in postmenopausal women: reanalysis of nine prospective studies. J Natl Cancer Inst 2002;94:606–16. 10.1093/jnci/94.8.606
    1. Berrino F, Pasanisi P, Bellati C et al. . Serum testosterone levels and breast cancer recurrence. Int J Cancer 2005;113:499–502. 10.1002/ijc.20582
    1. Micheli A, Meneghini E, Secreto G et al. . Plasma testosterone and prognosis of postmenopausal breast cancer patients. J Clin Oncol 2007;25:2685–90. 10.1200/JCO.2006.09.0118
    1. Gunter MJ, Hoover DR, Yu H et al. . Insulin, insulin-like growth factor-I, and risk of breast cancer in postmenopausal women. J Natl Cancer Inst 2009;101:48–60. 10.1093/jnci/djn415
    1. Goodwin PJ, Ennis M, Pritchard KI et al. . Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. J Clin Oncol 2002;20:42–51. 10.1200/JCO.20.1.42
    1. Key TJ, Appleby PN, Reeves GK, et al. , Endogenous H, Breast Cancer Collaborative G . Insulin-like growth factor 1 (IGF1), IGF binding protein 3 (IGFBP3), and breast cancer risk: pooled individual data analysis of 17 prospective studies. Lancet Oncol 2010;11:530–42. 10.1016/S1470-2045(10)70095-4
    1. Pasanisi P, Berrino F, De Petris M et al. . Metabolic syndrome as a prognostic factor for breast cancer recurrences. Int J Cancer 2006;119:236–8. 10.1002/ijc.21812
    1. Siemes C, Visser LE, Coebergh JW et al. . C-reactive protein levels, variation in the C-reactive protein gene, and cancer risk: the Rotterdam Study. J Clin Oncol 2006;24:5216–22. 10.1200/JCO.2006.07.1381
    1. Pierce BL, Ballard-Barbash R, Bernstein L et al. . Elevated biomarkers of inflammation are associated with reduced survival among breast cancer patients. J Clin Oncol 2009;27:3437–44. 10.1200/JCO.2008.18.9068
    1. Allin KH, Nordestgaard BG, Flyger H et al. . Elevated pre-treatment levels of plasma C-reactive protein are associated with poor prognosis after breast cancer: a cohort study. Breast Cancer Res 2011;13:R55 10.1186/bcr2891
    1. Villaseñor A, Flatt SW, Marinac C et al. . Postdiagnosis C-reactive protein and breast cancer survivorship: findings from the WHEL study. Cancer Epidemiol Biomarkers Prev 2014;23:189–99. 10.1158/1055-9965.EPI-13-0852
    1. Algire C, Amrein L, Bazile M et al. . Diet and tumor LKB1 expression interact to determine sensitivity to anti-neoplastic effects of metformin in vivo. Oncogene 2011;30:1174–82. 10.1038/onc.2010.483
    1. Romaguera D, Vergnaud AC, Peeters PH et al. . Is concordance with World Cancer Research Fund/American Institute for Cancer Research guidelines for cancer prevention related to subsequent risk of cancer? Results from the EPIC study. Am J Clin Nutr 2012;96:150–63. 10.3945/ajcn.111.031674
    1. Hastert TA, Beresford SA, Patterson RE et al. . Adherence to WCRF/AICR cancer prevention recommendations and risk of postmenopausal breast cancer. Cancer Epidemiol Biomarkers Prev 2013;22:1498–508. 10.1158/1055-9965.EPI-13-0210
    1. Holick CN, Newcomb PA, Trentham-Dietz A et al. . Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiol Biomarkers Prev 2008;17:379–86. 10.1158/1055-9965.EPI-07-0771
    1. Holmes MD, Chen WY, Hankinson SE et al. . Physical activity's impact on the association of fat and fiber intake with survival after breast cancer. Am J Epidemiol 2009;170:1250–6. 10.1093/aje/kwp291
    1. Zhong S, Jiang T, Ma T et al. . Association between physical activity and mortality in breast cancer: a meta-analysis of cohort studies. Eur J Epidemiol 2014;29:391–404. 10.1007/s10654-014-9916-1
    1. Minkler M, Wallerstein N. Community-based participatory research for health: from process to outcomes. John Wiley & Sons, New York; 2nd edn, 2010.
    1. Uzunlulu M, Telci Caklili O, Oguz A. Association between metabolic syndrome and cancer. Ann Nutr Metab 2016;68:173–9. 10.1159/000443743
    1. Bruno E, Gargano G, Villarini A et al. . Adherence to WCRF/AICR cancer prevention recommendations and metabolic syndrome in breast cancer patients. Int J Cancer 2016;138:237–44. 10.1002/ijc.29689
    1. Villarini A, Pasanisi P, Traina A et al. . Lifestyle and breast cancer recurrences: the DIANA-5 trial. Tumori 2012;98:1–18. 10.1700/1053.11494
    1. Schröder H, Mendez MA, Ribas-Barba L et al. . Mediterranean diet and waist circumference in a representative national sample of young Spaniards. Int J Pediatr Obes 2010;5:516–19. 10.3109/17477161003777417
    1. Anderson AS, Key TJ, Norat T et al. . European Code Against Cancer 4th edition: obesity, body fatness and cancer. Cancer Epidemiol 2015;39(Suppl 1):S34–45. 10.1016/j.canep.2015.01.017
    1. Norat T, Scoccianti C, Boutron-Ruault MC et al. . European Code Against Cancer 4th edition: diet and cancer. Cancer Epidemiol 2015;39(Suppl 1):S56–66. 10.1016/j.canep.2014.12.016
    1. Leitzmann M, Powers H, Anderson AS et al. . European Code Against Cancer 4th edition: physical activity and cancer. Cancer Epidemiol 2015;39(Suppl 1):S46–55. 10.1016/j.canep.2015.03.009
    1. Scoccianti C, Cecchini M, Anderson AS et al. . European Code Against Cancer 4th Edition: alcohol drinking and cancer. Cancer Epidemiol 2015;39(Suppl 1):S67–74. 10.1016/j.canep.2015.01.007
    1. Vergnaud AC, Norat T, Romaguera D et al. . Fruit and vegetable consumption and prospective weight change in participants of the European Prospective Investigation into Cancer and Nutrition-Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating Out of Home, and Obesity study. Am J Clin Nutr 2012;95:184–93. 10.3945/ajcn.111.019968
    1. Mozaffarian D, Hao T, Rimm EB et al. . Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med 2011;364:2392–404. 10.1056/NEJMoa1014296
    1. Berrino F, Bellati C, Secreto G et al. . Reducing bioavailable sex hormones through a comprehensive change in diet: the diet and androgens (DIANA) randomized trial. Cancer Epidemiol Biomarkers Prev 2001;10:25–33.
    1. Ahmed SA, Hamed MA, Omar OS. Clinical utility of certain biomarkers as predictors of breast cancer with or without metastasis among Egyptian females. Tumour Biol 2015;36:815–22. 10.1007/s13277-014-2689-z
    1. Yigit E, Gönüllü G, Yücel I et al. . Relation between hemostatic parameters and prognostic/predictive factors in breast cancer. Eur J Intern Med 2008;19:602–7. 10.1016/j.ejim.2007.06.036
    1. Cheng CW, Adams GB, Perin L et al. . Prolonged fasting reduces IGF-1/PKA to promote hematopoietic-stem-cell-based regeneration and reverse immunosuppression. Cell Stem Cell 2014;14:810–23. 10.1016/j.stem.2014.04.014

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