Comprehensive Lifestyle Change

Improving Breast Cancer Prevention and Outcomes

The Link Between Lifestyle and Cancer

Just as tumor biology research continues to demonstrate the importance of the tumor microenvironment and systemic factors (e.g., genomic abnormalities, angiogenesis, inflammation, cytokine regulation, hormone dysregulation, etc.) in facilitating or controlling cancer growth, recent studies also indicate that lifestyle factors can modify these cancer-related biological processes and influence long-term treatment results. Lifestyle factors such as body weight and composition, diet, physical activity, stress and social support can foster either an inhospitable or hospitable environment for cancer growth.

In the case of breast cancer, extensive epidemiological research has shown that excess weight, unhealthy diet, low levels of physical activity and excessive sedentary behavior are associated with having both an increased risk of breast cancer and worse clinical outcomes. Moreover, preclinical and clinical research shows that psychosocial factors such as stress, depression and inadequate social support can negatively influence outcomes after a diagnosis of breast cancer.

A New Cancer Intervention Strategy

Modern oncology treatment is focused on destroying or controlling cancer cells. While this is an essential aspect of therapy, it is becoming more and more evident that truly effective cancer care should also foster a strong anti-cancer terrain by strengthening the body’s natural defenses. Yet, few studies have addressed how to measure the quality and effectiveness of these defenses, how to strengthen them through lifestyle interventions like diet, nutrition, physical activity and stress management, and how to tell if a given person’s lifestyle program is working as well as possible to help fight off cancer. Most lifestyle intervention research focuses only on modifying diet and exercise, limiting the benefits that could be derived from a more comprehensive approach.

To date, only one randomized clinical trial has examined the effects of comprehensive lifestyle change on clinical outcomes for women with breast cancer. Patients on this trial had decreased recurrence of disease, increased breast cancer-specific survival and increased overall survival. Thus, there is an urgent need for a comprehensive program that incorporates social support, stress management, mindfulness and other intervention strategies and delivery methods to sustain lifestyle changes and improve cancer prevention and long-term outcomes.

Comprehensive Lifestyle Change: Research to Transform Health Care

The University of Texas MD Anderson Cancer Center seeks philanthropic funding to examine comprehensive lifestyle change in different settings and to advance the goals of the Integrative Medicine Program. Led by Lorenzo Cohen, Ph.D., professor and director of the Integrative Medicine Program, the long-term program goal is to improve clinical outcomes and quality of life in cancer patients through the use of a comprehensive lifestyle approach. Although the initial focus is on women who are at risk for breast cancer or being treated for breast cancer, the program is also relevant to the prevention and treatment of a number of different cancers in men and women, including prostate, colorectal and endometrial cancer.

A pilot version of the program has already been tested for feasibility and efficacy in a randomized controlled trial design versus usual care in women with stage II and III breast cancer undergoing radiotherapy. The pilot program was deemed feasible with high recruitment and retention rates as well as overwhelming enthusiasm for the specific intervention components and high engagement in lifestyle change. Compliance with the intervention and sustained behavior change was excellent.

A unique aspect of the program is the mind-body component, which is often missing from other lifestyle programs that only focus on diet and physical activity. Stress management and mindfulness approaches are applied across all aspects of behavior change and program participants have remarked on the importance of these components in helping them to sustain behavior change in their new way of life. Initial analyses of quality of life, fitness measures and biological pathways show substantial differences between groups. MD Anderson now seeks support to extend this research toward the following objectives:

  • To expand the current cohort of women with stage II and III breast cancer undergoing in- person comprehensive lifestyle counseling during radiotherapy, followed by FaceTime counseling for the subsequent 12 months.
    Also, to compare the comprehensive lifestyle counseling program to conventional lifestyle change that only includes diet and exercise counseling. The primary aim of this trial is to decrease recurrence of disease, and a secondary objective is to assess cancer-specific pathways, quality of life and other outcomes.
  • To test the feasibility and initial outcomes of delivering the standardized comprehensive lifestyle intervention using mobile health technology for women with breast cancer undergoing radiotherapy. After an initial in- person orientation session, all components
    of the program will be delivered remotely. This will provide access to more women and enable us to expand the study to include women with stage 0-III breast cancer. In addition to feasibility, we will assess biological, physiological and quality of life outcomes.
  • To test the feasibility and initial outcomes of delivering the standardized comprehensive lifestyle intervention using mobile health technology for women at risk for breast cancer with the long-term goal of decreasing the incidence of breast cancer. In addition to feasibility, we will assess biological, physiological and quality of life outcomes.

MD Anderson: A Unique Environment to Conduct Transformative Research

In 2017, U.S. News & World Report’s annual “Best Hospitals” survey ranked MD Anderson as the top hospital in the nation for cancer care. MD Anderson has achieved the No. 1 ranking 13 times in the past 16 years and has been named one of the nation’s 2 top two cancer hospitals since the survey began in 1990. The institution places a high value on basic, translational and clinical research and has developed an effective and efficient infrastructure for conducting research. The research program at MD Anderson is considered one of the most productive in the world aimed solely at cancer, and institutional leaders ensure that research innovations developed here are likely to influence the course of research in many other cancer centers.

MD Anderson’s Integrative Medicine Program is one of the largest and most active in the country, and it plays an important role in the institution’s mission to treat the whole person across the cancer care continuum — from prevention and treatment through survivorship. The program maintains an active research portfolio in many areas of integrative oncology; however, it is critical to move this area of research forward to determine the effects of implementing comprehensive lifestyle and behavior change on cancer prevention and control.

The Integrative Medicine Program is at the cutting edge of the best and most important cancer research today. Even so, it is very difficult to obtain federal and industry grant support for research focused on lifestyle and natural interventions because such interventions stand outside the traditional focus on single molecular interventions that lead to the most cleanly interpretable results, and because they cannot result in patentable (viz., profitable) treatments. Funding agencies also prefer to focus on behavioral programs that modify either one or two behaviors (such as diet and exercise). 

Thus, philanthropists with vision are absolutely necessary to help foster this type of comprehensive research endeavor. If such research demonstrates the benefits of lifestyle changes as an effective approach for disease prevention and management — and thereby changes the perspective of the medical and scientific establishment on these interventions — then it will be much easier to continue research in this area with the support of federal grants. In fact, MD Anderson researchers have a track record of obtaining $5 of federal research funding for every initial $1 of philanthropy invested in a new program.

Philanthropic partners with the foresight to understand the value of investing in the right people and giving them the freedom to follow their creative instincts in pursuing new discoveries are critical to the success of this program. A gift to the Integrative Medicine Program would have impact far beyond MD Anderson’s laboratories and clinics — ultimately benefiting people worldwide through shared advances. Working together, we can truly make a difference in the quality of life of cancer patients and their families. Your support would be essential not only in achieving the goals of the Integrative Medicine Program, but also in Making Cancer History®.

The link below (and at the top of the page) will take you to a “donate” page on MD Anderson’s website that is linked to the Comprehensive Lifestyle Change account where your donation will directly support our research.