Melinda L. Irwin, PhD, MPH

Examining the effects of lifestyle interventions and how they can be integrated into a personalized care plan.

Impact

Higher levels of physical activity and adopting a high-quality diet have been associated with lower mortality in breast cancer patients. The physiological mechanisms behind this correlation, however, are currently unclear. These lifestyle factors are often impacted most during the first year after a breast cancer diagnosis and can often deteriorate during treatment. Therefore, intervening with improved nutrition and exercise regimens as well as weight management programs as soon as possible after diagnosis may have the biggest impact on breast cancer outcomes. Clinical trials and follow-up with the trial participants can further define the correlations between lifestyle and cancer outcomes and help elucidate potential mechanisms that may be involved.

Dr. Irwin’s work is focused on exercise and nutrition-associated changes in breast cancer biomarkers, adherence to cancer treatment and therapy, weight management, and quality of life in women diagnosed with breast cancer. She and her team design clinical trials that aim to answer questions on how changes to these lifestyle factors could be incorporated into standard cancer treatment to improve outcomes for those diagnosed with breast cancer.

Progress Thus Far

Dr. Irwin’s team has completed the first year of their phase III clinical trial, The Lifestyle, Exercise And Nutrition Early after Diagnosis (LEANer) Study, designed to test the effect of nutrition and physical activity intervention on chemotherapy and endocrine therapy adherence and completion, treatment side effects, changes in biomarkers, and patient-reported outcomes. This is one of the first studies to examine the effects of nutrition and exercise intervention at the start of chemotherapy and up to five years after diagnosis.

Dr. Irwin has found that participants in the lifestyle intervention group made improvements to their exercise and diet quality, but that these changes did not improve adherence to chemotherapy compared to the group who were provided the usual care. However, participants in the lifestyle intervention group were more likely to lack all signs of cancer in tissue samples removed from hormone receptive-positive/HER2-negative and triple-negative breast cancer patients undergoing chemotherapy before surgery.

What’s next

The team will continue to follow the trial participants at one-, two-, and five-year milestones to further understand the impact of intervention on diet, physical activity, immune, and metabolic biomarkers, and patient-reported outcomes. Additionally, they will evaluate the impact lifestyle intervention has on cognitive function, depression, and adherence to endocrine therapy among those taking aromatase inhibitors or tamoxifen, drugs that lower the risk of breast cancer recurrence. Dr. Irwin’s clinical trial findings could accelerate a shift in cancer care to include nutrition, exercise, and weight management services beginning at diagnosis.