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Article Excerpt
While the risk for developing breast cancer may vary by age, lifestyle, and environmental and genetic factors, no woman is risk-free. About 182,460 women in the United States experienced invasive breast cancer in 2008, and about 40,480 women died from the disease. Right now, about 2.5 million breast cancer survivors live in the United States (American Cancer Society [ACS], 2008b).
Breast cancer is the leading cause of cancer death in Hispanic women (ACS, 2008a); population-based studies also show that they are more likely to be diagnosed at a later stage than non-Hispanic White women (Tammemagi, 2007). Epidemiologic studies have reported a rising rate of breast cancer diagnosis for Hispanic women (McNeil, 2006) perhaps due in part to the growing Hispanic population (Americans, 2005). Quality of life (QOL) also may be threatened more intensely among Hispanic women because they are diagnosed at a later stage, and more likely to undergo intense therapy and suffer the side effects of that therapy (Buki et al., 2008).
Whenever breast cancer is diagnosed, improved adjuvant therapy regimens and better therapy for recurrent disease increase survival and life span (Carlson et al., 2006; Chlebowski et al., 2006). Treatment is effective, but survival comes with a cost. Side effects plague many women during treatment. The National Cancer Institute is committed strongly to eliminating such suffering due to cancer and to improving treatment, thus reducing cancer-related health disparities such as those that exist in the Hispanic population (Thomas, Benjamin, Almario, & Lathan, 2006).
To our knowledge, a community-based program for a primarily Hispanic population during breast cancer treatment has not been conducted with collaboration of nurses, physicians, physical therapist, and community health club facility. The purpose of the current study was to evaluate the feasibility of a structured exercise intervention during treatment in a predominately Hispanic population of women.
Theoretical and Scientific Background
A comprehensive literature review of women with breast cancer who are overweight or gain weight after diagnosis found that they were at greater risk for breast cancer recurrence and death than lighter women (Carmichael & Bates, 2004; Harvie, Hooper, & Howell, 2003; Stephenson & Rose, 2003; Wenten, Gilliland, Baumgartner, & Samet, 2002). Obesity also was found to be associated with hormonal profiles likely to stimulate breast cancer growth (Slattery et al., 2007). Several authors noted that exercise reduces the perception of cancer treatment side effects and possibly reduces the chance of recurrence (perhaps indirectly through decreasing obesity) (Carmichael & Bates, 2004; Collins, Nash, Round, & Newman, 2004). Turner, Hayes, and Reul-Hirche (2004) proposed that providing a supervised, structured exercise program, and health care provider monitoring within that program might improve participation in the program. The majority of research into exercise after breast cancer diagnosis has not looked at sustaining the exercise as a lifestyle in Hispanic women.
This investigation is based on sustaining a wellness-oriented framework, the transtheoretical model (TTM) of behavioral change. This model proposes that people experience behavior change as processes unfolding over time (Prochaska, Redding, & Evers, 1997). The TTM first was used to address cessation of negative health behaviors, such as smoking, and also has been used for the acquisition of positive health behaviors, such as breast cancer screening and exercise in breast cancer survivors (Lipkus, Rimer, & Strigo, 1996; Ott et al., 2004). The TTM of change process proposes that individuals progress through a series of five stages (Glanz, Rimer, & Lewis, 2002). In the first stage of pre-contemplation, people do not intend to take action in the foreseeable future, usually measured as in the next 6 months. In the second stage, known as contemplation, people intend to change in the next 6 months. Individuals are more aware of the benefits of changing, but they also are aware of the drawbacks. Ambivalence about changing can keep people stuck in this stage for long periods of time. The preparation stage occurs when individuals plan to start a new activity in the next month. These individuals have had some significant change in their lives in the past year. Women undergoing breast cancer treatment would be in a situation to begin an action-oriented program, such as the structured exercise program. According to the TTM, people reach the action stage when they have made observable and significant exercise lifestyle modifications for 6 months (Prochaska et al., 1997). The women in this study who participated previously in weight training or a type of high-impact exercise as a lifestyle were in the maintenance stage of the TTM, and they would not be followed in this study because they would already have an established routine.
Fatigue. The most prominent side effects during the first year after breast cancer surgery are fatigue and emotional distress (Ashing-Giwa, Padilla, Bohorquez, Tejero, & Garcia, 2006). The fatigue experienced by persons with cancer is different from the usual tiredness experienced by healthy people. Patients experience physical, emotional, and mental exhaustion; have less desire to do normal activities, think, or concentrate; and may complain of a...
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